Heel & Arch Pain (Plantar Faciitis)
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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 worst 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 the worst, 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. This is because the spur does not
project toward the sole and does not bear weight. It is simply growing in
response to the pull of the tendon. 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, ice
the painful area for 15 minutes twice per day. In addition, oral
anti-inflammatories are 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 is advised. So is the use of a
night splint.
This device prevents the fascia from healing in a
contracted position at night greatly reducing the morning pain. 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
can be a frustrating injury because healing can take many weeks, particularly
in long standing cases- so be patient. For athletes, cross-training is advised
during healing, as well as a gradual return to full activity.
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