Plantar Fasciitis & Fasciitis Pain

Plantar Fasciitis Overview:

Plantar fasciitis is the most common cause of heel pain. It occurs when the long, flat ligament on the bottom of the foot (plantar fascia) stretches irregularly and develops small tears that cause the ligament to become inflamed. This inflammation is caused most often by walking with an abnormal step (abnormal inward twisting of the foot, called pronation). Over time, this slightly abnormal step may increase tension on the plantar fascia and cause it to become inflamed.

Treatment without surgery is usually successful in relieving the inflammation and pain of plantar fasciitis, especially if treatment is started when the symptoms of heel pain are first noticed.

Plantar fasciitis can be aggravated by certain activities that put repeated stress on the plantar fascia ligament. Activities such as prolonged walking or standing, or sports such as running or basketball, can put additional stress on the plantar fascia ligament. If the heel pain is not treated, plantar fasciitis can become long-lasting (chronic) and cause constant heel pain while standing or walking. Other health conditions, such as being overweight, can put additional stress on the ligament.

Although plantar fasciitis is a common problem among middle-aged adults and some athletes, treatment is easy to follow and usually successful if started soon after the symptoms begin.

The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles and ligaments. In its back, is the strong Achilles tendon that inserts the tendons of the calf muscles, and below it is the tight attachment of the plantar fascia that forms the vault of the arch of the sole (the plantar arch).

Causes of Plantar Fasciitis & Heel Spurs:

When walking with a normal step, the plantar fascia ligament stretches as the foot strikes the ground. When walking with an abnormal step, the plantar fascia ligament can stretch irregularly, become stressed, and develop small tears. These small tears can cause the ligament to become inflamed (plantar fasciitis).

The repetitive stress of certain conditions or activities can lead to small tears in the ligament and inflammation. Conditions or activities that may lead to plantar fasciitis include:

Biomechanical factors, such as abnormal inward twisting (pronation), high arches, flat feet, or tight tendons at the back of the heel (Achilles tendons).
Excessive pronation, which can cause tension in the plantar fascia as the arch lowers during standing or walking, has been found in about 85% of people with plantar fasciitis.
Repetitive foot use, such as from jobs or activities that require prolonged walking or standing on hard or irregular surfaces or from sports such as running.
Aggravating factors, such as being overweight or poorly cushioned shoes.
Natural process of aging.
In rare cases, a single, traumatic injury to the foot.

How Plantar Fasciitis & Heel Spurs Progress:

Plantar fasciitis usually develops gradually. Heel pain may only occur when taking the first steps after getting out of bed or when taking the first steps after sitting for a long period of time. If the plantar fascia ligament is not rested, the inflammation and heel pain will get worse. Other conditions or aggravating factors, such as the repetitive stress of walking, standing, running, or jumping, will contribute to the inflammation and pain. In some cases, the inflamed ligament may not heal because many people who have plantar fasciitis do not completely stop the aggravating activity.

Most people develop irritation and inflammation of the plantar fascia because of “overuse” of their feet by excessive running, jumping, jogging or twisting of the feet, resulting in excessive pronation (inner turning of feet). The injury may also result in small tears of the plantar fascia.

The pain is described as being dull aching or sharp and can be reproduced by flexing the toes upwards (dorsiflexion) and tensing the fascia. Symptoms tend to worsen after standing and walking, in the morning, after awaking or after prolonged sitting. This happens because the fascia is being stressed again after a protracted rest. As the person walks, the fascia “warms up” and lengthens slightly, reducing the tension and the associated pain.

The repetitive stretch of the fascia over years can also irritate the insertion site of the fascia to the heel bone and lead to the ingrowth into the soft tissue of the heel of a hook-shaped spur of the heel bone. A common misconception is that the heel pain is mostly due to the bone spur. The truth is that the pain is due primarily or exclusively to the inflammation of the fascia (plantar fasciitis) and not to the bone spur because significant heel pain occurs in the absence of spurs, and large bone spurs can be detected by X-rays in people with no heel pain.

Plantar Fasciitis Risk Factors:

Risk factors that may increase the chance of developing plantar fasciitis include:

Being middle-aged.
Having an abnormal step or abnormal foot biomechanics, such as high arches or flat feet.
Having a sudden weight gain, or being overweight.
Having tightness in the Achilles tendon, which attaches the calf muscle to the heel bone. (Also see Achilles Tendonitis)
Certain habits or activities:
- Wearing shoes with poor cushioning.
- Walking or running without being conditioned for these activities.
- Changing a walking or running surface, for example, from grass to concrete.
- Having a job that involves prolonged standing on hard surfaces.

The greatest risk factors for plantar fasciitis are being middle-aged and having an abnormal step or abnormal foot biomechanics that stress the plantar fascia ligament when walking or standing.

Athletes, especially runners, are at increased risk for plantar fasciitis. In athletes, a number of factors are associated with development of plantar fasciitis. These factors can lead the athlete to change his or her gait (the way the feet strike the ground), which can cause symptoms and injury. Risk factors for athletes include:

Biomechanical factors, such as decreased flexibility in the foot and ankle, imbalances in muscle strength (muscles in one leg or foot are weaker than the other), abnormal foot mechanics (when stepping down), and tightness in the Achilles tendon. (Also see Achilles Tendonitis)
The repetitive nature of sports activities and improper training.

Other specific risks for athletes include:

Rapidly increasing the number of miles run.
Running on steep hills.
Wearing running shoes that are worn out.
Wearing running shoes that do not have a cushioned sole or enough arch support.
Abruptly changing the intensity or duration of the running routine.

Other Forms Of Heel Pain:

Bruised Heels -
A bruised heel can occur when there is a tremendous amount of impact around the heel region of the foot. This can be associated with shoes that are worn out or shoes that offer very little protection to the bottom of the foot. The soft tissue around the heel gets bruised and inflamed. If you do not have a good heel cup for the foot to rest in, then the fat pad splays outwardly and reduces the amount of material directly underneath the heel bone. At that point, the foot has less shock absorbing capabilities.

Heel Pump Bumps -
Heel pump bump is associated with the style of shoe that is referred to as high heel pumps. Heel pump bump just designates its location, stating that it is on back of the heel bone. It may exist either on the left or right side. The pump bump is generally to the outside of the Achilles tendon. The bump generally starts out very small as soft tissue inflammation. As more friction and pressure continues in back of the heel bone, the soft tissue inflammation expands.

Achilles Tendon Pain -
Pain can be created in this tendon in a number of different situations. One of the causes of Achilles tendon pain can be associated with the foot pronating. As the foot pronates, collapses, and the heel bone begins to twist sideways, it stretches the Achilles tendon, very much like a guitar string, and puts stress on the tendon. Pain can be created in this tendon in a number of different situations. One of the causes of Achilles tendon pain can be associated with the foot pronating. As the foot pronates, collapses, and the heel bone begins to twist sideways, it stretches the Achilles tendon, very much like a guitar string, and puts stress on the tendon.

This information comes from Plantar-Fasciitis.org, a collection of knowledge on plantar fasciitis, heel spurs, and heel pain. The purpose of this website is to offer medical knowledge including causes and the latest treatment option.