Common Foot Problems

Foot problems are a common occurrence. At one time or another just about everyone will experience either pain or discomfort in their feet.  While there are some things that can be done to minimize or prevent problems, they are still likely to occur simply because we use our feet all the time and they bear a lot of weight.  Wearing shoes made of quality materials and with adequate support and solid construction can make a big difference.   Visiting ones podiatrist as soon as major problems arise is a good idea and wearing shoes which are the correct size can also lessen the likelihood of foot problems.  In this article we will discuss some common foot problems. We will first list a number of them and then follow that up with a more in-depth discussion of a few of them.

Arthritis,  tendinitis in the Achilles heel, pain in the ankles,  burning feet,  athletes foot,  foot ulcers, gout, Morton’s toe, neuropathy and heel fissures are all common foot problems. These affect million of people. Individuals may not only suffer from one of these conditions but multiple ones. This can mean that a person has extreme pain every time that they walk. In these cases and in most cases of severe foot pain, a visit to the podiatrist may be in order. When that is not possible, there are some over-the-counter (or internet) options that may work to alleviate pain.  Now, let’s take a little closer look at some of the common foot ailments we listed above.

Plantar Fasciitis: Plantar fasciitis is a very common problem that affects the heel and the arch. It is the result of small tears in the plantar fascia. This condition can cause a lot of pain, discomfort and stiffness. To treat it, an individual may use arch supports or orthotics. Wearing custom made orthotics is usually the best choice. Anti-inflammation and pain medication may also be helpful.

Neuroma: This is a condition where irritation in the nerves occurs and causes swelling. The nerve may thicken and cause discomfort and pain. This often times affects the ball area of the foot.

Hammer Toes: Hammer toes are another pretty common foot condition.   Individuals who have them essentially have a deformed toe. This is due to an imbalance in the tendons.

 

Achilles Tendinitis: Tendinitis of the Achilles is another condition of that affects the foot area and which can be very painful. It is essentially the case of an inflamed Achilles tendon. Over time, if it is not properly treated, the tendon take may become thicker and bumps or nodules may form on it. Eventually, if nothing is done, this can lead to the tearing of the tendon.

This would obviously be quite painful and cause some serious problems. Surgery would be needed to repair a burst or ruptured Achilles tendon. This can be very costly and will require a cast and therapy. To avoid this, it is important to seek proper treatment and care. In this case, the saying is true, “an ounce of prevention is worth a pound of cure.”

Custom Foot Orthotics For Plantar Fasciitis

Plantar Fasciitis is a very serious condition. Individuals who suffer from it will have pain in the heels of their foot and perhaps along the entire arch or bottom of the foot. Persons often feel the worst pain when they wake up in the morning.  It is only after they have begun to walk around, warming up and stretching out their foot that they feel some relief.  It is always best to treat plantar fasciitis as early as possible.  As soon as an individual begins to feel pain and suspect that is it due to plantar fasciitis or it has been diagnosed definitively by a doctor, it is best to take action. This will typically allow the problem to be solved much quicker then if nothing at all is done.

There are a number of things that individuals can do to treat this condition. They include stretching, wearing supportive shoes, resting, using orthotics, taking anti-inflammatory medications and putting arch supports in their shoes. One of the very best options is custom foot orthotics.  A Podiatrist will work with the patient to create an orthotic specifically for their foot. Sometimes individuals will buy mass produced orthotics and foot supports, and while some may be helpful, they are never is good as custom-made functional devices because the latter takes a persons foot construction into consideration so that they fit perfectly and also provides the support in the areas that a person needs them.

Custom-made, functional foot orthotics have been discovered to be one the very best options when treating Plantar Fasciitis, even better then taking NSAIDS, wearing heal cups or being injected with cortisone.  For those who would rather not take medications, custom foot orthotics provide for an approach to treatment that is not invasive at all and pose few to no serious health risks.

