The plantar fascia is a thick, ligamentous connective tissue that runs from the heel bone to the ball of the foot. This strong and tight tissue helps maintain the arch of the foot. It is also one of the major transmitters of weight across the foot as you walk or run. Thus, tremendous stress is placed on the plantar fascia, often leading to plantar fasciitis- a stabbing or burning pain in the heel or arch of the foot. Plantar fasciitis is particularly common in runners. People who are overweight, women who are pregnant and those who wear shoes with inadequate support are also at a higher risk. Prolonged plantar fasciitis frequently leads to heel spurs, a hook of bone that can form on the heel bone. The heel spur itself is not thought to be the primary cause of pain, rather inflammation and irritation of the plantar fascia is thought to be the primary problem.
The plantar fascia spans the long arch of the foot from the heel to the base of the toes, where it blends with the soft tissues, then anchoring to the base of the toes. Plantar Fascia. The plantar fascia is a common cause of heel pain. As the bony attachment at the heel is considered the plantar fascia?s ?weak spot?, the patient will present with pain at the heel, mainly on the inside. The most common predisposing factor to this condition is the pronating (flattening feet) - 52% - whilst there is also some evidence that a very high arch, in a rigid foot (pes cavus), also was reasonably common - 42%.
Plantar fasciitis is a condition of irritation to the plantar fascia, the thick ligament on the bottom of your foot. It classically causes pain and stiffness on the bottom of your heel and feels worse in the morning with the first steps out of bed and also in the beginning of an activity after a period of rest. For instance, after driving a car, people feel pain when they first get out, or runners will feel discomfort for the first few minutes of their run. This occurs because the plantar fascia is not well supplied by blood, which makes this condition slow in healing, and a certain amount of activity is needed to get the area to warm up. Plantar fasciitis can occur for various reasons: use of improper, non-supportive shoes; over-training in sports; lack of flexibility; weight gain; prolonged standing; and, interestingly, prolonged bed rest.
The diagnosis of heel pain and heel spurs is made by a through history of the course of the condition and by physical exam. Weight bearing x-rays are useful in determining if a heel spur is present and to rule out rare causes of heel pain such as a stress fracture of the heel bone, the presence of bone tumors or evidence of soft tissue damage caused by certain connective tissue disorders.
Non Surgical Treatment
If pain and other symptoms of inflammation-redness, swelling, heat-persist, you should limit normal daily activities and contact our office, or another doctor of podiatric medicine. Your foot would be examined, and an X-ray may be taken to rule out problems of the bone. Early treatment might involve oral or injectable anti-inflammatory medication, taping, padding, massage, stretching, exercise, shoe recommendations, physiotherapy, over-the-counter shoe inserts or, if the condition is chronic and there is a biomechanical basis to the complaint, orthoses (or orthotic devices) may be used to permanently take strain off the fascia. Only rarely is surgery required for heel pain. If necessary, however, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa, or removal of a neuroma or other soft-tissue growth.
When a diagnosis of plantar fasciitis is made early, most patients respond to conservative treatment and don?t require surgical intervention. Often, when there is a secondary diagnosis contributing to your pain, such as an entrapped nerve, and you are non-responsive to conservative care, surgery may be considered. Dr. Talarico will discuss all options and which approach would be the most beneficial for your condition.
Why do I have pain in my heel?
It is not always possible to prevent heel pain, but there are measures you can take to help avoid further episodes. Being overweight can place excess pressure and strain on your feet, particularly on your heels. This increases the risk of damaging your feet and heels. If you are overweight, losing weight and maintaining a healthy weight by combining regular exercise with a healthy, balanced diet can be beneficial for your feet. You can calculate your body mass index (BMI) to find out whether you are a healthy weight for your height and build. To work out your BMI, divide your weight in kilograms by your height in metres squared. A BMI of less than 18.5 means that you are underweight, 18.5-24.9 means that your weight is healthy, 25-29 means that you are overweight, 30-40 means that you are obese, over 40 means that you are morbidly obese. You can also use the BMI healthy weight calculator to work out your BMI.