A Novel Approach To A Runner’S Foot Pain

Abstract

HISTORY: 32-year old female recreational runner experienced the insidious onset of bilateral heel pain, followed by arch pain in the AM and after running. She was treated for plantar fasciitis by a podiatrist with custom orthotics, night splints and rest. She discontinued the orthotics due to discomfort and persistence of pain. She began cycling due to being unable to run. Three months later, her pain finally resolved and she returned to running. At this time, she decided to try transitioning to a forefoot strike pattern in minimal shoes. She increased her distance from 400m to 2000m before she experienced the onset of BIL dorsolateral foot pain, which she continued to run through. She increased to running 10km before a reaggravation of her heel and arch pain caused her to stop. She then sought treatment at the running clinic. PHYSICAL EXAMINATION: The patient reported pain with walking and running. Palpation of the 4th and 5th metatarsals elicited tenderness, reproducing her complaint of dorsolateral foot pain. Palpation of her medial arch elicited tenderness and reproduced her complaint of plantar fascia pain. A manual muscle test revealed normal muscle performance of her lower leg muscles. During running, she exhibited increased foot inversion at foot-strike, followed by rapid pronation. She also demonstrated increased femoral internal rotation and adduction. She reported a VAS of 6/10 for the dorsolateral foot pain, and 3/10 heel pain. DIFFERENTIAL DIAGNOSIS: -Plantar fasciitis -Metatarsal stress reaction/fracture FINAL/WORKING DIAGNOSIS: -Plantar fasciitis -Possible metatarsal stress reaction TREATMENT AND OUTCOMES: 1. 8 weeks of rest to unload possible stress reaction. During this time, her dorsolateral foot pain resolved. Her heel and arch pain did not. 2. Progressive intrinsic and extrinsic foot strengthening. 3. Movement reeducation, using bilateral dynamic movements and unilateral dynamic movements to improve her lower extremity control. 4. Gait training to reduce her excessive inversion, rapid pronation, femoral adduction/internal rotation during running. 5. Run time was slowly increased to 35 min over 4 weeks. Patient was pain free at discharge. 6. Patient then independently progressed to prior level of running. She has had no reaggravation of her plantar fasciitis as of a 2-year follow-up.