Plantar Fasciitis - Heel Pain

One of the most painful problems in the foot is heel pain. The term Plantar fasciitis describes a condition in which the plantar fascia, a ligament-like band that runs from the heel to the ball of the foot, becomes damaged, inflamed and painful. This condition is commonly caused by abnormal stress along the plantar fascia at its attachment to the heel bone (calcaneus), usually from excessive pronation of the foot. This movement of the foot will then elongate the foot and strain the plantar fascia even more. Feet that roll in at the ankle will cause a pull along the plantar fascia, usually at the heel. Repeated pulling will damage the fibres of the fascia and lead to the pain of ‘plantar fasciitis’. Plantar fasciitis can afflict one or both feet.

Symptoms

Plantar fasciitis often leads to point tenderness on the inside portion of the heel where the heel and arch meet. This painful tenderness is usually greatest in the morning when you first place your heel on the ground and are struck by a sharp pain. You may also experience pain when you get up after periods of rest. This is because your ligaments will have cooled down during rest, and cool ligaments do not stretch well.

Treatment

The podiatrist will assess your foot and identify the cause of the plantar fascial pain. As plantar fasciitis is predominantly caused by over pronation of the feet, a treatment plan to control this motion will be implemented. If left untreated, plantar fasciitis can become a chronic and debilitating ailment that may eventually require cortisone injections or surgery.

Who Gets Plantar Fasciitis

The greatest incidence of this type of heel pain is with middle-aged women. It is also seen in those who take part in regular sporting activities, who are significantly overweight and who are on their feet a great deal. Heel pain can also occur in children, usually between 8 and 13 years, as they become increasingly active in sporting activities.

The Causes of heel pain

Whilst heel pain has many causes, it is usually the result of faulty biomechanics (abnormalities in the way we walk). This can place too much stress on the heel bone and the soft tissues that are attached to it. The stress may also result from injury, or a bruise incurred whilst walking, running or jumping on hard surfaces; wearing poorly made shoes; or being significantly overweight. Changed employment conditions or participation in a new sport are often causes of heel pain. Systemic diseases such as arthritis and diabetes can also contribute to heel pain.

HEEL SPURS

Another common cause of heel pain is the heel spur, a bony growth under the heel bone. Whilst there are no visible features to be seen of the heel, a deep painful spot can be found in or around the middle of the sole of the heel (see diagram). It has been estimated that up to 10 per cent of the population may have heel spurs without feeling any pain. Heel spurs result from strain along the soft tissue structures within the long arch of the foot. This may result from biomechanical imbalance within the foot, a condition common that afflicts many people.

Other Causes of Heel Pain

Excessive rolling in of the feet when walking.
An inflamed bursa (bursitis) - a small, irritated sack of fluid at the back of the heel.
A neuroma (a nerve growth)
Other soft-tissue growths.
Heel bumps or ‘pump bumps’ - a bony enlargement at the back of the heel bone.
Bruises or stress fractures of the heel bone.

Overcoming the Problem

If pain and other symptoms of inflammation including redness and swelling - persist, you should limit normal daily activities and consult a podiatrist. Your podiatrist may initiate a series of radiological examinations to look for heel spurs or fractures. Many times people have found that if you wear shoes that have a comfortable heel height – say 4 cms – for the first few steps after periods of rest, that their heel and arch pain is less whilst the foot warms up.

Treatment

Early treatment might involve exercise and shoe recommendations, taping or strapping and anti-inflammatory medication Taping or strapping supports the foot, holds stressed muscles in a restful state and limits the stretching of the plantar fascia.

Other physical therapies may also be used, including ice packs and ultra-sound as well as massage. Orthotic therapy to limit the hyper pronation and thus the elongation of the feet is also recommended.

Outcome

These treatments will effectively treat the majority of heel and arch pain without the need for surgery with only a relatively few cases of heel pain ultimately requiring surgery. The goal of surgery is usually for the removal of a spur. Surgery also may involve the release of the plantar fascia, removal of a bursa, or the removal of a neuroma or other soft-tissue growth.