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Plantar Fasciitis (Heel Pain)

Overstretching of the fascia leads to excess traction and inflammation at the origin of the plantar fascia (plantar fasciitis). The development of scar tissue makes the fascia less flexible and causes further traction from other parts of the foot.

Symptoms

During initial periods of weight bearing after rest, the patient presents with a dull-to-sharp pain in the medial plantar calcaneal area. The pain is more severe in the morning when first arising because the plantar fascia is more inflexible at this time.

Biomechanical etiology

Excess subtalar joint pronation lowers the arch structure, elongates the foot, and places a tractional force on the plantar fascia. Over time, these tractional forces result in inflammation of the fascia and surrounding tissues, causing pain in the arch and heel. This may lead to the development of a bony growth on the calcaneal tuberosity (heel spur), causing a sharp pain right in the center of the heel.

Tight calf muscles can add to plantar fascial pain if the foot cannot dorsiflex at the level of the ankle during the propulsive phase of gait. This results in the foot dorsiflexing at the midtarsal joint, which in turn places extra strain on the plantar fascia.

Treatment

Biomechanical plantar fasciitis is best treated mechanically by correcting abnormal foot mechanics. Orthotics designed to control excess subtalar joint pronation will, via the windlass mechanism, assist the arch in rising and reduce plantar fascial tension. Surgery is seldom required and should be avoided whenever possible.

Additional treatment

  • Ice therapy (20 minutes, several times per day)
  • Anti-inflammatory drugs
  • Electrotherapeutic modalities
  • Night splint

Exercises

  • Plantar fascia stretch
  • Toe raises
  • Calf stretches