Initial Biomechanical Podiatry Assessment

Presenting Complaint

38yo male (NHI: ZXC4829) presenting with localized R plantar heel pain.

• R medial calcaneal tubercle pain.
• Insidious onset following a rapid increase in road running volume.
• Onset 6 weeks ago (approx. 01/03/2026).
• Sharp, stabbing pain (VAS 7/10) on first steps in the morning, easing to a dull ache (VAS 3/10) after 10 mins of ambulation. Worsens again late evening or post-run.
• Aggravated by barefoot walking on hard wooden floors, running > 5 km, incline treadmill work, and prolonged standing.
• Relieved by rest, wearing cushioned running shoes indoors, ice pack application for 15 mins, and ibuprofen (Nurofen®) 400 mg PO PRN.
• Seen by GP 3 weeks ago; prescribed oral NSAIDs and advised to rest for 1 week, which provided temporary relief until running resumed.

History of Injury

R lateral ankle sprain (ATFL) 3 years ago playing social football; resolved with conservative physio rehab.

History of bilateral medial tibial stress syndrome (MTSS) 5 years ago, resolved with footwear update.

Activity Levels

Runs 3x/week, 5–8 km per session on asphalt at moderate pace (5:00 min/km). Patient believes rapid mileage increase for upcoming half-marathon directly contributed to onset.

Ceased speed/interval track sessions 3 weeks ago due to severe post-run pain the following morning.

Footwear and Orthotics

• Running: Asics Gel-Kayano 29, engineered mesh upper, lace-up.
• Work/Daily: R.M. Williams Comfort Craftsman, leather upper, elastic-sided pull-on boot.

Asics show excessive medial midsole compression and lateral heel outsole wear; approx. 700 km mileage, due for replacement. Work boots have minimal arch support and a firm heel counter.

Previously used off-the-shelf gel heel cups 2 years ago for general fatigue; discarded after 3 months as they slipped in shoes.

Patient Goals

Return to pain-free 10 km runs within 6 weeks and complete the Auckland half-marathon in October.

Assessment of Condition

Marked POP at R medial calcaneal tubercle and along the proximal 2 cm of the central band of the plantar aponeurosis. Mild TOP R medial gastrocnemius belly.

• Windlass test: Positive on R, reproducing chief complaint (VAS 6/10).
• Ankle dorsiflexion (Silfverskiöld test): Restricted bilaterally; knee extended L 5°, R 2°; knee flexed L 15°, R 12° (gastroc-soleus equinus).
• Foot Posture Index (FPI-6): L +6, R +8 (pronated foot type, worse on R).
• Single-leg heel raise: R reproduces mild plantar ache at end-range plantarflexion; reduced endurance R (14 reps) vs L (22 reps).

Mild non-pitting oedema localized to R plantar medial heel pad. Pes planovalgus deformity noted on weight-bearing, with R navicular drop > 10 mm.

Gait

Visual gait analysis (barefoot and shod): Early heel lift bilaterally, abductory twist noted on R at propulsive phase, prolonged midstance pronation R > L, and delayed resupination.

Patient reported 4/10 sharp pain at R heel strike and toe-off during barefoot walking; reduced to 1/10 when shod in Asics.

Treatment of Condition

Radial shockwave therapy (rESWT), myofascial dry needling, low-Dye strapping, and plantar felt padding applied today.

rESWT: 2,500 pulses, 2.2 bar intensity, 10 Hz frequency, 15 mm transmitter head applied to R proximal plantar fascia and medial calcaneal insertion.

Strapping: Rigid sports tape (38 mm Leukotape) applied to R foot using a modified low-Dye technique with calcaneal slings to offload the plantar aponeurosis and control subtalar pronation.

Dry needling: 4 needles inserted into R medial and lateral gastrocnemius trigger points; local twitch responses elicited, patient reported a dull, heavy ache that subsided within 2 mins.

Padding: 5 mm semi-compressed felt crescent pad applied directly to the plantar R heel, positioned just anterior to the medial calcaneal tubercle to offload the painful insertion.

Advised to keep tape and felt padding dry, leave in situ for 3–5 days, and remove immediately if skin irritation, itching, or ischaemic pain occurs; soak with baby oil prior to removal to protect skin.

Advised to avoid barefoot walking completely (use recovery slides indoors), reduce running volume by 50% on flat surfaces only, avoid hills/speedwork, and replace Asics Kayano 29 with a fresh pair (Kayano 30 or Brooks Adrenaline GTS).

Light scalpel debridement of mild hyperkeratosis at R medial hallux IPJ.

Custom EVA foot orthotics recommended if symptoms do not improve by > 50% after 3 sessions of shockwave and taping; future prescription would require a deep heel cup, 4° medial rearfoot skive, and a plantar fascia groove to accommodate the prominent central band. Patient expressed concern regarding orthotic fit inside his R.M. Williams work boots.

Prescribed Exercises

• Modified Rathleff protocol (slow heavy calf raises with a rolled towel under the hallux/lesser toes): 3 sets of 8–12 reps, 3 sec concentric, 2 sec isometric hold, 3 sec eccentric, performed every second day.
• Gastrocnemius and soleus wall stretches: 3 x 45 sec holds, twice daily.

Told to expect mild muscular fatigue in the calf and up to a 3/10 tolerable ache in the plantar heel during loading, which must settle within 24 hours; if morning pain increases the next day, reduce load.

Supplied with a firm spiky massage ball for plantar fascia self-release (2 mins daily before getting out of bed).

Progress to single-leg weighted calf raises (adding 5 kg in a backpack) in 2 weeks if current bodyweight exercises remain < 3/10 pain.

Plan

Return in 7 days (21/04/2026) for second rESWT session and review.

Assess response to initial shockwave, evaluate skin tolerance and pain relief from low-Dye taping, inspect newly purchased running shoes, and check technique for Rathleff loading exercises.

Email exercise rehabilitation videos via Physitrack and a formal footwear recommendation letter today; patient to send photos of his new running shoes via WhatsApp once purchased.