Heel Pain Case Study: How We Treated Acute Plantar Fasciitis and Helped a Runner Get Back on Track
Heel Pain Case Study: How We Treated Acute Plantar Fasciitis and Helped a Runner Get Back on Track
Introduction
A majority of the musculoskeletal (MSK) cases we see at Kenilworth Footcare involve heel pain that affects day-to-day activities. This can be something they have experienced for weeks, months or years. About 1 in 10 of us will experience a prolonged episode of heel pain during our lifetime, with more middle-aged and older adults at risk. This may be due to factors such as repetitive overload (compression and stretching), reduced ligament/tendon elasticity, and reduced muscle flexibility. All of these can cause injury to the key structures of the heel. Being overweight and inactive also contributes to this and any musculoskeletal issue.
The patient: sudden heel pain after returning to running
I recently saw a 56-year-old gent at Kenilworth Footcare, in good general health and leading a mainly sedentary lifestyle. During the Covid pandemic, he started running regularly but then got out of the habit. He had consequently gained weight, approximately 20 kg over 2 years and therefore decided to “get fit, lose some timber”. He increased his daily step count and began running again. Six weeks ago, while out running, he felt a “pop” under the left foot and, in the following days, experienced intense pain (7/10) when getting out of bed and after sitting in a chair. This had remained and intensified before he came to see us.
What heel pain can be (and why assessment matters)
Our gent was keen to be able to walk pain-free and get back into running so I worked through some key assessments, including gait analysis on our footscanner, to check what was injured and what could be the cause. It was clear when “poking and prodding” and running my fingers along the arch of the foot that the elastic sheet of collagen, the plantar fascia, was involved – you could feel a “grainy” surface on that side compared to the right foot. The pain level for this patient was 7/10 when putting their foot down in the morning and after sitting for a while and standing. After ruling out other causes of heel pain (there are at least 20, maybe more) I worked to try to work out…..
Was there muscle tightness/weakness causing strain on the bottom of the foot?
Was there a joint restriction or “insufficiency” causing strain on the bottom of the foot?
Were there any other clues in the medical history or changes when the injury took place to help me diagnose the issue.
What could I do to reduce pain and begin to rehabilitate the injured structure?
Assessment findings: why plantar fasciitis was most likely
The evidence and assessment findings pointed to an acute case of plantar fasciitis. As mentioned above, the plantar fascia is a tough, thin elastic sheet of collagen (quite unique in the human body) that helps to anchor the arch of the foot and reform the arch of the foot for propelling forward on each step.
If you think you might be suffering with plantar fasciitis, book your assessment HERE.
Treatment plan: offload first, then rebuild strength
Working with the patient, I implemented a strategy to offload the plantar fascia to allow it to recover in the short term and then begin to restrengthen it for longer term resilience:
1. Footwear
I recommended a shoe with a stiff (therefore supportive) outer sole and forefoot rocker (curve) – many running shoes have this style.
2. Taping
By using stiff tape on the bottom of the foot, we can support the fascia so it doesn't have to stretch as much.
3. Rolling/massage of the painful fascia
4. Reducing barefoot walking and use of flat, flexible footwear (even indoors)
5. Exercises
To strengthen and increase the range of motion of key muscle groups – the calf muscles and the muscles on the bottom of the foot.
Results after 3 weeks
After 3 weeks, the patient returned and reported that his pain was now a 2/10 when putting his foot down in the morning, and he was not noticing the issue very much. He was happy with his new running shoes (people are often surprised by how comfortable they are to walk in day-to-day). He had not found the taping so useful, but had found the stretching and massaging of the foot worked well for him. We agreed to increase the exercises and start to put the plantar fascia under more stress through key exercises (the fascia acts like a tendon, which we know requires appropriate stress/exercises to reorientate tendon fibres and promote healing).
Next steps: physiotherapy and whole-body resilience
The patient will be returning in 5 weeks to have a session with our Physiotherapist, Merryn Catley to continue to rehabilitate the fascia and to develop resilience. Merryn will also look at other parts of the body that may benefit from developing strength and flexibility. Ultimately, we want our patients to know how to prevent re-injury from occurring and what to do if it does.
Key takeaways for preventing heel pain coming back
This case highlights the importance of the following in treating this and many other musculoskeletal conditions:
Each patient is different so treatment plans and progression needs to be a collaborative process – some patients can develop the habit of daily exercises while others may need a group/gym setting for this to work for example. If you find that “Dr. Google” and other approaches to curing heel pain have not worked for you up to now, it could be that a collaborative process with a foot specialist/physiotherapist team would be more effective.
Heel pain as a condition can take as many months to treat as it did to develop. So if you are experiencing heel pain, do not ignore it. This case has improved well over a short period of time, but many other cases do take longer and after 3-6 months may require additional treatments.
Footwear, footwear, footwear. One of the top MSK podiatrists in the country stated recently during a training session that over 80% of cases he treats involve footwear improvements as a treatment. We can help you to ensure your shoes are correctly sized, providing appropriate support and offloading “problem” areas of the foot.
When embarking on a programme of exercise following an extended period of inactivity and weight gain, strength training – hips, knees, calves – is one of the best ways to reduce the risk of injury. Again, we can advise on this – you can book in with either Charlie Cunningham, Podiatrist or Merryn Cately, Physiotherapist for advice.
Contact Kenilworth Footcare:
📞 01926 563555
📍 2 Oaks Precinct, Kenilworth CV8 1DP
With free parking and ground-floor access. We're here to help you get back to the activities you love, comfortably and confidently.