A custom foot orthotic typically uses semi-rigid materials and the device may be the length of the entire foot or 3/4s of it. The arch support used is mostly longitudinal.  The cost of a custom foot orthotic may or may not be covered by an individual’s health insurance. It is important for person to find out this information prior to ordering them so that there are no surprises at the checkout counter.   If they work to relieve a person’s Plantar Fasciitis pain, then they may actually be pretty priceless.

Custom foot orthotics can be prescribed and designed by a Podiatrist. They will work to create an orthotic that is perfectly suited for the patient’s foot, their condition and whatever specific problems they have reported. A good custom orthotic, combined with stretching, rest and when needed, anti-inflammatory and/or pain medications can be a very effective way to treat plantar fasciitis.

Custom orthotics can be a great way to treat Plantar Fasciitis.  This very painful condition can be difficult to tolerate and subsequently, will require some sort of treatment. Wearing orthotics is an easy, non-invasive way to experience relief.

Foot Orthotics Comparison

Question: I’m interested in full length custom orthotics to put in hiking boots for hiking in the mountains.  I have plantar fasciitis in one foot.  What is the difference between your $99 model and $199 model?  What are the life expectancies?  Thanks.  – Mark

Answer: Our $99 product is considered a semi-custom device. At Footcare Express, we have a library of engineered shells that are used to match the length, width and arch height of your foam cast impression. The $199 product is a completely custom-made arch support designed and fabricated from your foam cast impression. These custom arch supports are manufactured using a variety of different materials based on discomforts, activity, use, etc. (Cast Foam Impressions are provided once purchase is made)

In either case, the materials are durable. The life expectancies for any of our products really depend on the amount and type of usage. We have had customers and patients replace their custom devices yearly, while others have gotten much longer “life”. Softer materials can wear and will out quicker. In most cases, each of these products can simply be refurbished without having to fabricate an entirely new product. Refurbish fees may vary.

I hope you find this information useful. Should you require any further assistance, please do not hesitate to contact us again.

Sincerely,
Customer Service Team

What are the Best Athletic Shoes?

At Footcare Express, I am asked all the time “What is the best athletic shoe? It is a question that is asked daily and has many answers. The best shoe depends on fit, comfort, construction, and the type of sports activity.

The function of an athletic shoe is to protect the foot from the many stresses of running, walking or other high impact activities. This function of footwear will help the athlete achieve his or her maximum potential. While in some parts of the world athletes run and participate in sports barefooted, most of us require and benefit from the use of sport specific shoes. The forces and motions that occur in different sports vary greatly. The type of activity that you are using them for should determine shoe purchases. For example, you would not want to buy a basketball shoe for running and visa versa. Walking and running shoes function best in a straight line where a tennis or basketball shoe requires lateral or side-to-side movements.

The majority of athletic shoes are not well designed. There are many shoes that have inflexible soles. This can cause calf muscles to work harder and can contribute to Achilles Tendonitis. If the shoe is too flexible in the midsole or they flex before the point where the toes bend, a stretch in the plantar fascia can occur and contribute to foot strain. This can be commonly referred to as Plantar Fasciitis. There are many top name companies that are cutting out the midsole of the shoe to make it lighter, however, the long term or even in some cases, the short term effects, can result in strains in the feet. Other things to look out for are inadequate support in the rearfoot or lack of room in the forefoot and poor shock absorption. In general, the most important factor is feel and fit. The best time to shop for an athletic shoe is at the end of the day when your feet are somewhat larger from the day’s walking. Also, make sure that there is a finger’s width at the front of the shoe. This will help prevent runner’s toe.

When shopping for the perfect shoe, it is also important to go to a place where the sales representative has knowledge of the appropriate footwear that matches the foot type. A person with a low arch needs footwear with a lot of support and good rearfoot control. Whereas, as person with a high arch needs more shock absorption and footwear that has a narrower heel. A wide heel may cause the rearfoot to move around too much in the shoe. A person with a “normal” foot would probably work best with a combination of the control and shock absorption. Believe it or not, most of the high-end athletic shoe companies have various styles of shoes that will accommodate different foot structures.

