On the day of examination, the lady tells that the problems started in November 2020 and persist with relatively the same intensity until today. She underwent an X-ray and diagnostic ultrasound which showed both the presence of a calcaneal spine and thickening of the plantar fascia at the calcaneus. Until our visit, she had undergone a cycle of FTH, which had not resulted in any significant improvement. She has also had PRP applied, which has so far made the condition slightly worse. In her free time, the lady goes for long hikes in the mountains, and she also walks a lot at work, about 10,000 steps a day.
On inspection, the palpatory tender area of the plantar fascia process on the calcaneus is slightly more on the medial side. Toe mobility was comparable to the left foot. The right ankle was slightly restricted in dorsal flexion, approx. 5° deficit, and plantar flexion was comparable compared to the left ankle.
When testing ankle muscle strength, we found a significant deficit in plantar flexor endurance strength, with the patient performing 18 full toe raises on the left leg and only 12 on the right. When performing the Windlass mechanism, there was an increased stiffness of the right plantar fascia with the left.
The patient presented with plantar fasciopathy rather than classic plantar fasciitis, as indicated by the long-standing pain and the failure to treat the problem with conventional anti-inflammatory agents.
Outpatient physiotherapy included shock wave therapy and special exercises to strengthen the intrinsic muscles of the foot. Mobility deficits were corrected by the application of active mobility exercises and the plantar fascia was strengthened by prolonged isometric contractions. After each therapy, a high-energy pain-relieving LASER was applied to the plantar fascia and calcaneus. In the second phase of rehabilitation, we assessed and restored the biomechanical gait pattern and the correctness of foot positioning during gait.
After the end of the treatment, the lady joined the preventive programme of the Medicofit clinic, which includes general fitness training, exercises to improve joint functionality and unilateral and bilateral strength exercises.