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What is Plantar Fasciitis (Heel Spurs)?

Although some experts distinguish between the terms plantar fasciitis and heel spurs, others do not, and the distinction is difficult to make, especially for a non-specialist. We will use the terms interchangeably.

The heel bone, the largest bone in the foot, is known anatomically as the calcaneus (kal-kā´nē-us). It is submitted to a great deal of shock and pressure, as it transmits weight from the body to the ground. Many people experience pain when they put weight on the heels of their feet, especially as they stand, run, or walk.

While there are a number of conditions that may result in heel pain, the most common one is known as plantar fasciitis (plan´tar/fas´´ē-ī´tis). Sometimes bony growths, known as heel spurs, develop on the heel bone but having a bony spur may not be painful at all.

The word plantar refers to the sole of the foot, and the plantar fascia (fash´ē-ah) is a broad band of fibrous tissue connecting the heel bone to the ball of the foot and the toes. The plantar fascia supports the medial longitudinal arch of the foot. Every time your foot hits the ground, the plantar fascia is stretched. Like the string of a bow, the tension on the fascia can therefore be very great. Because the fascia has limited elastic properties, repetitive stretching often results in microtears at its point of origin at the heel. When you experience pain in your heel or arch as a result of too much tension, the fascia may become inflamed: this is a sign of plantar fasciitis.

Chronic plantar fasciitis may cause the development of bony growths where the plantar tissue meets the calcaneus: Heel spurs occur when calcium deposits form as a result of the plantar tissue pulling away from the heel bone. Both plantar fasciitis and heel spurs can cause even more pain by irritating the nerves that serve the heel.

Contrary to popular opinion, it is not the presence of bone spurs that causes pain in the heel, but instead the chronic inflammation of the torn fascia. The spur may be a sign, and not a cause, of plantar fasciitis. About one-half of the patients with plantar fasciitis have heel spurs, which may also arise because of osteoarthritis (os´´tē-ō-ar-thrī´tis) or other conditions. Recent studies suggest that in fact bone spurs are more often associated with a muscle of the foot (known as the flexor digitorum brevis) than with the plantar fascia.

Causes of Plantar Fasciitis (Heel Spurs)

While plantar fasciitis may occur at any age, it is most common in middle-aged females and younger male runners. Obesity is present in 90% of the women who are affected and in 40% of the men. Considered a chronic inflammatory syndrome rather than a post-traumatic disorder, plantar fasciitis is common in those people who experience sudden weight gain or in overweight individuals who abruptly increase their activity level. The condition is often chronic, developing slowly over a long period of time.

People who spend a great deal of time on their feet, especially on hard surfaces, run the risk of overstressing the plantar fascia. This applies to certain occupational groups, such as teachers, store clerks, or people who work on loading docks. Certain sports, such as running, basketball, and aerobics (especially stair-stepping) can also put excessive strain on the plantar fascia.

Anyone who suddenly increases their physical activity, lunging after shots in a game of tennis, for example, after a long period not playing the game, or attempting to push a stalled car, may also overstress the plantar fascia. This is especially true if various contributing factors are present. Plantar fasciitis is usually the result of a biomechanical problem, such as flat feet that tend to roll in at the edges (pronate). Pronation causes the plantar fascia to be stretched excessively, resulting in inflammation.

Contributing factors to plantar fasciitis include:

  • Inheriting a foot type that is more likely to develop the condition, such as flat feet or an unusually high arch (known as pes cavus (pes/kāv´us))
  • Limb length inequality
  • The use of tight, ill-fitting shoes
  • Obesity
  • With age, the plantar fascia loses elasticity
  • Weight-bearing activities, such as standing for long periods of time, jogging, or lifting heavy weights
  • Inflexible calf muscles and a diminished range of ankle motion
  • Weak foot muscles
  • Heel pain sometimes has a neurological, traumatic, or systemic origin

Symptoms of Plantar Fasciitis (Heel Spurs)

When the foot rests during the night, the fascia contracts. With the first steps of the day, the irritated tissue is stretched, resulting in pain. If you experience heel pain with the first few steps you take in the morning, plantar fasciitis is quite likely to be the cause. While the pain usually occurs in the heel, it can radiate throughout the bottom of the foot towards the toes.

Seeking prompt treatment can relieve the condition and prevent the development of further injuries to the foot and weight-bearing joints. When patients seek treatment for plantar fasciitis, many believe the condition came about as the result of a stone bruise or recent increase in daily activity. It is not unusual for a patient to endure symptoms for many years before seeking medical treatment.

