Heel Pain, Heel Spur, Plantar Fasciitis and Arch Pain

The most common cause of heel or arch pain is actually caused by a painful stretching or micro-tearing of the plantar fascia. The plantar fascia is a fibrous or tendon-like structure that courses along the bottom of the foot connecting the toes and calcaneus or heel bone. During normal conditions, the fascia is flexible and strong. However due to factors such as abnormal stress, excessive weight, age, or improper foot support, the fascia can become weakened, irritated or inflamed. If the foot flattens excessively or becomes unstable at critical times during the gait cycle, the attachment of the plantar fascia onto the calcaneus may begin to stretch and pull away from the calcaneus. This painful condition is called plantar fasciitis. In addition to plantar fasciitis, after many years, a heel spur may develop on the bottom of the calcaneus.

  • Heel spurs are visible on a lateral view x-ray of the foot. X-rays sometimes reveal very large heel spurs that do not produce pain. It is not the bone, but rather the inflammation of the fascia attaching to the heel which causes discomfort.
  • The heel pain or plantar fasciitis is especially noticeable to the patient during the toe-off phase of gait.
  • The onset is gradual, yet most patients report the pain during the first steps on the floor in the morning, or after extended resting periods during the day.
  • The patient may also report having had either a sudden increase in daily activities, an increase in weight or a recent change in footwear.

Cause

  • The most frequent cause is an abnormal or excessive internal motion of the foot.
  • During resting or non-weight bearing periods, the plantar fascia shortens. When body weight is rapidly applied to the foot, the fascia must stretch and quickly lengthen, causing micro-tears in the fascia.
  • Hypermobility, (excessive internal motion) of the foot can induce future or coexisting problems involving the knee, hip, sacroiliac joint or the low back region.

Treatment

  • Plantar Fasciitis and calcaneal heel spurs, when treated early, are usually controlled with conservative or non-surgical treatment.
  • Although the development of plantar fasciitis or takes a long time, we only tend to pay attention to it when the pain has become significant. In general, the longer the pain has been present, the longer it takes to resolve.
  • Although soft heel materials appear to cushion the heel, they do not address the problem of foot support, which initially caused the problem. Therefore, with soft heel cushions, the painful heel tends to return.
  • An orthotic should be used to stabilize the foot.
  • The role of the orthotic in these conditions is to prevent excess pronation and rapid excessive lengthening of the plantar fascia. The orthotic control limits the micro-tearing of the plantar fascia, thereby decreasing the pain.
  • In addition to the use of foot orthotics, steroid (cortisone) injections, changing shoes, foot taping, and mild stretching exercises are also helpful. Significant weight reduction also helps, but often being overweight is caused by inactivity due to foot pain!
  • The use of an extracorporeal shock wave (E.S.W.), has recently shown to be effective for the treatment of chronic plantar fasciitis. The strong electrohydraulic acoustic (sound) energy provides a non-surgical method of treatment. The Ossatron (www.healthtronics.com) has been effectively utilized.
  • In some cases, if conservative care is not effective, heel spur surgery may be necessary.

Orthotic Treatment Is Effective for the Following Problems:

Plantar Fasciitis: pain directly beneath or in front of the heel; chronic inflammation of the fascia as a result of excessive pronation.

Achilles Tendonitis: inflammation of the sheath surrounding the Achilles tendon; pain behind the heel, ankle and lower calf Counter-rotation of the tibia against the femur as a result of excessive pronation causes two heads of the tendon to torque against each other and stretch the tendon.

Chondromalacia Patellae: a degeneration of the cartilage covering the underside of the patella; knee pain and medial soreness result. Excessive pronation counter-rotates the tibia against the femur creating undue stress that prevents the patellar from tracking properly. The femoral condyles irritate and damage the retro surface of the patella.

Shin Splints: inflammation of the tendons and muscles in the front or on the medial side of the lower leg. Excessive pronation and overuse syndrome creates pulling of the Tibialis anterior or posterior muscles and damages these muscles at their tendinous insertion on the tibia.

Hallux Valgus (Bunions): a (sometimes painful) bump at the medial base of the great toe. Excessive pronation and hypermobility of first metatarsal ray causes toe-off to come off the medial (inside) side instead of the plantar surface of the great toe. This force stretches and distorts the joint.

Neuroma: inter-metatarsal forefoot pain located at the ball of the foot and/or toe numbness. Generally located between the 3rd and 4th metatarsal bones (third inner space). Caused by pressure on the cross-over lateral-medial plantar nerve, and associated with a number of flexible foot types.

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All information on this site © 2011 Joshua Kaye, DPM.