Pedorthic Case Study: Plantar Fasciitis in an Active Adult

by Babs Aiyede C. Ped (C)
Certified Pedorthist
updated Apr 14, 2026

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Who Is the Patient?

The patient is a 34-year-old who loves staying active — they rock climb indoors, run, lift weights, snowboard, and do a lot of walking. They were referred for pedorthic assessment  by their physiotherapist and family doctor because of pain in the bottom of their left foot.

In the recent past, they tore their left calf muscle and had some mid-back pain that eventually went away.

 

What Was the Problem?

For about a month, the patient had been feeling an aching pain in the arch of their left foot. It started gradually and got worse after doing calf exercises during physiotherapy rehab for a torn left calf muscle.  The pain was worst:

• The day after running
• When first getting out of bed or stood up after sitting for a while

Rolling their foot on a cold water bottle, wearing supportive footwear and physiotherapy (shockwave therapy) helped.

 

What the Examination Found

Looking at the feet and legs:

• No obvious signs of swelling
• Limited movement in some of the small joints of the midfoot
• Stiff big toes (both feet)
• Tight calf muscles and hamstrings
• Flat feet (both feet, left more than right)
• The feet rolled inward more than normal (called overpronation)

Two special tests:

• The Supination Resistance Test — (Checks how hard it is to lift the arch and roll the foot outward).  The patient scored 5 out of 5 (hardest possible) on both feet, suggesting that the plantar fascia (and other structures that support the arches) are under greater strain..
• The Jack Test — (Checks whether the big toe can help the arch rise during walking). They also scored 5/5 on both feet, meaning this mechanism was significantly impaired.

Watching them walk:

• Landed heavily on their heels
• Feet pointed outward, especially on the left
• Feet stayed rolled inward (pronated) for too long during each step
• Pushed off through the middle of his foot instead of through his big toe, which is less efficient

 

Clinical Impression: 

The pedorthic assessment revealed signs and symptoms that were suggestive of:

• Left plantar fasciitis 
• Flat feet (pes planus)

 

Treatment Plan

The patient was measured, casted, and fitted with custom foot orthotics, which are specially made shoe inserts designed for their specific foot shape and movement patterns. They were built to reduce the stress being placed on the plantar fascia.

They also continued with physiotherapy and their home exercise routine.

 

Results

Four weeks after getting the orthotics, they reported major improvement. The foot was mostly pain-free in daily life. Pain only came back under very high-demand situations (like walking 10,000 steps without orthotics). They were working toward returning to running.

 

Why Did This Happen? Key Concepts Explained

1. What Is the Plantar Fascia?

The plantar fascia is a thick band of tough tissue that runs along the bottom of the foot, connecting the heel to the base of the toes. Think of it like a bowstring on the bottom of your foot. It:

• Supports the arch
• Helps the foot become a rigid lever when you push off while walking or running
• Stores and releases energy like a spring during running

2. Flat Feet and Arch Pain

When the arch flattens out under your body weight, the plantar fascia gets stretched. This pulling force is called tensile load. Not everyone with flat feet gets pain, but in this case, the left foot was more flat than the right, which matched the side that hurt.

3. The Windlass Mechanism (How the Arch Powers Your Push-Off)

When your toes bend upward as your heel lifts off the ground, it automatically tightens the plantar fascia and raises the arch. This turns the foot into a rigid lever, which is much more efficient for walking and running. This is called the windlass mechanism.

If this system doesn’t work properly, the plantar fascia has to work harder and gets repeatedly overstretched.

In this case: Stiff big toe joints and overpronated feet were preventing this mechanism from working the way it should, especially on the left.

4. Why The Walking Pattern Made Things Worse

Heavy heel striking: Tight calf muscles limited how much the ankle could bend, making them slam their heel harder into the ground. The foot then compensated by rolling inward more, putting extra strain on the plantar fascia.

Toe-Out Gait: Walking with your toes pointed out shifts how forces travel through the foot, increasing the load on the inner arch and plantar fascia.

Staying pronated (rolled in) too long: Ideally, the foot rolls inward briefly when it first hits the ground, then rolls back outward as you prepare to push off.  In this case, the left foot stayed rolled in for too long, keeping the foot “unlocked” when it should be stiffening up. This meant the plantar fascia was under continuous strain throughout each step.

Pushing off from the wrong part of the foot: Instead of pushing off through the big toe (the most powerful and efficient way), the patient was pushing off through the middle toes. This bypassed the windlass mechanism and put even more strain on the plantar fascia.

 

The Big Picture

Plantar fasciitis doesn’t usually have just one cause, rather it’s a combination of factors that together create repeated overloading of the tissue until it becomes irritated and painful.

In this case, the combination of:

• Flat feet and overpronation
• Stiff big toes
• Tight calf muscles
• Inefficient walking patterns

…all added up to too much stress on the plantar fascia.

Pedorthics helped by providing custom foot orthotics to decrease the mechanical imbalances in the feet and reduce the load on the tissue. Physiotherapy helped by managing pain, promoting healing, improving joint mobility, and rebuilding strength. Together, the treatments from the two professions worked much better than either one alone.