DESCRIPTION

The most common cause of heel pain is plantar fasciitis. Plantar fasciitis (pronounced PLAN-tar fashee-EYE-tiss) is an inflammation of the plantar fascia ("plantar" means the bottom of the foot, "fascia" is a type of connective tissue, and "itis" means "inflammation"). The plantar fascia is the thick ligamentous band in the bottom of the foot which is attached to the heel, and runs forward to insert into the ball of the foot. The plantar fascia encapsulates muscles in the bottom of the foot, but it's main function is to support the arch of the foot by acting as a bowstring that connects the ball of the foot to the heel. This "support" enables us to propel ourselves forward more effectively. The plantar fascia endures tension that is approximately 2 times body weight during walking at the moment when the heel of the trailing leg begins to lift off the ground. This moment of maximum tension is increased and "sharpened" (it increases suddenly) if there is lack of flexibility in the calf muscles. Plantar fasciitis pain is usually located in the center or the inner side of the bottom of the heel. The pain is most intense when first standing, after any period of rest. Most people with this problem experience their greatest pain in the morning, with the first few steps after sleeping. After several minutes of walking, the pain becomes less intense and may disappear completely, only to return later with prolonged walking or standing. The heel may hurt or the condition may become worse from the heel striking the ground, but plantar fasciitis is not caused by the heel striking the ground. Plantar fasciitis is often referred to as heel spur syndrome and may very well involve a "so called" heel spur that is not the actual cause of the pain, just a sign that the plantar fascia has been under increased stress for a long time. Heel spurs are deposits of calcium in the plantar fascia near its attachment to the heel that result from repetitive stresses and inflammation in the plantar fascia. Heel spurs are the body's response to injury and inflammation. Since they begin as deposits in tissue ("calcification"), they are a bendable mixture of calcium deposits in tissue. They are not necessarily spike-shaped, but flat or shelf-like. They appear like spikes because x-rays are taken from the side looking down along the edge of the shelf. Pain rarely results from heel spurs poking into tissue. Many people have heel spurs and they do not have any pain. The condition is usually caused by a change or increase in activities, foot biomechanical defects such as over-pronation or under-pronation, non supportive footwear, lack of flexibility in the calf muscles, being overweight, a sudden injury, spending too much time on the feet, or muscle weakness. The cause occasionally is unknown and mysterious.

TREATMENT

Despite the claims of various product manufacturers, there is no cure-all. Different combinations of treatments help different people. Patients often learn they need to be an active force in their treatment. Experimenting with several different treatments is often necessary before finding those that help. Treatment must usually be directed towards realigning the foot as it goes through the gait cycle, and reversing the abnormal effects of pronation and supination on the plantar fascia and heel. This is accomplished by use of custom molded foot orthotics. Stay in good supportive shoes, preferably "motion control" or "stability"shoes with extra heel cushioning. Use of anti-inflammatory medications, physical therapy, and cortisone injections are common treatments. Stretching the calf muscles several times a day is very important. Use of a night splint may also be beneficial. Before stepping down after sleeping or resting, stretch the arch of the foot by pulling up on the ball of the foot and toes, as far as you comfortably can, and holding the foot in this postion for ten seconds. Repeat at least five times. You should feel a pull on the bottom of the foot, especially in the arch. This stretches the plantar fascia, and prepares it for weightbearing. Decrease your standing and walking as much as possible. If the pain becomes intense, applying ice will reduce it. Place the ice directly on the heel and arch for at least 15 minutes (you can keep the ice in place by wrapping the ice against your foot with an elastic bandage). Casting of the involved foot is often helpful simply by making the individual become less active and immobilizing the inflamed tissues. Elevating the heel will reduce the tension on the calf muscle and thus reduce the pull of the plantar fascia. Women can accomplish this by wearing a shoe with a 2-inch heel; or by placing heel pads in the shoe. Losing weight may be an issue for many people with plantar fasciitis. A relatively new procedure called ESWT may be used but is quite expensive if all else fails. Surgery may be a last resort if all other conservative measures are exhausted.