Heel Pain – An Aircraft Engineer’s Story

With the Aviation Show currently on, our thoughts turned to the world class aviation industry here in the Middle East, and all the aviation professionals we’ve treated over the years. From those in the air – cabin crew, pilots to those on the ground – air traffic controllers, ground crew, aircraft engineers and more – they are very interesting patients, with demanding careers and particular stresses on their feet. Chief Podiatrist Michelle Champlin discusses a recent case.
The Aircraft Engineer with Heel Pain
I recently saw a very pleasant gentleman who came into our Clinic, having been referred by his GP, reporting chronic heel pain. Aged 53, he enjoyed his challenging career in Dubai as an aircraft engineer, for over a decade. However, he had been experiencing increasing heel pain over the past year.
On discussion, the patient reported that he had not been going out for his usual evening walks and had found he had put on about 10kgs in weight – he now found walking painful so therefore was now further put off enjoying his nightly walks. His job also involved a lot of time on his feet inspecting aircraft in the hangar, wearing good quality, sturdy protective safety boots. Previous x-rays had shown nothing abnormal to his calcaneum or other foot bones and he experienced only short term relief from over the counter soft insoles from the pharmacy. As part of his job, the patient received annual thorough medicals and all his blood results etc had been normal. He also said the pain was worse in the morning when he got out of bed.
How We Diagnosed the Problem
As Podiatrists, we review the patient’s overall health history and any other medical issues, have a thorough discussion with the patient about when the pain started, what if anything makes it worse or better (medication, time of day, acitivity, type of footwear etc). This helps clarify any symptoms. We then look for signs – by carrying out a thorough lower limb biomechanical assessment – analyzing the patient’s foot and leg posture when both weight bearing and lying down, during gait (walking), examine footwear for wear pattern, palpate the feet to identify specific pain / tenderness and so on.
Having completed our assessment with the patient, the diagnosis was plantar fasciitis.
Why Did He Develop Plantar Fasciitis?
The patient was at higher risk of developing this because of several factors:
• A job that involves a lot of standing or walking (e.g. teachers, hairdressers, nurses)
• Work footwear that was designed primarily for safety, so whilst protecting the foot from injury, provided little cushioning
• An underlying biomechanical issue – the patient actually over-pronated, or his ankle joints ‘rolled in’ causing his long arches to collapse and more strain to be placed on the plantar fascia
• Increased weight exacerbated the pain due to increased weight on the feet.
As we can see, a number of factors came together to cause the patient’s plantar fasciitis, which was now affecting the patient’s quality of life – unable to go for his evening walks and causing pain throughout his working day.
So Why Didn’t the Cushioning Insoles Help?
Unfortunately, cushioning over-the-counter insoles alone will not generally fix plantar fasciitis. The plantar fascia is like an ‘emergency strap’ of tissue connecting the heel bone forward to the midfoot that should not be relied upon constantly to hold foot posture. But when your ankle joints roll in, your intrinsic muscles and ligaments become lax, your medial long arch flattens and your foot is not tight and toned, this emergency band is forced into action, pulling at the insertion point at the heel.
Why is it Worse in the Morning?
The reason the heel pain is worse in the morning is that the plantar fascia has been repairing itself overnight and when you stand up and walk in the morning, the sudden weight bearing causes little micro-tear injuries again to it.
What Can be Done to Treat it?
Plantar fasciitis treatment will normally involve one or a combination of:
• Custom corrective orthotics to correct any underlying biomechanical issue, contributing to strain on the plantar fascia
• Footwear advice (such as cushioned sports shoes)
• Foot exercises to gently stretch the fascia
• Weight loss if you’re overweight
• NSAIDs in the short term such as ibuprofen until foot posture improves
• Steroid injections – to be used in the short term and with caution – cortisone injections lessen the good fatty padding of your feet and will in the long term worsen your symptoms
The Good News
Plantar fasciitis is treatable and not a pain you need to live with. In this case, we agreed with the patient that correcting the underlying over-pronation would alleviate the stress on his plantar fascia. We have treated many professionals who wear specific uniform shoes for work – within the airline industry pilots, cabin crew, ground crew and flight engineers. We also see many teachers, nurses, hairdressers and salespeople with the condition. We have designed custom orthotics specifically for various work shoes and we fit this particular patient with a very slim fit corrective orthotic that easily fit into his existing safety boots, that he could easily transfer into his sports shoes for his evening walk too.
The Aircraft Engineer – Treatment & Outcome
After we cast the patient’s feet to obtain his foot mold, Mrs Champlin made the patient’s orthotics in our lab from scratch – a time consuming and skilled process, but the only way to achieve precision in correcting each individual’s unique prescription. The patient was soon fitted with his orthotics into both his sports shoes and work boots, with a final check on his alignment when standing on them to ensure perfection. We also talked with the patient again about his diagnosis, treatment plan and time, when to wear his orthotics (at work and generally as much as possible before coming back in 6 weeks for review).
The patient felt almost immediate relief on his orthotics. Within the 6 weeks, his long arches had notably tightened, toned and lifted and his over-pronation and his foot posture much improved. The patient noted that he felt much happier, relieved and in fact pain free. He only felt slight twinges when not wearing his orthotics – he had been prescribed these to wear for 12 weeks only, so was only halfway through treatment, with this the expected time for all of his foot muscles and ligaments to tighten and pull back into shape with his excellent daily wearing to work.
After another 6 weeks, the patient’s foot posture was excellent and no more pain. All that remained was for us to ‘neutralize’ the prescription of his custom orthotics in our lab while he waited, and he could wear them once or twice a week in the future when he went on his walks. (The patient had actually grown very fond of his orthotics and said he would really miss wearing them). Just like braces for the teeth, we tend to see our custom orthotic patients back for a check up to alter their prescription and modify the orthotics as their foot posture improves and the arch lifts.
How Long Do You Wear Orthotics?
After this – there’s generally no need for this patient to rely on them lifelong – far from it. In fact, the aim is to return the patient’s feet to functioning well on their own, without relying or becoming ‘lazy’ again by relying on the orthotics. As they are ‘corrective orthotics’ – we work very differently to other practitioners (and in fact quite like engineers!) by correcting the structure of the foot. Chief Podiatrist Michelle Champlin explains “That’s why cushioning gel or foam soft insoles from a shop are a bit like propping up a collapsing bridge with chewing gum – you’re not fixing the foot’s structural problem.”
Could Your Heel Pain Be Plantar Fasciitis?
In Dubai, we see a lot of patients with plantar fasciitis as barefoot walking is common on hard concrete or tiled floors, or wearing footwear such as flip flops or ballet pumps that have no cushioning.
Here’s some more of our Risk Factors For Developing Plantar Fasciitis
• Middle-Aged
• Runners or other athletes whose feet do repetitive, weight bearing activity (like running)
• Recent increase in weight
• Pregnancy
• Jobs that involve you being on your feet a lot
• Shoes with little cushioning or support
If you’re experiencing sharp stabbing heel pain, or a dull bruise like ache, which may be worse in the morning or after walking for long periods, you may have plantar fasciitis. Heel pain can affect your quality of life, affect your physical activity and even lead to you limping. So make an appointment with the expert Podiatrists at Dubai Podiatry Centre for effective, long term relief. ;
We can be contacted on +971 4 3435390.