Patient came to Sydney Heel Pain clinic complaining of heel pain from plantar fasciitis. The patient has worked in construction for about 4 years and his heel pain began around 12-18 months prior to coming to Sydney Heel Pain. Within the past 6 months, the pain and occurrence of the pain have increased. The patient notices the pain is most intense first thing in the morning when getting out of bed, but then subsides a bit in the morning hours. The pain becomes intense again in the afternoons after several hours of work.
Patient’s heel pain has become debilitating and he fears the plantar fasciitis will interrupt his career. Patient has been taking over-the-counter pain medication daily, with some relief, but needs a more effective and long-term solution for his heel pain. Over the past year, he has also tried a variety of at-home treatments. The patient has changed his work boots to something more supportive. The new work boots did not seem to help. Patient then tried using cushion inserts for the heel. These added a bit of comfort, but did not last and only offered minimal relief. Patient has been icing and massaging his heel for almost 2 months and is not seeing significant effects. His plantar fasciitis persists.
The patient most recently visited his primary care doctor who suggested he see a podiatrist for the most appropriate assessment and treatment of his foot pain before prescribing any long-term pain medications. A family member referred him to Sydney Heel Pain, suggesting custom foot orthotics.
A biomechanical assessment was needed to assess whether the patient had physical foot or ankle factors that could be contributing to the patient’s heel pain. The podiatrist at Sydney Heel Pain Clinic recorded the patient’s foot movements while walking using a treadmill and digital software. An ultrasound scan and thorough physical exam of the foot, ankle, and calf were also done.
As is typical with plantar fasciitis , the patient had a significant jump response, when pressure was applied to medial slip of the fascia, at the insertion on to the heel.
The podiatrist concluded that the patient had low arches in both feet. His left foot arch was slightly higher than his right. These low arches, likely accompanied by the patient carrying heavy loads in his workplace, has caused plantar fasciitis, an inflammation of the fascia that runs from the base of the heel through the arch of the foot.
The podiatrist suggested a two-part approach to address the patient’s heel pain from plantar fasciitis.
First, the patient will be fitted with custom-made sports orthotics for his work boots. This is a common approach to plantar fasciitis. This will provide the most effective support for his arches while standing, walking, and carrying loads during his long working hours. This will provide a long-term solution to end the inflammation and to prevent further inflammation. Patient was also encouraged to avoid going barefoot while not working in favour of keeping his arches supported.
Next, the podiatrist prescribed a series of shockwave therapy treatments. This would provide immediate relief from the heel pain and would stimulate collagen production & promote new blood vessel formation. The patient was informed he would likely need a series of shockwave therapy treatments over the course of 3-6 weeks for the most effective and thorough relief of the plantar fasciitis
The patient could continue with his normal work schedule and daily routine during the treatment. No interruption of daily life would occur. The patient would be fitted for his custom sports orthotics and would begin the first shockwave therapy treatment within the next week.
The first shockwave therapy treatment was for approximately 4 minutes and the patient tolerated the treatment well. He reported a mild discomfort during the treatment and reported a decrease in pain immediately following treatment. The custom orthotics were fitted to his work boots and trainers.
One week later, the patient came back for the second shockwave therapy treatment and reported a lessening of pain from an 8 to a 4 on a 10-point scale over the past week. Immediately following the second treatment, the patient again reported an immediate relief in pain.
The patient continued shockwave therapy for a total of 4 treatments over 4 weeks. At this time, the patient reported his pain was almost completely gone—rating the pain a 1 on a 10-point scale. Since the effects of the treatment continue in the days to weeks after the therapy ends, the therapy was discontinued.
The patient was scheduled for a follow-up assessment for 6-8 weeks later. At the follow-up, the patient reported no pain in his heel and continued to use the custom orthotics. His plantar fasciitis and heel pain were successfully treated.
This details of this case study are specific to this patient. If you suffer from heel pain, or plantar fasciitis consult a podiatrist for a full assessment and treatment plan specific to your needs.
Written by Karl Lockett