Mr. J, a 57 year old Quantity Surveyor, presented to the clinic with a 5 week history of increasing pain over the sole of his right foot. A keen golfer, who usually managed 18 holes several times a week, his symptoms had become so intense that he had to stop playing three weeks after the pain began. It was then that he attended his GP who diagnosed Plantar Fasciitis and prescribed a course of Non-steroidal anti-inflammatory drugs (NSAIDs). Mr. J was also placed on a waiting list for physiotherapy. He admitted that two weeks of NSAIDs had helped to control some of his pain but it was still quite intense and his mobility was limited.
On examination Mr. J had tenderness and increase tissue tone along the inside (medial arch) of his right foot running towards his toes, which became an intense sharp pain when he placed his weight through it. He reported that pain often came on following the first few steps after getting out of bed morning or getting up after sitting for more than ten minutes. We observed Mr. J’s gait when wearing his shoes and noticed that the medial arch of the right foot tended to pronate (collapse inwards) which became more marked when barefoot. On reflection he realized that footwear that offered better arch support tended to be much more comfortable.
We agreed with the original diagnosis of Plantar Fasciitis and spoke to Mr. J about a suitable treatment plan. We explained how osteopathy could help treat his foot and outlined some basic ‘do’s and don’ts’ to help manage his condition. We also explained how it would be important to have assessment by a Podiatrist to see if orthotics had a role to play.
Following several treatments Mr. J reported that his symptoms were less acute through a combination of treatment and self-management. He had also been for an assessment by a Podiatrist who confirmed that he had a pronated arch on his right foot that would be helped by a bespoke orthotic.
Eight weeks later, after several further treatments and wearing his new bespoke orthotics, he reported that his foot felt 90% better and he had booked in for 9 holes of golf.
This is pain and inflammation in the plantar fascia, the tough fibrous band of connective tissue that runs under the small bones of the foot and acts like a shock-absorber and helps stabilize the arches. Plantar Fasciitis is thickening of this fascia due to injury or as a consequence of accumulated smaller injuries.
~ It is more common in active 40 to 70 year olds.
~ Slightly more common in women than men.
> Sudden increased high impact exercise on hard surfaces.
> Jobs that involve standing for long periods, e.g. waitressing.
> Being overweight.
> Foot arch problems.
> Altered gait and biomechanics caused by ankle knee or hip problems.
> Shoes that have poor arch support.
> Increased weight gain, e.g. latter stages of pregnancy.
~ Sharp stabbing pain under heel or instep of foot.
~ Made worse by standing, particularly first thing in morning.
~ Occasionally pain may be accompanied by tingly, numbness and/or swelling.
Treatment is tailored to the individual depending on presenting symptoms, age and activity of individual.