The plantar fascia is a broad fan shaped strap of strong body tissue which stretches from the bottom of the heel bone to the ball of the foot. It helps to hold the foot bones and joints in place.
When it is over stressed (over stretched) typical symptoms occur. The heels hurt most of all first thing in the morning or after a period of rest. The Heel Pain
is also very sore after standing for a long time.
To understand the cause of the pain one must understand the anatomy of the foot and some basic mechanics in the function of the foot. A thick ligament, called the plantar fascia, is attached into the
bottom of the heel and fans out into the ball of the foot, attaching into the base of the toes. The plantar fascia is made of dense, fibrous connective tissue that will stretch very little. It acts
something like a shock absorber. As the foot impacts the ground with each step, it flattens out lengthening the foot. This action pulls on the plantar fascia, which stretches slightly. When the heel
comes off the ground the tension on the ligament is released. Anything that causes the foot to flatten excessively will cause the plantar fascia to stretch greater that it is accustom to doing. One
consequence of this is the development of small tears where the ligament attaches into the heel bone. When these small tears occur, a very small amount of bleeding occurs and the tension of the
plantar fascia on the heel bone produces a spur on the bottom of the heel to form. Pain experienced in the bottom of the heel is not produced by the presence of the spur. The pain is due to excessive
tension of the plantar fascia as it tears from its attachment into the heel bone. Heel spur formation is secondary to the excessive pull of the plantar fascia where it attaches to the heel bone. Many
people have heel spurs at the attachment of the plantar fascia with out having any symptoms or pain. There are some less common causes of heel pain but they are relatively uncommon. There are several
factors that cause the foot to flatten and excessively stretching the plantar fascia. The primary factor is the structure of a joint complex below the ankle joint, called the subtalar joint. The
movement of this joint complex causes the arch of the foot to flatten and to heighten. Flattening of the arch of the foot is termed pronation and heightening of the arch is called supination. If
there is excessive pronation of the foot during walking and standing, the plantar fascia is strained. Over time, this will cause a weakening of the ligament where it attaches into the heel bone,
causing pain. When a person is at rest and off of their feet, the plantar fascia attempts to mend itself. Then, with the first few steps the fascia re-tears causing pain. Generally, after the first
few steps the pain diminishes. This is why the heel pain tends to be worse the first few steps in the morning or after rest. Another factor that contributes to the flattening of the arch of the foot
is tightness of the calf muscles. The calf muscle attaches into the foot by the achilles tendon into the back of the heel. When the calf muscle is tight it limits the movement of the ankle joint.
When ankle joint motion is limited by the tightness of the calf muscle it forces the subtalar joint to pronate excessively. Excessive subtalar joint pronation can cause several different problems to
occur in the foot. In this instance, it results in excessive tension of the plantar fascia. Tightness of the calf muscles can be a result of several different factors. Exercise, such as walking or
jogging will cause the calf muscle to tighten. Inactivity or prolonged rest will also cause the calf muscle to tighten. Women who wear high heels and men who wear western style cowboy boots will,
over time, develop tightness in the calf muscles.
Usually when a patient comes in they?ll explain that they have severe pain in the heel. It?s usually worse during the first step in the morning when they get out of bed. Many people say if they walk
for a period of time, it gets a little bit better. But if they sit down and get back up, the pain will come back and it?s one of those intermittent come and go types of pain. Heel pain patients will
say it feels like a toothache in the heel area or even into the arch area. A lot of times it will get better with rest and then it will just come right back. So it?s one of those nuisance type things
that just never goes away. The following are common signs of heel pain and plantar fasciitis. Pain that is worse first thing in the morning. Pain that develops after heavy activity or exercise. Pain
that occurs when standing up after sitting for a long period of time. Severe, toothache type of pain in the bottom of the heel.
Depending on the condition, the cause of heel pain is diagnosed using a number of tests, including medical history, physical examination, including examination of joints and muscles of the foot and
Non Surgical Treatment
Curing posterior heel pain requires calming the inflammation, resting the foot and increasing calf flexibility. Ice therapy and anti-inflammatory medications can be used to reduce the inflammation.
Stopping exercises that stress the calf and Achilles is important. This includes walking, running and the use of stair climbers and elliptical machines. Placing a heel lift in each shoe can reduce
some of the excess strain on the back of the heel. Stretching exercises to increase calf flexibility are important in curing this problem and preventing its recurrence. Wearing running shoes also
provides good foot support and helps with this condition. Sometimes a walking boot is used to immobilize the ankle and let the area completely rest. Physical therapy is sometimes ordered to help
reduce the inflammation and pain and to help improve the flexibility of the calf muscles. Occasionally these measures fail to relieve the pain and surgery may be needed. The surgical procedure
involves removing bone spurs and repairing any damage to the tendon.
Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue
to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you. No matter what
kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive
shoes, stretching, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.
Make sure you wear appropriate supportive shoes. Don't over-train in sports. Make sure you warm up, cool down and undertake an exercise regime that helps maintain flexibility. Manage your weight,
obesity is a factor in causing plantar fasciitis. Avoid walking and running on hard surfaces if you are prone to pain. You should follow the recognized management protocol "RICED" rest, ice,
compression, elevation and diagnosis. Rest, keep off the injured ankle as much as possible. Ice, applied for 20 minutes at a time every hour as long as swelling persists. Compression, support the
ankle and foot with a firmly (not tightly) wrapped elastic bandage. Elevation, keep foot above heart level to minimize bruising and swelling. Diagnosis. Consult a medical professional (such as a
Podiatrist or doctor) especially if you are worried about the injury, or if the pain or swelling gets worse. If the pain or swelling has not gone down significantly within 48 hours, also seek
treatment. An accurate diagnosis is essential for proper rehabilitation of moderate to severe injuries.