Case Study August 2017 Treatment of Arch Pain by Sports Podiatrist
Initial Consultation with Sports Podiatrist
A 33 year old female arrived at the Sydney heel pain clinic in Miranda to discuss her chronic foot pain with a sports podiatrist. She reports a burning sensation and a stabbing pain through the arches of both feet of approximately 6 months. She is a healthy individual with no chronic disease and is a keen Runner. She boasts good foot health and has never seen a sports podiatrist before. She enjoys Cross fit exercising in addition to 3 middle distance runs each week. She informs the sports podiatrist that during her exercise classes she carries out ballistic activities such as jumping and lunging. She also carries out sprints and skipping. The sports podiatrist carries out an assessment of her gym shoes and her running shoes. This lady informs the sports podiatrist that she has undertaken some home remedies herself, such as rolling her foot on a frozen water bottle and massaging her calf muscles with a foam roller. This patient also advises the podiatrist that her friend is a physiotherapist and he applied some strapping to both feet, and this provided some short-term relief. She also explains that she has been carrying out calf muscle and foot stretches at the gym. She demonstrates the stretching technique to the sports podiatrist by standing on a step and dropping her heels down towards the ground.
Physical Assessment by Sports Podiatrist
The sports podiatrist carried out a thorough physical assessment in order to make a full diagnosis. Pressure was applied to the plantar fascia through the arches of both feet and the patient reported significant pain during this assessment. The podiatrist also palpated along the line of the peroneal tendons. There was also mild pain during this assessment. Upon examination of the tibialis posterior tendon there was also tightness and pain. With the patient lying face down, the sports podiatrist also palpated the superficial and deep calf muscles. Once again the patient reported tenderness during this examination.
Diagnosis by Sports Podiatrist
The sports podiatrist explained to this patient that she had all the symptoms of plantar fasciitis and mild peroneal tendonitis. She also had the symptoms of shin splints – more specifically known as tibialis posterior tendonitis.
Biomechanical Assessment by Sports Podiatrist
The patient was asked to stand in a relaxed position facing straight ahead so that the sports podiatrist could carry out some foot measurements. The medial arches of both feet were measured and the findings were significant – both arches measured 33 mm from the pedestal. From a posterior angle, both heels stood vertically with minimal eversion. Leg length appeared to be equal and there was mild external rotation at both feet. Pelvic alignment appeared normal. A high arched foot type / pes cavus foot type was noted.
With the patient lying down the sports podiatrist carried out some muscle testing and joint range of motion analysis. Tight calf muscles were noted and a reduced range of motion at the ankle joint was apparent. Hamstrings were also tight answer hip flexors. The patient was observed walking and running on a treadmill and the podiatrist recorded this using digital software on the iPad. As can be expected with a pes cavus foot type, this patient demonstrated a very stable foot type with very mild pronation. She had a fairly short stride due to restricted hamstring range and demonstrated a midfoot strike. Early heel lift was also noted, possibly due to the restricted range of motion through the ankle joint, due to tight calf muscles.
Footwear Analysis by Sports Podiatrist
This patient was running in an Asics Gel Nimbus and was cross training in a typical flat gym shoe. The Asics Gel Nimbus is a neutral shoe and is well suited to this patients foot type. The podiatrist informed the patient that her cross training shoe might need to be changed throughout the course of her treatment. As a general rule, a perfectly flat, and a flexible shoe, offers less support and often lacks sufficient arch support for this particular foot type.
Suggested Treatment by Sports Podiatrist
Primarily it was explained to this patient that she had a significant amount of stress through the sole of her foot due to her high arch foot type. To this end the podiatrist advised the patient that the lining from her running shoes should be removed and replaced with prescription orthotics to support the arch and reduce the strain on the plantar fascia. The podiatrist used digital software to capture three-dimensional foot scans for the patient. It was also explained to the patient that her tight calf muscles were a huge part of her problem and the podiatrist demonstrated some effective stretching techniques to help. Hamstring and hip flexor stretches were also performed. It was recommended that this lady temporarily stop using her flat gym shoe and instead carry out her CrossFit exercising with her Asics Gel Nimbus.
In order to assist with ankle joint range of motion and to enable more efficient calf stretching, the podiatrist carried out some dry needling into both calf muscles. Deep tissue dry needling was well tolerated and twitch response was noted. The patient was booked in for a follow-up session of dry needling a week later. She was also booked in for a two week follow up to collect and be fitted with her prescription orthotics. An additional dry needling session was also scheduled for this time. The sports podiatrist applied rigid sports tape to both feet as a temporary form of relief for the plantar fascia. The patient reported instant relief as she walked barefoot in the clinic with the tape in place.
The sports podiatrist also insisted that the patient refrain from any of the home remedies and stretches that she herself had been doing prior to this initial consultation. Quite often, therapeutic home remedies can give short-term relief but cause long-term irritation which prevents healing.
8 Week Follow Up
This lady returned to see the podiatrist 8 weeks in from her Orthotic fitting appointment. She reported to the sports podiatrist that her orthotics were very comfortable and that her foot pain had totally subsided. She informed the clinic that the pain reduced significantly approximately 3 weeks into her treatment. She recently decided to move her orthotics into her flat cross-training shoe and found this to be very comfortable.
Please note that the information contained in this case study should not be taken as general foot health advice. If you have any foot pain you should seek the help of a suitably qualified sports podiatrist.