A Bony Growth on the Heel
The plantar fascia is a band of fibrous tissue that is attached to the heel bone (calcaneus). This tissue runs along the bottom of the foot and attaches to the metatarsal bones at the ball of the foot. When subjected to repeated trauma, such as running, or from a sports injury, the plantar fascia can become inflamed at the point it attaches to the heel bone. The resulting inflammation can lead to a condition known as plantar fasciitis. Plantar fasciitis in turn can cause a spura small bony projection on the underside of the heelto form. Plantar fasciitis can cause significant heel pain, making walking and running difficult. Heel spurs typically do not cause pain until the surrounding tissue becomes inflamed, so that an individual may have a spur without knowing it. The treatment for plantar fasciitis includes placing ice on the area to decrease swelling, adding heel inserts to shoes, splinting the area at night, stretching exercises for the calf and heel, use of oral nonsteroidal anti-inflammatory drugs and cortisone injections into the area to relieve pain, and, rarely, surgery to expand the fascia.
Inflammation of fibrous tissue where it connects to the heel bone is the cause of most of the pain that occurs in heel spurs, not the spur itself.
Avoid Excess Trauma to Feet
A band of fibrous tissue (plantar fascia) runs along the bottom of the foot and forms an arch. This band of tissue is connected to the heel bone (calcaneus) on one end and the metatarsal bones located at the ball of the foot. The tissue can become inflamed when it is repeatedly stretched at the point where it is attached to the heel bone, resulting in a condition known as plantar fasciitis. Plantar fasciitis (sometimes called painful heel syndrome) can cause mild pain in the heel area only when weight is placed on it; in its more serious form, it can cause intense, constant throbbing pain. For most sufferers, the pain is most intense upon arising in the morning, or after sitting, standing or walking for long periods. Plantar fasciitis can lead to the formation of a heel spur, a small bony growth.
Typical Causes: Plantar fasciitis can be caused by a variety of factors, including excessive running or running on hills or sandy surfaces. The condition can also occur in people who have flat feet or highly arched feet, or in persons who wear shoes without good arch supports. It was once thought that heel spurs were the cause of pain in plantar fasciitis; actually, the heel spur itself probably does not cause pain. The tissue inflammation is the cause of the heel pain in these patients. In fact, many patients experiencing pain as a symptom may not show a clear image of a heel spur after an x-ray is taken, although the spur may develop later. As the heel spur grows larger, the heel pain may actually improve as the foot adapts to the changes. This is why surgery to remove a heel spur is not routinely performed in many patients.
Diagnosis: The diagnosis of plantar fasciitis is usually made by examination of the heel and determining what sort of pressure is causing the pain. Typically, plantar fasciitis itself does not cause heel swelling or warmth. Other conditions that can induce heel pain, such as rheumatoid arthritis, gout, ankylosing spondylitis, stress fractures, or nerve compression injuries, can be ruled put as causes by examination and x-ray.
Treatment: Most sufferers of heel pain due to calcaneal spur syndrome find relief from avoiding activities that caused the inflammation in the first place, such as switching from running or engaging in other weight-bearing exercises to swimming or hiking. Placing a foam pad, heel cup or orthotic insert in the shoe may be helpful. The use of a nonsteroidal anti-inflammatory drug, available without a prescription, is often recommended for inflammation and pain. Corticosteroid injections can help to control inflammation. Proper stretching of the heel and calf prior to activity, and using an ice pack on the area after the activity, can also help relieve pain. For some patients, wrapping the area to avoid nighttime movement is effective. Relief from pain and healing of inflammation may take several weeks to several months. If none of the treatments is effective, further tests may be done to see if there are other injuries to the heel. As stated, surgery to remove spurs is rarely necessary since the spur is typically not the cause of heel pain, but in some patients, surgery to relieve the tightness of the inflamed plantar fascia at the heel may be performed. After surgery, the foot is kept immobile for several weeks, followed by several weeks of physical therapy to help healing and increase the mobility of the foot.
Inflammation of the Plantar Fascia
Plantar fasciitis is a common cause of heel pain that is more severe in the morning but becomes less painful as the day continues. This condition occurs due to tiny tears in the plantar fascia�the piece of fibrous tissue connecting the heel to the base of the foot. With repeated trauma to the fascia, this tissue cannot heal quickly enough and begins to degenerate. Plantar fasciitis can cause chronic pain if it is not treated. Typical treatment includes rest, anti-inflammatory pain medications, and an exercise program comprising stretching and strengthening the muscles and tendons of the foot and calf. Evaluation of the patient’s shoes may help determine whether improper fitting is leading to this condition. The use of an orthotic during the daytime and foot splints at night may provide relief. If those who suffer from plantar fasciitis do not improve with these treatments, surgery may be a successful option.
A Common Cause of Heel Pain
Plantar fasciitis is the diagnosis in about 15% of all office visits for foot-related pain. Typically, it is not a serious condition and often disappears on its own in six to 18 months; however, simple treatments can lead to improvement in two to three months. In some cases, it can significantly limit a person’s ability to function in routine activities. If left untrearcd, the symptoms usually worsen and can lead to problems with the knee and hip and can cause back pain due to difficulty walking.
The Pattern of Symptoms
The symptoms of plantar fasciitis develop gradually, beginning with a mild pain in the heel bone after exercise, upon rising from bed in the morning, or after resuming activity following a period of rest. After the pain continues for a period of time, patients often begin to walk with a limp. At first the pain lessens after walking, but eventually it worsens as activity levels increase.
The people who are most likely to develop plantar fasciitis are those who frequently stand or walk throughout the day or chose who walk or run for exercise. Although it is not clear exactly what causes this condition, it seems the problem begins with tiny tears in the plantar fascia from repeated trauma. People who are overweight, those with flat feet or high arches, and women ages 40 to 60 are at greater risk for this condition.
The primary treatment is rest. Most people suffering from plantar fasciitis find relief, at least in part, by staying off their feet whenever possible. Some patients find that cold packs applied to the area for 20 minutes several times a day or after activities give some relief. In addition, inflammatory drugs (ibuprofen or naproxen) to help manage the pain. When the condition is first diagnosed, the patient should have a shoe check to determine if improperly fitting shoes are causing or worsening the problem. Patients are often advised not to walk on hard surfaces and not to go barefoot. Shoes should be well cushioned, especially in the midsole area, and should have the appropriate arch supporr for the patient. Some patients will benefit from an orthotic shoe insert, such as a rubber heel pad for cushioning. Most patients are also given a series of stretching and strengthening exercises to help keep the muscles active and flexible and to avoid future bouts of this painful condition.
If the Condition Persists
Patients who do not find relief with these simple treatments within two to three months may be given a local injection of cortisone. Nighttime splints may help keep the fascia properly flexed during sleep, making the first steps in the morning much less painful Some patients benefit from a walking cast for use during the daytime for several weeks. A last resort is to undergo surgery to release the plantar fascia by one of several techniques. This surgery is usually successful in a high percentage of the patients who are unable to find relief from less invasive treatments.