Healthy Life: Classical Case (900)

健康生活：Classical Case (Ankle / Heel)

蘇鎮邦 (Christopher So)：
舒整物理治療師 (Manipulative Physiotherapist) 人類工程師 (Ergonomist)

Recently, I had a 30 year old man visit me with a painful right heel which may be caused by plantar fasciitis or a calcaneal spur. If there is a bony spur on the X ray then it is usually at a late stage. Because this is his first incidence of heel pain and he is young, an X ray is not necessary yet. During the consultation, it emerged that the most likely cause is his daily riding of a bicycle to work about 10 km for the past 2 weeks.

Moreover, he played golf for the past two weekends. He started to feel pain in his heel during walking. The degree of pain is about 7/10. When I measured his dorsiflexion (Figure 1), his right ankle is 11 cm and left is 9 cm. Therefore, it should not be the calf tension on the heel that causes plantar fasciitis and pain in the heel.

Figure 1 : Dorsiflexion

After the first treatment, he returned with a good response. I gave him a pair of heel pads especially for his leather work shoes. On the third treatment, his pain had reduced to 2/10. That means he had improved 70 -80 %. I urged him to continue stretching exercises and ice his heels twice a day until he had achieved 100% relief.

He asked me why he only had 2 treatments for his sprained left ankle last time but this time he needed 3 treatments. I looked at his records. I discovered that his dorsiflexion for the right ankle was 11 cm and his left ankle was 8 cm. After 2 treatments, his left ankle dorsiflexion had improved to 10.5 cm and that meant it had improved by more than 80%. Therefore, I let him go but urged him to do the exercises until 100%. Obviously, he had not done that because his left ankle was only 9 cm on initial examination this time.

Moreover, he came to me two days after spraining his ankle because he had pain when walking and it was quite unbearable. Therefore, he responded much faster. In the present case it was a month since the last injury. However, it did not affect his walking or daily activities. He waited 2 weeks instead of 2 days. One more treatment was necessary to bring his improvement to 80%. Also, the stiffness in his left ankle could cause added pressure on the right especially during walking and cycling and that caused his right heel pain. I strongly advised him to do his exercises until he was 100% before he stopped.

Dear readers. Do not rely solely on the treatments from the physiotherapist. We need to be responsible for our own full recovery. This is a classical case indicating that the left ankle did not fully recover, and even 2 cm difference, can cause problems for the right ankle.