When ever a patient comes
into the office complaining of
heel pain my first question is,
"Is the pain worse with the
first few steps in the morning
and when you first get up and
walk after sitting a while?"
These are the classic symptoms
for a condition known as plantar
fasciitis ("itis" refers to
inflammation, appendicitis is
inflammation of the appendix,
fasciitis is inflammation of the
fascia).
The plantar fascia is a
fibrous band of tissue that
connects the heel to the base of
all five toes. The plantar
fascia acts like a spring and is
responsible for maintaining your
arch. As you take a step, the
plantar fascia permits the arch
to
pronate
and flatten out a
bit to allow the foot to adapt
to what ever terrain it happens
to be walking. At the end of the
step the plantar fascia helps
the foot to
supinate
and become rigid
again so that a forceful
push-off can be achieved.
The plantar fasca becomes
inflamed if the foot pronates or
rolls over too much and
stretches out the plantar fasca
too much. This causes
inflammation where the plantar
fascia is attached to the heel.
The plantar fasca actually pulls
away from the bone and this is
what causes the pain. One way
that the body protects itself
against this pulling away from
the bone is to build up more
bone in that area. The resulting
build-up of bone is called a
bone spur. A bone spur
in-and-of-itself sounds painful
but usually it is not what is
causing the pain. The pain is
caused by the tearing away of
the fascia from the bone.
The body is a rapid healer.
When you go to bed or even if
you just sit down for a while
the bone starts to heal in this
area. However when you get up
and start walking again ...ouch!
You just tore away the newly
repaired bone.
Most heel pain is caused by a
biomechanical problem and can be
corrected with an arch support.
However the correct arch support
requires the correct diagnosis.
The plantar fasciitis can be
caused by an arch that is either
too flat, an arch that is too
high or a tight Achilles tendon.
The over the counter cushioning
devices are helpful to reduce
the pain and may help calm
things down a bit and allow the
healing to start but in order to
prevent it from returning you
have to correct the problem and
this requires the correct
diagnosis. Custom arch supports
will match the contour of your
foot that will limit the
pronation, reduce foot pain and
allow the heel to heal.
