Case Study – A Complex Heel Pain Condition at the Sports Podiatrist, Sydney
Case History by Sports Podiatrist at Sydney Podiatrist Clinic, Martin Place
A 62 year old gentleman comes to see the sports podiatrist at Sydney Podiatrist clinics with a complex heel condition in his right foot. He has been informed that he is suffering with plantar fasciitis and his condition has been going on for almost two years. The patient has an ultrasound report which confirms a mild case of plantar fasciitis and he describes a pain under the base of his heel centrally, and medially. However, this patient has symptoms that are not consistent with a common case of plantar fasciitis. He informs the sports podiatrist that he has pain around the lateral side of his heel, and that this pain can be brought on by a simple twisting movement of his ankle. He reports 3 recent ankle sprains in short succession. This patient has spent some time with a sports podiatrist in Sydney, but he was unable to help with this particular condition, and he is keen for a second opinion. The patient is becoming increasingly frustrated and has been given conflicting advice from a variety of practitioners. The patient demonstrates typical symptoms of plantar fasciitis in that he feels a significant pain each morning when his heel is placed on the ground. The pain dissipates within the first 10 to 15 minutes of his day. However, the pain around the lateral side of his heel persists throughout the day and does not seem to ease.
This gentleman informs the sports podiatrist at Sydney podiatrist clinics that he has been advised to apply ice packs to the base of his heel, to roll his heel on a hard object such as a golf ball, and to take anti-inflammatory medication to reduce the pain and promote healing. He has tried all of these home remedies to no avail. This patient was referred for an x-ray of his foot by his local GP which revealed nothing of any significance. He informs the practitioner that he was then advised by the GP to seek the advice of a second sports podiatrist in Sydney.
Second Opinion by Sports Podiatrist, Sydney, Martin Place
The sports podiatrist, Sydney based, at the Martin Place rooms carried out a physical assessment of the patient’s right heel. The patient reported pain when pressure was applied to the plantar aspect of the heel around the attachments of the plantar fascia. Pain was evident centrally and also medially as can be expected with this condition. However, there was also pain laterally and proximally around the side of the patients heel. This area of pain did not relate to the plantar fascia. The sports podiatrist was suspicious that there was some pathology with the tendon of the abductor digiti minimus muscle or the sural nerve. The patient was informed by the Sports podiatrist that he did have plantar fasciitis but that there was also another condition affecting his heel. The patient was referred for a repeat ultrasound in order to assess this area in more detail. The patient returned to the sports podiatrist at Sydney podiatry clinic one week later to discuss the results of his ultrasound. The ultrasound report did not reveal anything of significance but simply confirmed that the patient had mild plantar fasciitis.
Treatment Plan by Sports Podiatrist, Sydney, Martin Place
The sports podiatrist decided to treat this patient for plantar fasciitis to see if there would be an improvement in both of his conditions. The patient was informed that there was a small chance that the pain he was experiencing laterally was a referred pain from the classic plantar fasciitis. Due to the fact that the patient was experiencing excruciating pain throughout the day, the sports podiatrist at Sydney podiatry clinic decided to fit the patient with an immobilisation boot. This would reduce the strain on all parts of the heel and allow rest and recovery. In addition to immobilisation, the sports podiatrist carried out Shockwave therapy. The treatment was applied to the typical areas of the plantar fascia and also to the troublesome part of the heel laterally. Interestingly, the patient was able to report discomfort during treatment of the plantar fascia, but did not report any of the pain around the lateral part of the heel.
The patient returned after one week for a second round of Shock Wave therapy and reported that there had been a significant improvement in the plantar fascia symptoms but no change to the lateral side of the heel.
The patient had a discussion with the sports podiatrist and mentioned that his colleague went to see a podiatrist at Sydney heel pain clinic, and experimented with some injection therapy. The podiatrist confirmed that he was able to perform such techniques and explained the benefits of diagnostic injection therapy in certain parts of the heel. The patient consented and the sports podiatrist injected 3 millilitres of xylocaine into to the lateral area of the lower fibula in order to block the sural nerve. Approximately 60 seconds later the patient reported that his symptoms improved slightly but not significantly. The podiatrist advised the patient to monitor the pain levels for the next 24 hours.
This current case study with the patient and sports podiatrist at Sydney podiatry clinic is still ongoing and findings are currently inconclusive.
Please note that the information contained in this case study came from a detailed history with one particular patient, and the contents should not be taken as general advice. If you are suffering with heel pain or any of the foot condition you should seek the help of a qualified sports podiatrist.
Case Study taken by Karl Lockett, Sports Podiatrist – Sydney Podiatry Clinics
Sydney Podiatrist clinics are located in Martin Place in Sydney’s central business district. There are satellite clinics in Parramatta, Spring Farm, Campsie and Miranda. There are general podiatry treatments available as well as sports podiatry problems such as heel pain with all of our podiatrists in Sydney.