Patient History

A 50-year-old Caucasian female presented with a sudden onset of severe left heel pain and an exacerbation of intermittent left knee pain. Awoke one morning with excruciating heel pain, without any preceding trauma, activity, or triggering event. She had never experienced heel pain previously.

Her morbid obesity has persisted throughout her life causing her to seek care intermittently for musculoskeletal complaints over the last 25 years.

Initial Exam Findings

Examination revealed sharp, stabbing pain upon palpation of the plantar aspect of the left heel, with tenderness extending into the plantar fascia and mild sensitivity along the medial arch. Walking aggravated symptoms and caused significant difficulty with weightbearing.

Palpation of the left knee revealed mild tenderness, which the patient reported had worsened since the onset of heel pain.

A digital foot scan revealed severe bilateral pronation with collapse of all three arches placing abnormal strain on the plantar fascia, predisposing the patient to plantar fasciitis and calcaneal spur formation.

Clinical Impressions

• Plantar fasciitis with suspected calcaneal heel spur (confirmed radiographically)
• Chronic left knee pain aggravated by altered gait mechanics
• Severe pronation with loss of three-arch stability bilaterally

Explained to the patient that excessive pronation increases tensile stress on the plantar fascia creating microtrauma at the calcaneal insertion resulting in calcium deposition and heel spur formation.

Treatment Plan / Methodology

• Erchonia GVL cold laser therapy to reduce inflammation and stimulate cellular repair.
• Kinesiology taping of the heel, Achilles, and medial arch to support tissue healing and reduce strain.
• Myofascial therapy applied to the lumbosacral region, left heel, and left knee.
• Spinal manipulation and mobilization in the lumbosacral spine, left foot, and ankle.
• Home care: relative rest, rolling a frozen water bottle under the heel, and activity modification.

After three weeks of persistent pain, the patient agreed to an x-ray revealing a left calcaneal heel spur. The patient proceeded with Foot Levelers InMotion® custom orthotics, ordered with bilateral heel spur correction adding a soft center to redistribute weight away from the spur and toward the heel perimeter.

Results

The patient reported immediate relief of heel pain with her orthotics and supportive care over the following four weeks:

• Pain decreased from 9/10 to 2/10 on the numeric pain scale.
• She regained the ability to walk one mile without pain overcoming years of chronic knee discomfort.
• She was very pleased at how quickly the custom orthotics improved her condition, stating she would not have believed the improvement possible without experiencing it firsthand.

Discussion

This case highlights the silent progression of plantar fasciitis and heel spur formation, often developing over decades of uncontrolled pronation before the first onset of pain. The sudden emergence of heel pain in this patient underscores the importance of early detection and proactive orthotic intervention.

Research confirms that excessive pronation flattens the plantar fascia, leading to micro tearing, inflammation, and eventual calcaneal spur development. Custom orthotics correct this biomechanical collapse by supporting all three arches, thereby reducing fascial strain, restoring balance through the kinetic chain, and relieving pain.

Conclusion

With Foot Levelers custom orthotics, heel spur correction, and complementary conservative therapies, this patient experienced rapid, measurable relief and a return to functional mobility.

Based on results from this case and others, my current clinical strategy includes adding heel spur correction to all custom orthotics for patients over age 50, even if heel pain is not yet present. This preemptive approach has yielded consistent success in preventing chronic plantar fasciitis and spur formation.

After 40 years of practice, I continue to rely on Foot Levelers orthotics and digital scanning technology as invaluable diagnostic, therapeutic, and patienteducation tools.

References

1. Menz, H. B., Dufour, A. B., Riskowski, J. L., Hillstrom, H. J., & Hannan, M. T. (2013). Foot posture, foot function and low back pain: The Framingham Foot Study. Rheumatology, 52(12), 2275–2282. https://doi.org/10.1093/rheumatology/ket298.
2. Ribeiro, A. P., et al. (2022). Effect of customized insoles on calcaneal spur syndrome: randomized controlled trial. Clinical Biomechanics, 97, 105698.
3. Zwirner, J., et al. (2021). Why heel spurs are traction spurs after all: a biomechanical analysis. Scientific Reports, 11, 15683.