Plantar fasciitis is the term commonly used to refer to heel and arch pain traced to an inflammation on the bottom of the foot. More specifically, plantar fasciitis is an inflammation of the connective tissue, called plantar fascia that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. Over-pronation is the most common cause of plantar fasciitis. As the foot rolls inward excessively when walking, it flattens the foot, lengthens the arch, and puts added tension on the plantar fascia. Over time, this causes inflammation.
Many factors attribute to plantar fasciitis including age, abnormal stance, high BMI, tight Achilles tendon, incorrect footwear, excessive activity such as walking and running, excessive pronation (flat feet), limited ankle flexion, trauma due to barefoot walking, and anything that will cause constant tension on the fascia. Any of these factors create a “biomechanical imbalance” of the arch. This imbalance causes stretching and tension of the plantar fascia which can ultimately result in micro-tears. These conditions are usually observed in obese individuals, commonly 40-60 year old women, and others who engage in high impact sports, such as runners due to the overuse and constant pounding on the plantar fascia.
Micro-tears are one proposed cause of plantar fasciitis, most commonly near the fascia and due to repetitive movement and stretching of the plantar fascia such as walking and running. The micro-tears healing create inflammation as with any normal bodily response. Consistent use of the already inflamed plantar fascia results in inadequate and improper healing which leads to the chronic symptoms of pain, stiffness, and tenderness.
Heel Spur Syndrome is used interchangeably with Plantar Fasciitis, with the development of heel spurs arising from the repetitive tensions of the plantar fascia. This is all caused by excessive motion in patients with inflammation of the plantar fascia resulting in an abnormal growth of the calcaneus. Heel spur development arises in similar situations as plantar fasciitis. It is observed in patients with high arches (Pes cavus) and Pes equinus as well as patients with flat feet (Pes Planus). Other predisposing factors for heel spurs include obesity, osteoarthritis, high activity levels, and age. This condition is often successfully treated with conservative measures, such as the use of anti-inflammatory medications, ice packs, stretching exercises, orthotic devices, and physical therapy. Note: Please consult your physician before taking any medications. In persistent cases, Extracorporeal Shock Wave Treatment (ESWT) may be used to treat the heel pain.
After assessing a someones history and physical examination, a specific diagnosis can be made. Other causes of heel pain can come from secondary factors or systemic conditions including nerve entrapment, lumbar spine disorders, tibial nerve problems, neuropathy, tarsal tunnel syndrome, Achilles tendonitis, fat pad atrophy, heel contusion, plantar fascia rupture, posterior tibial tendonitis, retrocalcaneal bursitis, calcaneal epiphysitis (Sever's disease), calcaneal stress fracture, infections, inflammatory arthropathies, subtalar arthritis, osteomalacia, Paget's disease, Sickle cell disease, metabolic diseases, tumors, vascular insufficiencies, and many more. There is not really any imaging study that can be used to diagnose plantar fasciitis, and they normally are only used in order to rule out other diagnoses, that is why a great clinician/podiatrist is the professional for you to see.
If you are experiencing any of these issues or symptoms you can start with wearing a properly fitted type shoe, and icing the area along with stretching. If your heel pain persists, you should seek the opinion of a professional, Dr. Theall. He will be able to provide you with the proper treatment and evaluation of the foot pain you are experiencing. Feel free to come or call Dr. Theall’s office, Gentle Touch Foot Care for a full comprehensive and thorough evaluation to discuss your foot health.