Case Study March 5th 2018 – Sports Podiatry Consultation with Podiatrist, Sydney
Mr Karl Lockett, Podiatrist – Sydney
A 42 year old female presents to the podiatrist at Sydney podiatrist clinic in Miranda , complaining of plantar fasciitis in both feet. This lady is approximately 10 kilos overweight and reports that she has been suffering with heel pain from plantar fasciitis for approximately 14 months. She feels significant pain each morning when she wakes, and struggles to walk without limping every morning. She reports to the sports podiatrist that the plantar fasciitis is causing throbbing sensations in both feet which he feels when sitting or lying down. This lady does not report any other significant medical conditions although her doctor has informed her that she is pre-diabetic. She has carried out fasting blood glucose testing, and blood sugars were found to be slightly elevated. She does not report any other autoimmune or inflammatory medical conditions. She has never had plantar fasciitis before, nor does she report any significant foot, ankle or lower leg conditions.
Note : Medical history taken by Karl Lockett, podiatrist, Sydney.
Ultrasound Imaging Assessment by Karl Lockett, Podiatrist, Sydney.
Due to the significant pain, this patient received a prescription from her GP for some anti inflammatory medication. The patient was taking the anti inflammatory medication each day for approximately 6 weeks. The pain reduced slightly, but was not significant, therefore she returned to her GP for further assistance. The GP referred the patient for ultrasound imaging of both feet, and the report concluded plantar fasciitis, bilaterally. Furthermore, the imaging revealed some micro tears in the fascia measuring approximately 2 x 9 x 3 m. The report was also suggestive of increased thickening of the plantar fascia bilaterally, to approximately 9 mm.
Physical Assessment by Sport Podiatrist
Firm pressure was applied to the plantar aspect of the calcaneus, by the sports podiatrist, around the attachment of the plantar fascia. As one would expect, in patients with plantar fasciitis, the patient reported significant pain and retracted her foot. Pressure was also applied to the medial aspect of the heel, which also elicited pain. The patient did not report pain as pressure was applied along the medial slip of the plantar fascia, through the arch of the feet.
Note: Physical assessment was carried out by Karl Lockett, podiatrist, Sydney.
Treatment Plan by Karl Lockett, Podiatrist, Sydney – Miranda
Due to the severity of this patient’s condition, the podiatrist in Sydney, Miranda, informed the patient that she would not be prescribed orthotics to treat her plantar fasciitis. In this instance, the pressure from the orthotics against the plantar fascia would be intolerable and the patient would not be able to walk comfortably. However, because it would be important to remove significant stress from the plunger to allow healing, the patient was informed that she would be prescribed an immobilisation boot which she would need to wear for at least 3 to 4 weeks. In order to provide additional support, the sports podiatrist informed the patient that rigid sports tape would be applied to the feet in order to reduce strain through the sole of the foot.
The assisting practitioner, Rami Ghorra, podiatrist, Sydney measured the patient and fitted her with an appropriate full height rebound at walker. The patient walked comfortably around the clinic with and reported no pain.
Due to extremely tight calf muscles, the patient was informed that she would benefit tremendously from deep tissue massage. To this end, the patient was scheduled for three massages at weekly intervals.
Follow Up Consultation with Karl Lockett, Podiatrist – Sydney.
Follow up appointment was organised 4 weeks in advance and upon the patients return to Sydney, podiatrist Karl Lockett carried out further assessment with colleague Rami Ghorra.
The patient reported approximately 60% drop in pain around the plantar fascia of her right foot. She had being compliant with the use of the immobilisation boot and reported to the sports podiatrist that she felt comfortable while mobile. She had been diligent with the application of cold ice packs and the reapplication of rigid sports tape around both feet. She informed the sports podiatrist that she had been stretching her calf muscles 3 times a day and that she felt an improvement in the range of motion through the ankle joint. When firm pressure was applied to the plantar fascia by the sports podiatrist, the patient reported less pain when compared to the physical assessment 4 weeks prior. Rami Ghorra assessed the plantar fascia in the left foot and this seemed to have improved by only by approximately 10%, which is not significant. The patient was informed that the immobilisation boot would be transferred from the right foot to the left foot once there was no remaining pathology in the right plantar fascia. The podiatrists at Sydney podiatrist clinics, try not to prescribe two immobilisation boots simultaneously due to balance issues. There is a danger that the patient will struggle to walk properly with two boots due to instability.
8 Week Check Up with Podiatrist at Sydney Podiatrist Clinic – Miranda
The patient returned for the second follow up with the podiatrist at the Sydney podiatrist clinic , Miranda after a further 4 weeks. She reported to the practitioners that the morning pain in the right heel had completely gone and that she had walked without the boot on the right foot for an hour or 2 here and there.
She had continued to apply ice packs to both feet and was stretching her calf muscles regularly. Whilst walking with the immobilisation boot on the left foot, she reported no pain whatsoever. The pain in the right foot was minimal and occasional, and she was happy to avoid the use of the boot on the right foot. The patient felt more support with the rigid sports tape in place and was continuing to apply this to both feet.
The patient was informed to continue with this treatment plan for the duration of the rehabilitation of her left foot, which would probably take a similar amount of time to heal. The sports podiatrists informed the patient that torn fascia can take up to 6 to 8 weeks to heal, and this seemed to be the case with her conditions. The podiatrists at Sydney podiatrist clinic informed the patient that she did not need to return to the clinic before 8 weeks, but to return to the practitioners if she had questions or problems. She was advised that once the boot was removed from her left foot, if she felt no symptoms and was comfortable and confident then she did not need to return to see the practitioners.
Please note that the information in this case study is not general advice.
Karl Lockett – Podiatrist, Sydney Podiatrist Clinic.