The Travelling Pod | Plantar Fasciitis in focus

Most migrants who pass through the Vias in Irapuato Mexico come from Venezuela in South America.

Their journey has been very tough and dangerous through all different terrains like the Darien Gap jungle (in the Colombia and Panama jungle). The migrants have done significant amounts of walking for long durations throughout uncustomed terrains and commonly completed with inappropriate footwear like ‘Croc style’ shoes.

I met one of many people who presented with inflammation in her planter fasciitis (PF) and tibialis posterior (TP) progressing in two weeks. This young Venezuelan woman felt pain at her medial heel and under her medial longitudinal arch when she was weight-bearing, mostly when walking.

I have found commonly in the Latin American culture that people can have high amounts of mobility in their midfoot and rearfoot, and this woman was no exception.

Clinical presentation

The weight-bearing tests I did were double and single heel raises, one leg squat, and watching her gait using my phone. She was able to do the heel raises without pain, which told me that her TP was functioning strong, but during palpation she felt pain. Therefore, her TP had a mild form of inflammation but did not affect her functionally.

The one-leg squat allowed me to see her hip, knee, and foot position during stance and movement. Her gluteal muscles were strong by maintaining her pelvis aligned, her knee was aligned/ flexing linearly until she bent her knee past 45 degrees, and then her knee medially adducted. Most likely her quadriceps muscles, especially the vastus medialis, were weak and needed a long-term exercise routine to influence her knee alignment during knee flexion. Her foot demonstrated the forces shifting medially with her midfoot pronating excessively. Lastly, during gait, I could see the same evidence of medial forces influencing her motion of pronation in her feet.

Treatment options

I am limited with my treatments but I was able to provide her with more suitable shoes that were kindly donated by local Mexicans. The shoe was more durable at the heel counter and through the midfoot to provide stability. Also, I gave her a semi-customised orthotic to offload and redirect the medially shifted forces. The best orthotic I could make was created from recycled materials from thongs/ flip-flops and donated materials.

Flip flops to orthotics

I collect unwanted thongs to cut and grind them into arch supports using a local carpenter’s factory. Then, I cut a 2mm medium firm material (donated) and marked out her bony landmarks; anterior calcaneus, navicular, anterior 1^st metatarsal, and base of 5^th metatarsal or their lateral arch. I find the best-suited shape and density from the pre-cut arch supports depending on her medial arch profile. I use my grinder to reshape the arch supports and lateral support according to her foot markings. I glued a 2mm soft EVA cover, and then, I used a firm material to make a rearfoot varus wedge under the device.

The lady was in a lot of pain and therefore we gave her some anti-inflammatories to use for three days since she was not allergic to them.

I suggested using a firm lemon (cheap to buy) to roll her arch in the mornings. I encouraged her to use her donated shoes with her orthotics to offload her overworking PF and TP.

Results

It is always scary watching a patient use their orthotics for the first time, especially because I could not accurately make it according to the dimensions of her feet. Encouragingly, they were comfortable to walk in and did not bother her. How effective and the duration of its support, I will never know because there is no follow-up, the women left on the passing train the next day. I do know that she felt more comfortable using the orthotics than without and her gait normalized compared to her guarded gait influenced by her pain.