Plantar Fasciitis

November 30, 2013 at 4:19 PM

Plantar Fasciitis

This is a painful condition of the heel.  The plantar fascia is a thin sheet of fibrous tissue which runs from the heel bone (calcaneus) to the front of the foot.  It probably acts as a “spring” to distribute the force of the foot hitting the ground when running and walking and helps to maintain the arch of the foot.

This is often and mistakenly believed to be the cause of a heel spur. A heel spur is in fact a normal finding on the heel bones of the majority of people and in fact is not really a spur at all but a normal part of the heel bone.  The plantar fascia actually inserts into the heel bone above where the “spur” is.  People often wonder why we don’t just “remove the spur” – the simple reason is that this isn’t the cause of the heel pain and will often lead to increasing pain rather than improving it.

Indeed although in rare cases surgery may be offered it doesn’t have a great track record.  A significant number of patients will experience little or no relief with surgery and a few will in fact be made worse!

Plantar Fasciitis is usually not an acute inflammatory condition and probably more correctly should be called Plantar Fasciiosis.  This is why a lot of anti-inflammatories don’t work for this condition. The type of inflammatory cells suppressed by anti-inflammatories are not involved in chronic conditions like Plantar Fasciitis!

Treatment is difficult as there is no one great cure.  It is important to reduce body weight as there is a very strong association with plantar fasciitis and a high BMI.  Increasing the padding between the heel and the ground can help.  Running shoes have a much better cushioning than dress shoes and reduce the force of each heel strike significantly which can add up to a big reduction in overall energy that the heel has absorbed each day!

Steroid injection can help but is often only a temporary “fix” and some patients find the pain is worse when the steroid wears off.  It is also often a very painful injection.

Orthotics are the other option – a rigid orthotic called an UCLB can certainly reduce the pain.

Finally if you are a smoker consider giving up as smokers have a higher incidence of chronic inflammatory conditions and are often more resistant to various treatments.

The good news is that although Plantar Fasciitis can be a very annoying problem it is not serious and will eventually settle by itself although it make run over several years.


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