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Plantar Fasciitis (heel spur)

The Plantar Fascia is a strong inelastic band of fibers which begins at the heel and extend into the toes. When the Plantar Fascia becomes inflamed, the pain is mainly in the arch of the foot. Medically, this condition is called Plantar Fasciitis. When the Plantar fascia becomes inflamed and the pain is mainly in the heel, medically this condition is called Heel Spur Syndrome. The usual cause of Plantar Fasciitis or Heel Spur Syndrome is excessive pulling on the Plantar Fascia from either excessive exercise, poor fitting shoe gear or poor foot alignment while running or standing.

Plantar fascia pain usually begins as a mild pain to either the arch area or the bottom of the heel. The discomfort in the foot is usually most noticeable with the first step in the morning and seems to improve after a period of "warming up" the foot. If untreated, the pain can become intolerable. In some individuals, actual heel spur formation can occur at the site of where the Plantar Fascia is connected to the heel. The heel spur is actually a ridge of bone which forms to reinforce where the Plantar Fascia attaches to the heel. The ridge of bone is not the main problem unless a small nerve under the Plantar fascia becomes entrapped. The Plantar Fascia is the primary pathological anatomical structure that is causing pain to the patient. If the pulling on the plantar fascia is corrected, it is important to understand that the heel spur that formed from the pulling is not important and does not need to be removed with surgery. There are many doctors who get the heel spur confused and tell the patient that a heel spur is causing their pain when in fact it is the injury to the Plantar Fascia that needs to be medically treated.

Home care for either Plantar Fasciitis or Heel Spur Syndrome primarily consists of resting the foot, applying ice to the affected area three times a day for ten minutes, and using a supportive athletic shoe for most activities during the day. Sometimes stretching the arch by rolling the foot on an empty soft drink bottle in the morning helps relieve some of the pain. In addition, using a heel pad or a padded insole can be helpful in relieving the pain in the heel. If these home treatments do not relieve the pain, treatment by a foot and ankle specialist is warranted.

In treating heel and arch related foot pain, an X-ray of the foot is usually obtained to rule out a rare heel stress fracture and to document if a heel spur has occurred. Sonography is used to evaluate the plantar fascia for signs of inflammation or tears. Once a diagnosis is made of either Heel Spur Syndrome or Plantar Fasciitis, initial treatment usually consists of orthopedic strapping, anti-inflammatory medications, the use of a night splint and functional foot orthotics. A night splint is required to hold the foot in the correct position during sleep to allow the Plantar Fascia to heal in the correct length as when standing and walking. A functional orthotic is required to control the amount of pulling that is occurring in the Plantar Fascia with weight bearing by controlling the position of the foot in the shoe. In some cases a cortisone injection is placed into the area of the origin of the Plantar Fascia to rapidly reduce the amount of pain that is present.

Surgical intervention for either Heel Spur Syndrome or Plantar Fasciitis is rarely indicated and should be considered only if a night splint and / or the functional foot orthotic has failed. The surgery is warranted if the Plantar Fascia band has become too short due to repeated injury to where the Plantar Fascia or the nerve under the Plantar Fascia has become entrapped. The surgery should only be performed by an experienced surgeon. The primary purpose of the operation is to lengthen the Plantar Fascia where it is anchored to the heel bone.

Because Heel Spur Syndrome and Plantar Fasciitis is an inflammatory condition, early intervention is essential to stop the repeated scarring of the Plantar Fascia that can lead to irreversible shortening of the Plantar Fascia, nerve entrapment and the formation of a painful adventitious bursa.

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