Case Study; Alan
Alan recently received a diagnosis of diabetes mellitus and since then he’s worked with his doctor to manage the condition. He is using the medication suggested to maintain his blood sugar levels but he aims to lower or eradicate the need for medication and control the diabetes through exercise and his diet. Alan works from home and needed a routine to get him moving and out of the house. He started a walking program. To encourage him, his wife bought him a watch that tracks fitness and steps. Within a few months he had settled into his new routine of daily walks and even joined a group on social media for motivation from others. He even challenged some of his new contacts to increase the walks to 3 miles per day. Alan, his new friends and physician were all really pleased with the progress and improvement in health. He was even able to drop the dosage needed of his prescription.
Alan was motivated by his improved health but a ‘bruise’ on his left heel started to slow him down. He thought he must have stepped on something. HIs wife looked at his heel but couldn’t see anything resembling a bruise. The discomfort increased over the weeks, was worse in the mornings or if he didn’t wear shoes to walk around the house. His walking pace has slowed down, he is taking shorter steps, and by some evenings he is in so much pain that he is limping. Alan visited family one weekend and they noticed the change in his walking. His daughter is a therapist and when listening to Alan explain the pain and affect it was having knew that rather than a bruise it actually sounded like the structures in his foot were inflamed. Alan confirmed with his doctor that it was indeed plantar fasciitis and Alan has been referred onto you for treatment.
So...
- Which anatomical structures attach to the base of the heel (calcaneus)? Which are inflamed in this case?
- Alan says there is more pain early morning or when walking without shoes on. Why could this be?
- What footwear would recommend Alan to wear and for what reason?
- Which lower leg muscles attach to the calcaneus? How may tightness in these affect plantar fasciitis?
- Do you recommend that Alan needs to stop walking completely? If so, is there another activity you would suggest to give time for the inflammation to get better?
Adapted from Dr. Tawny Chamberlain, PT, DPT, Department Chair and Program Director, Physical Therapist Assistant Program, South University, Richmond
Case Study; Jack, 44, Golf enthusiast who has tweaked his lower back