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 orthotic. However the correct orthotic 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.
