Footnotes / Blog
Wow! I can’t believe i haven’t talked about heel pain yet…so lets get into it.
Heel Spurs, Heel Pain, and Plantar Fasciitis are all terms that are thrown around that generally indicate the same pathology. Heel pain is caused by inflammation of the plantar fascia at its insertion to the plantar aspect of the calcaneus, hence the term “Plantar Fasciitis”
Plantar fasciitis is probably the most common cause of heel pain in adults. The plantar fascia is a thick band of fibrous connective tissue that attaches to the heel bone, runs across the bottom of the foot and then fans out to connect at the base of each toe. It provides support for the arch of the foot, helps to lift the arch during normal walking, and also acts as a shock absorber during walking and running.
During normal walking the plantar fascia lengthens and then shortens as the foot lands. If the plantar fascia is insufficiently elastic, repetitive lengthening and shortening can result in damage to the fibers, causing small tears. The pulling and shortening of this band also causes a piece of bone to pull out of the calcaneus, which becomes to be known as a heel spur.
This is most common in overuse injuries such as prolonged weight-bearing activities, or extended periods of standing. The resultant inflammation and swelling produces the pain of plantar fasciitis. Damage is most common in areas where the stress on the connective tissue is greatest and where the fascia is thinnest, as it curves around the back of the heel. The pain of plantar fasciitis is usually at its worst in the early morning hours. The first change that takes place while we sleep is that we don’t move as much, so the tissue on the bottom of our foot does not stretch. Hence, it loses some elasticity during the night and is painfully stiff in the morning.
Treatment may include placement of a heel pad or insole (to relieve pressure from the painful area), ice, rest, NSAIDS (non-steroidal anti-inflammatory drugs), special foot strappings, and changes to your shoe type. In some cases cortisone injections, or a referral to physical therapy for treatment may be needed. In difficult case’s Platelet Rich Plasma (PRP), Radiofrequency Ablation, or Endoscopic Plantar Fascia Release may need to be performed.
Exercises may be the most important treatment modality, as they are not only effective for the relief of active plantar fasciitis, but also help to minimize recurrence of this painful condition.