Diagnosis is usually made on the basis a patient's history and on the finding of localized tenderness. Patients are often asked to walk, so that the doctor might analyze their gait. Sometimes people with plantar fasciitis put more weight on their toes in order to compensate for heel pain, particularly going barefoot to the bathroom after awakening.

X-rays are sometimes used to check for stress fractures, arthritis, or for a serious condition known as osteomyelitis, which occurs when an infection spreads into the bone. Blood tests may be ordered if a systemic condition is suspected. Sometimes magnetic resonance imaging (MRI) scans are used, but for the most part the diagnosis of plantar fasciitis requires only medical observation.

Heel pain may accompany any of several other conditions that need to be identified or ruled out. Among these are:

  • the rupture of the plantar fasciitis, a relatively uncommon injury. MRI scans can aid greatly in the diagnosis of this condition.
  • Haglund's (hahg-loonds) disease, a bony prominence on the outer side of the heel.
  • Sever's (see-verz) disease – a condition that usually affects boys between the ages of six and ten, especially those who are both obese and extremely active. The pain is usually more severe after athletic activity. Pain is over the entire back of the heel
  • Systemic inflammatory disorders such as arthritis, gout, and lupus can cause heel pain.
  • Sciatica
  • Psoriasis
  • Bone bruises, stone bruises, and stress fractures
  • Nerve injuries or growths, known as neuroma
  • Heel bursitis or heel bone abnormalities
  • Tumors
  • Tarsal tunnel syndrome
  • Osteomyelitis

Treatment of Plantar Fasciitis (Heel Spurs)

If treatment is begun early, most patients with plantar fasciitis can be relieved of symptoms within six weeks. Patients whose work is physically demanding, involving standing, walking, or bearing weight, may need up to eight weeks of treatment. Plantar fasciitis can be a chronic, frustrating problem, especially when many contributing factors are involved.

Proper treatment of heel pain involves finding a way to absorb shock to the heel. The first step is often to cushion and elevate the heel, transferring pressure away from the plantar fascia. Orthotics, special inserts that go into the shoes made of shock absorbing materials, are used to cup or cradle the heel and elevate the back of the foot. When the condition is related to pronation, as is usually the case with plantar fasciitis, the orthotic must provide good arch support.

The choice of footwear is also important. Shoes with a firm heel, good arch support, and appropriate heel height are the ideal choice. Doctors familiar with foot ailments are usually able to recommend particular kinds of shoes. The best shoe sole and heel is one that you feel your foot sink into the shoe on weight bearing.

Early evaluation and treatment usually eliminate the need for surgery. In the case of heel pain, conservative measures are almost always pursued for at least six months before surgery is considered.

Other components of treatment may include:

  • Stretching exercises, especially calf stretching exercises
  • Stretching the Achilles tendon
  • Massaging the plantar fascia by rolling the foot over a 3–4-inch diameter tube, such as a rolling pin
  • Losing weight is often a critical component of treatment
  • It may be necessary to change one's occupation or modify other activities
  • It is best to avoid walking barefoot on hard surfaces
  • Anti-inflammatory medication, such as aspirin or ibuprofen, may be recommended for discomfort
  • Corticosteroid injections are occasionally used, though with caution
  • Ice massage, often each night before bed
  • Stretching the plantar fascia as the patient sleeps, using night splints (this has proven to be a highly effective form of treatment, affording relief in as many as 83% of all cases)
  • Some physicians recommend temporary casting with a short leg cast
  • Surgery is sometimes though rarely used to remove heel spurs that may interfere with properly fitted shoes

Surgery for Plantar Fasciitis (Heel Spurs)

A surgical procedure known as an endoscopic plantar fasciotomy is reserved for that small percentage of patients in whom conservative measures fail despite the correction of biomechanical abnormalities. Less invasive than traditional open heel surgery, this surgery represents a technological advance over those used in the past. Patient compliance with the orthopedic surgeons' recommendations is very important before and after any surgical procedure.

Recovering from plantar fasciitis does not happen overnight. It involves looking at many aspects of your particular lifestyle, as well as at your general health. Many comfort measures can make the condition more manageable. Physical therapy, ultrasound treatment, whirlpool baths, heat, massage, and ice treatment can all be used to pamper and relieve the feet.

The information provided herein is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting a licensed physician.

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