Heel & Arch Pain

Heel & Arch Pain (Plantar Faciitis)

The plantar fascia is thick band of connective tissue that runs from the heel bone into the tendons of the toes. It helps to support the arch and aid in propulsion. Inflammation of this tissue is referred to as plantar fasciitis. The symptoms of plantar fasciitis are pain in the heel and arch with standing or walking. It is usually worse when first getting up from bed or after being off your feet for an extended period. For many, the first few steps in the morning are excruciating, then it "loosens up" and feels better.

The underlying cause of plantar fasciitis is excess strain on the arch and fascia. This strain causes the fascia to stretch, tear and pull away from its attachment on the heel bone. Inflammation occurs at this site and creates pain. If this process continues for an extended period of time a bone spur may even develop at the fascia attachment. However, the spur itself is usually not the source of the pain. It is simply growing in response to the pull of the fascia. The pain that occurs at the heel is due to the pull of the fascia and inflammation on the periosteum, which is the tissue that covers bone.

Individuals at risk for his condition are those who are over-weight, those who put excess strain on the arch such as from heavy lifting or with athletes, training errors - especially "too much too soon". It is a common running injury because when running, 3 to 4 times ones body weight goes through their legs with each stride. Even in spite of training properly, some will get this condition. In this case abnormal pronation which leads to arch collapse may be the cause.

To treat this condition, one needs to treat the both the inflammation and the underlying mechanics. To address the inflammation, icing, rest and oral anti-inflammatories can be helpful. The mechanical factors can be broken down into several areas: shoe gear, biomechanics, and for athletes, training. Shoes with collapsed heel counters, which allow the heels to roll in, are harmful, as are shoes with broken-down midsoles or heels which are unstable. Shoes with a cushion crepe midsole are preferable over hard-soled shoes because they provide shock absorption. This is especially important for individuals who do much standing, walking or running on hard surfaces. The mechanical factors can be over-training, too much too soon, excessive body weight and abnormal pronation with arch collapse. If the pronation is mild the condition can often be controlled with over-the-counter arch supports and taping. In more severe cases it may be necessary to fabricate a custom orthotic. An additional aggravating factor can be tightness in the Achilles tendon. If this is present, stretching can help. 

The key element in successful treatment is wearing supportive shoes throughout the healing process and never going barefoot when you are on your feet. It may sound excessive, but even keeping your shoes at the bedside is advised. This condition can be a frustrating injury because healing can take many weeks, particularly in long standing cases.  For athletes, non impact cross-training is advised during healing, as well as a gradual return to full activity.