- 14 years old
- Plays rep basketball and football
- No medical conditions
Jack first presented to us with his parents, seeking help for bilateral foot pain beneath his arches, with additional left-sided hip and lower back discomfort. Jack’s pain had been worsening for eight weeks and was now interfering with Jack’s ability to play for his teams without regularly hobbling off the court.
We completed a comprehensive biomechanical examination that assessed Jack’s gait, muscle strength, range of motion, flexibility, and examining his areas of pain. His assessment revealed:
- An apparent limb length difference with the right leg being ~6mm shorter than the left
- Pes planus (very flat) foot type
- Hyper-pronation – with the left foot pronating more than right
- Heel pain – bilateral but worse in the left foot
- Good flexibility – hip, hamstring and ankle
Diagnosis: Three Distinct Findings
We diagnosed Jack with:
- Plantar fasciitis – inflammation of the plantar fascia
- Abductor hallucis tendinopathy – damage to the tendon of the abductor hallucis muscle, which shares its origin with the plantar fascia
- A leg length difference – 6mm shorter right femur, which was confirmed with an EOS standing scan
When left uncorrected, differences in leg lengths can result in a tilted pelvis that can cause a range of problems with the lower back muscles, the hips, the knees and lower limbs too. Many patients with a leg length difference will unknowingly hike up the hip of the longer foot, abduct the foot, or perform other compensations to clear the ground during walking. It is these compensations that can cause muscle strains, imbalances and pain.
Jack’s treatment involved:
- Custom orthotics with different arch height corrections between the left and right, as well as a 3mm heel raise on the right orthotic
- Gluteal, piriformis, hamstring and calf stretching
- Core and gluteal strengthening exercises
- Footwear advice
- Low-dye taping in-clinic to help alleviate Jack’s painful symptoms
At Jack’s two month check, his foot pain had completely gone, though some pain still persisted in his left hip and lower back. We adjusted his orthotic to build the right foot up to a 5mm raise, and this resolved the pain with one more month.
We last checked in with Jack six months ago for a follow-up. He reported that he’s been playing rep basketball and football pain-free and always wears his orthotics when active. He was feeling strong through his hips, glutes and legs and really excelling with his sports performance. Aside from annual orthotic checks, Jack does not require further treatment at this point.