Plantar Fasciitis is often referred to as heel pain and it is a common foot condition. It usually starts as a dull intermittent pain under the heel and it may progress to a sharp pain. Usually heel pain is much worse in the morning with the first few steps, or after sitting for a period of time and then standing up. The pain normally dissappears when you start walking but comes back after a period of rest. If left untreated Plantar Fasciitis may develop into a to severe and persistent pain that can stop people from normal activities such as walking, running or sports. The plantar fascia is a broad band of fibrous tissue which runs along the bottom surface of the foot from the heel bone to the toes. It is attached to the heel bone (calcaneus) and fans forward toward the ball of the foot. Plantar Fasciitis is caused by inflammation of the tissues and ligament connected to the heel bone, due to excessive pulling and stretching of the fibrous bands that support the arch of the foot. Continuation of this irritation can lead to heel pain and also arch pain. In some patients a bony growth on the bottom of the heel bone called a heel spur. Not all heel pain is plantar fasciitis, heel pain syndrome is caused by repetitive pressure placed on the heel of the foot when walking, which causes soreness of the heel. The itis part of Fasciitis is Latin for inflammation of a certain part of the body. For example, Bursitis refers to the inflammation of the Bursa - the natural cushion padding that supports the heel of the foot (the bursa). Bursitis is often associated with Plantar Fasciitis, which affects the arch and heel of the foot. Local steroid injections are effective, but can be quite painful and increase the risk of plantar fascia rupture. Surgical management is a last resort and should only be considered after 12 months of failed conservative treatment. Surgery consists of plantar fascia release, plantar nerve release and debridement of the calcaneal spur. Sore heels can also be attributed to achilles tendonitis with symptoms localised at the back of the heel.
Heel Spur Syndrome
Bursitis and Plantar Fasciitis can occur when a person increases their levels of physical activity or when the heels fat pad becomes thinner as a result of age. This means less protection for the heel and foot and more chance of injury. Poor fitting shoes, obesity, biomechanical problems such as mal-alignment of the foot, including over-pronation, gout and rheumatoid arthritis are also possible causes for plantar fasciitis problems.Treatment options include: Cold presses or ice packs, Anti-inflammatory drugs, gel heel cushioning, massage of the foot, muscle strengthening and also stretching exercises. Orthotics insoles are the most effective treatment for this type of foot condition because they address the underlying biomechanical cause. I.e. orthotics reduce the strain and tension on the injured ligament, allowing the tissue to heal much faster. It should be noted that orthotics are not the same as arch supports. Orthotics address biomechanical function of the foot, while arch supports simply support the arch. Appropriate footwear is a key consideration for the prevention of plantar fasciitis. Heel pain or plantar fasciitis is one of the most common foot complaints seen in an Orthopaedic unit. Plantar fasciitis was first described thirty years ago, but we are no closer in understanding the true medical aetiology of this condition. Theories have been proposed ranging from inflammation to nerve entrapment. Plantar fasciitis typically can occurs in people from all ages from teenagers to the elderly. The patient usually experiences uni-lateral heel pain (specifically on the anterior medial border of the calcaneal tuberosity) with their first step in the morning, this pain eases after a few steps but re-occurs by the end of the day. Calcaneal spurs have been previously associated with plantar fasciitis.