Shoes are not made to last forever, especially with the rigorous activity we put them through. A shoe’s midsole only lasts so long. The soft materials the are used in the shoe normally compress over a period of time and wear out. Eventually, the materials breakdown and no longer serve the function they once had when they were new. Most doctors will suggest that running shoes be replaced every 350 to 550 miles. This means that if you are running 20 miles a week, you should consider changing very 20 to 25 weeks. Many people feel that if they don’t see the sole wear down, then the shoe is still in good shape. The materials can be worn down without the shoe wear even being noticeable.

So it is very important to wear the proper footwear, especially during sports. Sometimes even the best footwear will not solve or help each person’s condition. At FootLabs, we try to help with these types of questions and create custom inserts for solving those hard to answer questions. Everyone has different make-ups and unique biomechanics. The best athletic shoes are those that are the best for you.

Plantar Fasciitis

Plantar fasciitis is a painful inflammatory condition of the foot caused by excessive wear to the plantar fascia that supports the arches of the foot or by biomechanical faults that cause abnormal pronation. The pain usually is felt on the underside of the heel, and is often most intense with the first steps of the day. It is commonly associated with long periods of weight bearing or sudden changes in weight bearing or activity. Obesity, weight gain, jobs that require a lot of walking on hard surfaces, shoes with little or no arch support, and inactivity are also associated with the condition.

Plantar fasciitis was formerly called “a dog’s heel” in the United Kingdom. It is sometimes known as “flip-flop disease” among US podiatrists. The condition often results in a heel spur on the calcaneus, in which case it is the underlying condition, and not the spur itself, which produces the pain.

Plantar fasciitis usually develops gradually, but it can come on suddenly and be severe. And although it can affect both feet, it more often occurs in only one foot at a time. Watch for:

• Sharp pain in the inside part of the bottom of your heel, which may feel like a knife sticking in the bottom of your foot
• Heel pain that tends to be worse with the first few steps after awakening, when climbing stairs or when standing on tiptoe
• Heel pain after long periods of standing or after getting up from a seated position
• Heel pain after, but not usually during, exercise
• Mild swelling in your heel

Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. But, if tension on that bowstring becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed. The causes of plantar fasciitis can be:

• Physical activity overload. Plantar fasciitis is common in long-distance runners. Jogging, walking or stair climbing also can place too much stress on your heel bone and the soft tissue attached to it, especially as part of an aggressive new training regimen. Even household exertion, such as moving furniture or large appliances, can trigger the pain.
• Arthritis. Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis.
• Diabetes. Although doctors don’t know why, plantar fasciitis occurs more often in people with diabetes.
• Faulty foot mechanics. Being flat-footed, having a high arch or even having an abnormal pattern of walking can adversely affect the way weight is distributed when you’re on your feet, putting added stress on the plantar fascia.
• Improper shoes. Shoes that are thin-soled, loose, or lack arch support or the ability to absorb shock don’t protect your feet. If you regularly wear shoes with high heels, your Achilles tendon which is attached to your heel can contract and shorten, causing strain on the tissue around your heel.

What is a Heel Spur?

Heel Spurs

Patients and doctors often confuse the terms heel spur and plantar fasciitis. While these two diagnoses are related, they are not the same. Plantar fasciitis refers to the inflammation of the plantar fascia–the tissue that forms the arch of the foot. A heel spur is a hook of bone that can form on the heel bone (calcaneus) and is associated with plantar fasciitis.

About 70 percent of patients with plantar fasciitis have a heel spur that can be seen on an X-ray. However, many patients without symptoms of pain can have a heel spur. The exact relationship between plantar fasciitis and heel spurs is not entirely understood. For more information about plantar fasciitis.

Who gets heel spurs?

