Sling Back Fasciitis
At CWG Footcare, we’ve identified a type of heel pain that we’ve coined sling-back fasciitis (SBF). This version of plantar fasciitis is particularly difficult to treat.
Plantar fasciitis is a common term used to describe several versions of heel or arch pain. Figure 1 illustrates the location of plantar fasciitis, central heel pain syndrome, and tension fasciitis/heel-spur syndrome. The blue oval (c) in Figure 1 illustrates the location of SBF along the medial corner or edge of the heel. SBF is similar to central heel pain syndrome because it involves a chronic contusion that rejects hard surfaces.
Although SBF can occur as the result of wearing almost any type of footwear lacking a heel counter, we’ve named it after its most obvious mechanism of origin (see Figure 2). Sling backs are open-backed shoes that do not have a heel counter. In sling backs, the heels are free to wander, so weight-bearing may not be centered.
Running shoes can also be a culprit. Reebok and Etonic shoes, for example, have a cupped heel shape inside, which creates a ridge of pressure. This cupped shape also exaggerates pressure on the heel when using soft orthotics, which flex with shoe shape.
While the vast majority of SBF patients are female, anyone with pronation problems, an externally rotated gait, or genu valgum of the knees is also a candidate. All of these conditions drive weight-bearing to the medial plantar corner of the heel, directly on the hard medial edge of the shoe.
This produces an acute or chronic contusion to the inside corner of the heel. As with most foot problems, an overweight patient can further accelerate the development of SBF.
Since SBF is usually more stubborn to treat than most other versions of heel pain, accurate recognition of the condition can help in both treatment and patient expectations.
Treating SBF
Consider bedrest or crutches for one to four weeks. While this approach is unconventional for most heel pain, keep in mind that SBF is usually one of the most debilitating forms of fasciitis and does not respond well to standard treatments. As with ankle sprains and other injuries, weight-bearing should gradually progress as acute symptoms subside.
By far the most effective initial steps in treating SBF include recognition, prolonged rest, and icing the affected area as often as possible. Ice massage is best; freeze water in a styrofoam cup, tear down the sides, and lightly rub the affected area with a rapid circular motion for six to ten minutes, five to ten times a day. Treatment of SBF will be most successful if it is combined with other efforts, including the use of NSAIDS.
Physiotherapy for SBF should be as non-weight-bearing as possible. Because there is likely a periosteal involvement of the calcaneus in SBF, sufferers may be hypersensitive to normal doses of ultrasound (overdoses of ultrasound typically result in a deep, prolonged periosteal ache).
Another important step in treating SBF is to identify the footwear worn at the time of injury and replace or modify it as necessary. For example, at CWG, we will sometimes silicone a running shoe’s interior to level out any ridges. The cup-shaped heel counter of orthotics can aggravate SBF, so they may have to be specially cushioned and/or have a flattened-out heel counter. A softer device may not adequately support the arch over the long term, so follow up will probably be required to augment the device.
If you are dealing with an unusually painful plantar fasciitis, consider that it may be SBF and treat it accordingly. Early recognition will go a long way towards giving the patient realistic expectations for healing, which will in turn help to reduce their frustration and anxiety over this very stubborn version of plantar fasciitis.
** The above information is not intended to replace a physicians advice. Seek a physicians advice first.
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