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Plantar Fasciitis

The two most common causes of pain in the bottom of the heel, the arch, or both the heel and the arch, are plantar fasciitis and heel spurs.

Plantar fasciitis is an inflammation of the plantar fascia. The plantar fascia is a thick ligamentous/fibrous band on the bottom of the foot that is attached to the heel, and runs forward to insert into the ball of the foot. Plantar fasciitis is a painful inflammation of this band, which usually occurs at its attachment to the heel; however, the inflammation and pain of plantar fasciitis can occur anywhere on the plantar fascia.

A Heel Spur is a piece of calcium or bone that sticks out from the bottom of the heel bone, and lies within the fibers of the plantar fascia. When walking, the spur digs into the plantar fascia and causes small micro-tears in the plantar fascia. This produces inflammation and pain in the heel, which at times may radiate into the arch.

The chief diagnostic sign of these problems is pain in the bottom of the heel or arch when first standing, which gradually improves with walking. This pain may later return with continued walking. The pain usually subsides after a period of rest.

The treatment involves correcting the underlying causative problems. Please read the following sections for more information on the problem and its treatment.

Plantar fasciitis and heel spur pain usually begins in the bottom of the heel, and frequently radiates into the arch. At times, however, the pain may be felt only in the arch. The pain is most intense when first standing, after any period of rest. Most people with this problem experience their greatest pain in the morning, with the first few steps after sleeping. After several minutes of walking, the pain usually becomes less intense and may disappear completely, only to return later with prolonged walking or standing. If a nerve is irritated due to the swollen plantar fascia, this pain may radiate into the ankle.

In the early stages of Plantar Fasciitis and Heel Spurs, the pain will usually subside quickly with getting off of the foot and resting. As the disease progresses, it may take longer periods of time for the pain to subside.

Each time we take a step forward, all of our body weight first rests on the heel of one foot. As our weight moves forward, the entire foot begins to bear the body's weight, and the foot flattens and this places a great deal of pressure and strain on the plantar fascia. There is very little "give" to the plantar fascia, so as it stretches only slightly, it pulls on its attachment to the heel. If the foot is properly aligned this pull causes no problems. However, if the foot is "pronated" (the foot rolls outward at the ankle, causing a break down of the inner side of the shoe), the arch falls excessively, and this causes an abnormal stretching of the relatively inflexible plantar fascia, which in turn pulls abnormally hard on the heel.

The same pathology occurs with "supination" (the rolling inward of the foot, causing a break down of the outer side of the shoe). Supinated feet are relatively inflexible, usually have a high arch, and a short or tight plantar fascia. Thus as weight is transferred from the heel to the remainder of the foot, the tight plantar fascia hardly stretches at all, and pulls with great force on its attachment to the heel.

In both cases, the abnormal stress placed on the attachment of the plantar fascia to the heel usually causes pain, inflammation, and possibly swelling. If this process continues, the plantar fascia partially tears away from the heel. The body will fill in this torn area with calcium; eventually it becomes bone, and a heel spur results.

Predisposing Factors: Those factors which increase your chances of developing Plantar Fasciitis and Heel Spurs are:

• History of previous episodes of Plantar Fasciitis or Heel Spur symptoms.
• Presence of Hereditary Biomechanical Foot Defects (those foot abnormalities that one is born with):

Pronation and Supination which were discussed above. Flat Feet (Arches) pull excessively on the Plantar Fascia. As the arch drops, the Plantar Fascia does not become longer, so there is a greater pull on it. This may eventually cause inflammation and pain in the heel or arch.
High Arches usually occur in feet that have a shortened Plantar Fascia. It is the shortened Plantar Fascia that actually helps to produce an abnormally high arch. When the Plantar Fascia is shorter than normal, there is an excessive pull on it that may eventually cause heel and arch inflammation and pain.
Short Leg Syndrome that is left untreated. This disease will increase the forces placed on the Plantar Fascia with each step that is taken. The foot on the longer leg carries the bodyıs entire weight longer than is normal (it takes longer for the short legıs foot to reach the ground). This increases the amount of weight the Plantar Fascia must bear, which increases the stresses on this structure. Because the foot on the short leg needs to fall further to reach the ground, it is continually "slammed" on to the ground. This will increase the force and weight on the Plantar Fascia of that foot. This may cause Plantar Fasciitis and Heel Spurs to form and be painful.

• Lifestyle Patterns that frequently lead to the occurrence of Plantar Fasciitis and Heel Spurs:
A Lifestyle that requires you to be on your feet for excessively long periods of time. Whether your job requires this or you enjoy weight-bearing leisure activities, the longer you are on your feet, the more common it is for Plantar Fasciitis and Heel Spurs to occur.
Frequent barefoot walking stresses the Plantar Fascia. Shoes with a supportive arch, well protected heel, and good sole provide some shock absorption for the Plantar Fascia. Without this shock absorption, Plantar Fasciitis and Heel Spurs may occur.

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