The most common cause of heel pain is plantar fascitis which is commonly referred to as a Heel Spur. Plantar fascia is a broad band of fibrous tissue which runs along the bottom surface of the foot, from the heel to the toes . Plantar fascitis is a condition in which the plantar fascia is inflamed. This condition can be very painful and cause considerable amount of suffering. Long standing inflammation causes the deposition of calcium at the point where the plantar fascia inserts into the heel. This results in the appearance of a sharp thorn like heel spur on x-ray. The heel spur is a-symtomatic (not painful), the pain arises from the inflammation of the plantar fascia. Symptoms include a dull ache which is felt most of the time with episodes of a sharp pain in the center of the heel or on the inside margin of the heel. ANATOMY
The plantar fascia is a thick, broad, inelastic band of fibrous tissue that courses along the bottom (plantar surface) of the foot. It is attached to the heel bone (calcaneus) and fans out to attach to the bottom of the metatarsal bones in the region of the ball of the foot. Because the normal foot has an arch, this tight band of tissue (plantar fascia) is at the base of the arch. In this position, the plantar fascia acts like a bowstring to maintain the arch of the foot.
Figure 1: Lateral (Side ) View of Foot
Plantar fasciitis refers to an inflammation of the plantar fascia. The inflammation in the tissue is the result of some type of injury to the plantar fascia. Typically, plantar fasciitis results from repeated trauma to the tissue where it attaches to the calcaneus.
Figure 2: Plantar (Bottom) View of Foot
This repeated trauma often results in microscopic tearing of the plantar fascia at or near the point of attachment of the tissue to the calcaneus. The result of the damage and inflammation is pain. If there is significant injury to the plantar fascia, the inflammatory reaction of the heel bone may produce spike-like projections of new bone called heel spurs. The spurs are not the cause of the initial pain of plantar fasciitis, they are the result of the problem. Most heel spurs are painless. Occasionally, they are associated with pain and discomfort and require medical treatment or even surgical removal Plantar fasciitis (heel-spur syndrome) is a common problem among people active in sports, especially runners. It typically starts as a dull, intermittent pain in the heel and may progress to sharp, constant pain. Often, it is usually worse in the morning or after sitting, and then decreases as the patient begins to walk around. In addition, the pain usually increases after standing or walking for long periods of time, and at the beginning of a sporting activity.
Repeated small injuries to the fascia (with or without inflammation) are thought to be the cause of plantar fasciitis. The injury is usually near to where the plantar fascia attaches to your heel bone.
You are more likely to injure your plantar fascia in certain situations. For example: * If you are on your feet for a lot of the time, or if you do lots of walking, running, standing, etc, when you are not used to it. (The condition is sometimes called 'policeman's heel', as policemen 'walking the beat' were said to be commonly affected.) Also, people with a sedentary lifestyle are more prone to plantar fasciitis. * If you have recently started exercising on a different surface. For example, running on the road instead of a track. * If you have been wearing shoes with poor cushioning or poor arch support. * If you are overweight, this will put extra strain on your heel. * If there is overuse or sudden stretching of your sole. For example: athletes who increase running intensity or distance; poor technique starting 'off the blocks', etc. * If you have a tight Achilles tendon (the big tendon at the bottom of your calf muscles above your heel). This can affect your ability to flex...
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