A 44 year old male presents with pain in the arch and the heel area of one foot following training for oz tag competition. The heel pain has been present for 3 weeks and came on very suddenly and the arch pain has been excruciating. The patient felt a snap in the arch of his foot during the game and was unable to weight bear for 2 days following. His doctor informed him that he had Plantar Fasciitis and an MRI was arranged. When the patient arrived with his MRI report it was confirmed that he did indeed have Plantar Fasciitis, but he also had a 1cm tear in the fascia, distal to the heel and along the mid arch area.
The patient informed us that the heel pain was so intense and that the Plantar Fasciitis so unbearable, that he had been placing his entire foot into a bucket of iced water. He did this on the day of the injury and each day for a week afterwards.
The patient was face up on the treatment table and firm finger pressure was applied to the medial aspect of the heel and central and medial slip of the Plantar Fascia. As to be expected with a case of Plantar Fasciitis, the patient had a positive “jump response” but did not retract his foot as much as would typically be seen. The iced baths clearly helping to reduce the inflammation and hence reduce the plantar fasciitis heel pain. Finger pressure was applied to the mid arch area, along the medial side of the foot and there was an area of tenderness that correlated with the location of the Plantar Fascial tear on the MRI report. The patient was informed that while he definitely had Plantar Fasciitis, his treatment plan had to be designed around the fact that he had been clinically diagnosed with a tear in the plantar fascia. Plantar Fasciitis without a tear can be treated more conservatively, but torn fascia needs a different form of intervention.
Surprisingly, this patient requested as much treatment as possible as he was keen to recover in time for oz tag finals in 3 weeks. He was informed that his heel pain will improve but may not resolve completely in 3 weeks as Plantar Fasciitis typically takes longer than this to heal. Most cases of Plantar Fasciitis will resolve inside approximately 6 weeks once treatment starts. Treatments such as shock wave therapy and dry needling can accelerate this process.
The patient was informed that his treatment would involve the following:
Plantar Fasciitis usually recovers quicker with shock wave therapy. This patient was treated at 1.5 Bar, 5 HZ and 2000 reps which lasted approximately 4 minutes. The probe was placed under the ball of the heel and moved along the mid arch of the foot around the area of torn fascia. The treatment was well tolerated and the patient reported that his plantar fasciitis heel pain reduced slightly, immediately after the treatment.
Low die taping was applied with rigid sports tape. Plantar fasciitis will usually feel better immediately with correct strapping and this patient reported less heel pain when weight bearing.
This patient was fitted with a cam walker and was asked to use the boot at all times, only removing it to sleep, shower and drive.
Plantar Fasciitis and the associated heel pain will reduce with the use of ice packs. The ice serves to constrict blood vessels and reduce inflammation, which reduces pain and can accelerate healing. This patient had already benefited from placing his entire foot in a bucket of iced water and he was happy and willing to continue to do the same. He was asked to do this at least once a day, particularly in the evenings, before bed. He reported that the pain that he was getting first thing in a morning as his foot hit the floor reduced significantly with the use of ice. To this end, it was not necessary, nor was it a good idea for this patient to take anti – inflammatory medication.
It is not uncommon to find that patients suffering with Plantar Fasciitis and other forms of heel pain have tight calf muscles. The tightness is usually a reduced range of motion at the ankle joint due to stiffness in the soleus or gastrocnemius muscle groups that cross the ankle joint. This patient was shown a very specific way to stretch the tight muscles without straining the plantar fascia at the same time. He was asked to demonstrate the stretches back to the Podiatrist in the room, 3 times on each leg so that his technique was good. This patient did not have the typical reduced range of motion that is usually seen, but the use of the Immobilisation boot and his compensated gait pattern would likely lead to stiffness in the muscles groups concerned. Hence, he was informed that stretching had to be part of his daily routine.
The patient returned to the clinic once a week for treatment with the shock wave therapy unit and to have his strapping removed and replaced. The rigid sports tape will usually stay in place for at least 5 days, regardless of getting wet in the shower or the pool. Patients are shown how to re-apply the tape in a very simple but effective manner, if they do remove it and wish to replace it.
3 treatments were carried out with the shock wave therapy machine and the patient reported feeling better each week. After the 3rd treatment, and to the surprise of all involved, there was only very mild pain in the heel and the patient was excited to go to oz tag training that evening. It was apparent that the Plantar Fasciitis had almost fully recovered and it was likely that the tear had healed. There was some mild plantar fasciitis heel pain when finger pressure was applied but not enough pain to cause concern.
No follow up appointments were made for this patient. He was asked to return to the clinic if his pain persisted and if it got worse with oz tag.
Please note that the treatment for this patient should not be taken as medical advice for a foot condition that you may have. If you have heel pain or Plantar Fasciitis you should be examined and advised by an appropriate health care practitioner.
More information: How we treat heel pain
Written by Karl Lockett