Case Study 15 August 2017 – City To Surf Runner Seeks Sports Podiatrist

Sports Podiatrist Takes Case History

A recreational runner presents to the sports podiatrist complaining of excruciating heel pain, following an annual run. This 42-year-old male reports that he completed the city to surf (an annual run in Sydney, NSW) on Sunday 13^th August and has since been unable to walk without a severe limp. He is a keen runner who usually covers 3-4 runs each week before work in a morning. His typical run is 7k’s (the bay run around Sydney’s inner west) and he informs the podiatrist that he has been covering this route for several years, without any problems. During his training for the city to surf, he increased the frequency to 5 runs each week, and was then aware of some calf cramps, calf tightness and a mild ache in the base of his right heel. He was able to complete his training as the dull ache would subside once he was warmed up. However, for the few hours that followed the run he was aware of the heel pain, and would feel it while he was sat on the bus to work. He informs the podiatrist that if he stood up from his office chair he was unable to walk without a limp.

The sports podiatrist enquired about pain in bed at night and the patient confirmed that he felt throbbing when he lay down, although the pain did not wake him from his sleep. The mornings were described as dreadful and the pain was at its worst. The patient would hobble for the first 20 minutes of his day.

The patient described to the podiatrist that during the run he felt pain for the first kilometre, which subsided quickly. However, after completing a steep incline the pain shot up and became quite unbearable. The patient was forced to change his gait and was not pushing off his right foot properly. He refused to stop running and did not reduce his speed to a walk. He was however forced to run slightly slower than usual. At the end of the run he removed his shoes and elevated his feet and applied an ice pack. He informed the sports podiatrist that he could feel throbbing in his heel and that it felt hot. He went to the nearest chemist in Bondi beach and collected a pair of crutches which he was still using. He took the day off work the following day and went to see his GP who recommended an X ray and some medication to reduce the pain and inflammation.

The sports podiatrist examined the X ray which did not show any abnormalities that related to the heel pain. The medication did not reduce his pain, and to this end he was advised to cease use.

Physical Assessment By Sports Podiatrist

The sports podiatrist examined the right foot and found extreme pain around the base of the heel, at the point where the plantar fascia attaches to the calcaneus. The patient was informed that he probably had plantar fasciitis and that he may have tears in the fascia too. The patient was unable to perform a single leg heel raise due to extreme pain. Upon assessment of the calf muscles the sports podiatrist also noted a limited range of ankle joint dorsiflexion. The tightness in the calf muscles was a likely contributing factor in the onset of this patient’s condition. The patient was given a referral for an ultra sound of his right foot and was asked to return to the podiatrist with the scans and a report.

Follow Up

The patient returned 2 days later to discuss treatment with the sports podiatrist. The ultra sound report described a deep surface tear of 7mm X 3mm. The patient was no longer using crutches as the pain was slightly better.

Sports Podiatrist Finds More Problems

Further assessment by the sports podiatrist revealed that this patient had a hyper mobile foot type that collapsed under load. His arch contour was low – 18mm left and 16mm right. Furthermore, he was using a lightweight running shoe which offered minimal control for his unstable foot type. The sports podiatrist advised the patient that his Asics gel cumulus was a neutral running shoe designed for a stable foot type. Due to the patient’s body weight, foot type, and broad foot width, he was advised to purchase an 8 series New Balance running shoe.

The patient also revealed to the sports podiatrist that he had been performing specific foot stretches which are known to strain the plantar fascia and can cause plantar fasciitis. He was advised to cease such stretching.

Treatment and Advice of Sports Podiatrist

The patient was informed by the sports podiatrist that the quickest and most reliable way to treat his condition was to immobilise the foot and ankle, via the use of an immobilisation boot. He would need to wear the boot for approximately 4- 6 weeks. He was also advised to apply an ice pack to his foot every evening for 30 minutes, and to elevate the foot. He was shown how to perform safe and reliable calf muscles stretches which would need to be performed twice daily.

The sports podiatrist advised the patient to return in 3 weeks for a check-up and to commence a course of shock wave therapy to stimulate and accelerate healing. Rigid sports tape was also applied to the affected foot to further reduce strain on the plantar fascia. The patient was shown how to apply the tape and was asked to replace it once every 5 days.

This patient will be reviewed in 3 weeks. It can take up to 8-12 weeks for a tear to heal in extreme cases. He will likely have 6 sessions of shock wave therapy.

Please note: The information outlined in this case study above, is specific to one individual person. It should not be taken as general advice. If you have any type of foot problem, please seek the help of a sports podiatrist.