A 51-year-old woman presented at Leading Edge Podiatry with heel pain in her left foot. She reported that the pain had been present for approximately 12 months and had gradually worsened over time. She was generally healthy with her only condition being Hypothyroidism and taking Thyroxine and Hormone Replacement Therapy. She worked as a nurse and was on her feet for most of the day often on hard concrete flooring. She also enjoyed dog walking and would like to do some jogging for exercise.
Patient’s Pain Symptoms
The patient reported that the heel pain was present in her left foot. Initially the onset of pain was when she first got out of bed in the morning and took her first few steps. For the first few months, the heel pain was quite sporadic. The pain would then subside somewhat but would return after prolonged periods of standing or walking. She described the pain as a sharp, stabbing sensation in the heel in the morning. Generally the end of the day was more like a bruise/aching pain. It is now chronic and the pain level around 8/10.
Examination and Assessment
The podiatrist carried out a thorough examination, beginning with a comprehensive history-taking. The patient’s feet were examined and palpated; the pain was worst when palpating underneath the heel bone and near the arch. The podiatrist also assessed the patient’s range of motion and strength in the foot and ankle joint, and the flexibility of her lower leg and foot muscles, ligaments and tendons.
The podiatrist conducted a biomechanical assessment and gait analysis as part of his diagnostic process. The patient demonstrated significant overpronation in her left foot in both feet with the left more severe than right. The patient was wearing slip on shoes with minimal cushioning and support.
Diagnosis and Treatment
The podiatrist diagnosed the patient with plantar fasciosis (often referred to as plantar fasciitis). The patient was advised to rest from walking and jogging for a few weeks and to avoid any other activities that caused pain. The podiatrist recommended to stretch the calf muscles and plantar fascia. The patient was recommended a course of shockwave therapy over 6 weeks and after shockwave anti-pronating strapping was applied to support the plantar fascia. This provided short term pain relief reducing the pain levels to 3/10. For longer term treatment, the patient was also fitted with custom-made orthotics to support the arch of the foot and reduce the strain on the plantar fascia. The patient was advised to wear supportive shoes with a cushioned sole and to avoid walking barefoot.
Progess
After the 6 weeks, more progressive exercises were prescribed to help strengthen the plantar fascia and reduce the recurrence of the plantar heel pain.
