Do You Suffer From Heel Pain? It Might Be Plantar Fasciitis

Plantar fasciitis is the most common cause of heel pain presenting to the outpatient clinic and is most common with the middle age population.  The plantar fascia is a flat thickening of connective tissue on the bottom of your foot that spans from your heel to your toes and primarily supports the arch of your foot.

Plantar fasciitis is thought to be an inflammatory process; however, it is actually a disorder of degenerative changes in the fascia.

Plantar fasciitis is diagnosed with:

  1. History of pain on taking the first few steps in the morning or after sitting for long periods of time
  2. Worsening pain with weight-bearing
  3. Pain and tenderness to palpation over the medial calcaneal (heel) tubercle. Pain and stiffness can improve after several steps.  Patients may have a collapsed arch (excessive pronation), flat feet, high arches, or tight Achilles tendon(s).  It can occur in one or both feet and can happen with younger individuals that are on their feet a lot.  Runners are especially susceptible to foot and heel pain.

Differential Diagnosis: Plantar fasciitis must be distinguished from other causes of plantar heel pain. Heel fat-pad atrophy typically occurs in elderly patients with pain in the central heel. These patients usually do not complain of pain upon first weight bearing in the morning. Tarsal tunnel syndrome is compression of the tibial nerve causing foot pain, weakness, and often times numbness or tingling in the sole or arch of the foot.  A calcaneal stress fracture is confirmed on examination with use of the squeeze test of the calcaneus (heel bone).  An X-ray would further confirm a stress fracture of the calcaneus.

Treatment: No single treatment is best for everyone since it can be caused by many different reasons.

Here are a few things to try:

  • Give your feet a rest, cut back on aggravating activities.  Do not walk or run on hard surfaces
  • In severe cases a walking boot or night splints are necessary
  • Control inflammation by taking anti-inflammatory medication and icing the your heel
  • Stretch both your calf muscles, gastrocnemius and soleus, and your toes
  • Consider arch supports and/or a new pair of shoes if your current shoes are old or worn.

If these steps do not resolve your plantar fasciitis the source of your pain might be related to intrinsic foot muscle weakness or lumbar nerve irritation.  Additional assistance with your condition would benefit from a manual physical therapist evaluating your movement patterns to determine the source of your plantar fasciitis.

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