is pain in the heel area that can vary in severity and
location. It is most common in adults. The heel is the first bone to contact the ground when walking and takes the full force of impact and the resulting shock of bearing weight during motion.
Plantar fasciitis can come from a number of underlying causes. Finding the precise reason for the heel pain is sometimes difficult. As you can imagine, when the foot is on the ground a tremendous
amount of force (the full weight of the body) is concentrated on the plantar fascia. This force stretches the plantar fascia as the arch of the foot tries to flatten from the weight of your body.
This is just how the string on a bow is stretched by the force of the bow trying to straighten. This leads to stress on the plantar fascia where it attaches to the heel bone. Small tears of the
fascia can result. These tears are normally repaired by the body. As this process of injury and repair repeats itself over and over again, a bone spur (a pointed outgrowth of the bone) sometimes
forms as the body's response to try to firmly attach the fascia to the heelbone. This appears on an X-ray of the foot as a heel spur. Bone spurs occur along with plantar fasciitis but they are not
the cause of the problem. As we age, the very important fat pad that makes up the fleshy portion of the heel becomes thinner and degenerates (starts to break down). This can lead to inadequate
padding on the heel. With less of a protective pad on the heel, there is a reduced amount of shock absorption. These are additional factors that might lead to plantar fasciitis. Some physicians feel
that the small nerves that travel under the plantar fascia on their way to the forefoot become irritated and may contribute to the pain. But some studies have been able to show that pain from
compression of the nerve is different from plantar fasciitis pain. In many cases, the actual source of the painful heel may not be defined clearly. Other factors that may contribute to the
development of plantar fasciitis include obesity, trauma, weak plantar flexor muscles, excessive foot pronation (flat foot) or other alignment problems in the foot and or ankle, and poor
Common symptoms, heel Spurs: the pain is usually worst on standing, particularly first thing in the morning when you get up. It is relatively common, though usually occurring in the over forty's age
group. There are no visible features on the heel but a deep localised painful spot can be found in or around the middle of the sole of the heel. Although it is often associated with a spur of bone
sticking out of the heel bone (heel spur syndrome), approximately ten per cent of the population have heel spurs without any pain. Heel Bursitis, pain can be felt at the back of the heel when the
ankle joint is moved and there may be a swelling on both sides of the Achilles tendon. Or you may feel pain deep inside the heel when it makes contact with the ground. Heel Bumps, recognised as firm
bumps on the back of the heel , they are often rubbed by shoes causing pain.
Your doctor will listen to your complaints about your heel and examine you to see what is causing the pain, and whether anything else has started it off. If the cause of your pain seems obvious, your
doctor may be happy to start treatment straight away. However, some tests may be helpful in ruling out other problems. Blood tests may be done for arthritis. An Xray will show any arthritis in the
ankle or subtalar joint, as well as any fracture or cyst in the calcaneum. (It will also show a spur if you have one, but as we know this is not the cause of the pain.) Occasionally a scan may be
used to help spot arthritis or a stress fracture.
Non Surgical Treatment
To properly treat heel pain, you must absorb shock, provide cushioning and elevate the heel to transfer pressure. This can be accomplished with a heel cup, visco heel cradle, or an orthotic designed
with materials that will absorb shock and shear forces. When the condition is pronation related (usually plantar fasciitis), an orthotic with medial posting and good arch support will control the
pronation and prevent the inflammation of the plantar fascia. Footwear selection is also an important criteria when treating heel pain. Shoes with a firm heel counter, good arch support, and
appropriate heel height are the ideal choice. If the problem persists, consult your foot doctor.
Surgery is a last resort in the treatment of heel pain. Physicians have developed many procedures in the last 100 years to try to cure heel pain. Most procedures that are commonly used today focus on
several areas, remove the bone spur (if one is present), release the plantar fascia (plantar fasciotomy), release pressure on the small nerves in the area. Usually the procedure is done through a
small incision on the inside edge of the foot, although some surgeons now perform this type of surgery using an endoscope. An endoscope is a tiny TV camera that can be inserted into a joint or under
the skin to allow the surgeon to see the structures involved in the surgery. By using the endoscope, a surgeon can complete the surgery with a smaller incision and presumably less damage to normal
tissues. It is unclear whether an endoscopic procedure for this condition is better than the traditional small incision. Surgery usually involves identifying the area where the plantar fascia
attaches to the heel and releasing the fascia partially from the bone. If a small spur is present this is removed. The small nerves that travel under the plantar fascia are identified and released
from anything that seems to be causing pressure on the nerves. This surgery can usually be done on an outpatient basis. This means you can leave the hospital the same day.
A variety of steps can be taken to avoid heel pain and accompanying afflictions. Wear shoes that fit well-front, back, and sides-and have shock-absorbent soles, rigid shanks, and supportive heel
counters. Wear the proper shoes for each activity. Do not wear shoes with excessive wear on heels or soles. Prepare properly before exercising. Warm up and do stretching exercises before and after
running. Pace yourself when you participate in athletic activities. Don?t underestimate your body's need for rest and good nutrition. If obese, lose weight.