Heel spurs are common in patients who have a history of foot pain caused by plantar fasciitis. In the setting of plantar fasciitis, heel spurs are most often seen in middle-aged men and women, but can be found in all age groups. The heel spur itself is not thought to be the primary cause of pain, rather inflammation and irritation of the plantar fascia is thought to be the primary problem. A heel spur diagnosis is made when an X-ray shows a hook of bone protruding from the bottom of the foot at the point where the plantar fascia is attached to the heel bone.

Why did I get a heel spur?

The plantar fascia is a thick, ligamentous connective tissue that runs from the calcaneus (heel bone) to the ball of the foot. This strong and tight tissue helps maintain the arch of the foot. It is also one of the major transmitters of weight across the foot as you walk or run. That’s why tremendous stress is placed on the plantar fascia.

When a patient has plantar fasciitis, the plantar fascia becomes inflamed and degenerative (worn out)–these abnormalities can make normal activities quite painful. Symptoms typically worsen early in the morning after sleep. At that time, the plantar fascia is tight so even simple movements stretch the contracted plantar fascia. As you begin to loosen the plantar fascia, the pain usually subsides, but often returns with prolonged standing or walking.
Heel spurs form in some patients who have plantar fasciitis, and tend to occur in patients who have had the problem for a prolonged period of time. While about 70 percent of patients with plantar fasciitis have a heel spur, X-rays also show about 50 percent of patients with no symptoms of plantar fasciitis also have a heel spur.

Treatment of heel spurs is the same as treatment of plantar fasciitis. Because these problems are related, the treatment is the same. The first step in the treatment of a heel spur is short-term rest and inflammation control. Here are the steps patients should take in order to cure the symptoms of plantar fasciitis and heel spurs:

Rest

The first treatment step is avoiding activities that aggravate symptoms. For example, take a few day off jogging or prolonged standing to try to rest the painful foot. Just resting usually helps eliminate the most severe pain, and will allow the inflammation to begin to settle down.

Heel Pain

Heel Pain

Heel Pain is one of the most common foot conditions among runners and other athletes. In fact, the population in general complains of heel pain more than other foot condition and there are several causes. Proper diagnosis and treatment are paramount in order to correct the problem.

A major cause of heel pain is Plantar Fasciitis. Plantar Fasciitis is an inflammation or irritation in the arch of the foot. The arch generally feels tight and the pain will worsen with excessive activity. Heel Spurs are another common cause of heel pain as well as the nerve condition called Tarsal Tunnel Syndrom. Twists and fractures are cause severe heel pain and are usually impact or pressure related.

Treatment of heel pain will depend upon the cause and treatments do vary so make sure to describe symptoms to a podiatrist or health care professional. During bouts of heel pain you may experience difficulty walking, pain during times of inactivity, pain lasting several days, swelling and infection. Any of these symptoms alone should compel you to seek treatment.

Again treatment for heel pain will vary and depending upon the severity of the condition and can range rest to surgery. Avoiding painful activities and resting can be all it takes to reduce the pain. Other home remedies include the application of ice, stretches, and/or over the counter anti-inflammatory medication.

Shoe inserts are often recommended but self diagnosing and choosing drugstore insoles could do more harm than good. Custom Foot Orthotics are available and are fabricated from a mold of your actual foot. Your podiatrist can recommend which type of orthoses will benefit your specific source of heel pain. Please seek treatment if you symptoms persist.

Arch Strain

Arch Pain / Arch Strain

Arch Strain or Arch Pain is simply inflammation in the arch of the foot causing a burning feeling or in some cases acute pain. There are many causes for this type of foot pain.

There may be some structural instability or imbalance in the foot which can directly cause discomfort. The most common ocurrence of foot arch pain is as a result of Plantar Fasciitis.  Plantar Fasciitis Orthotics can be fabricated to help alleviate or correct the pain.

There is a band of tissue running across the bottom of the foot called the plantar fascia extending from the forefoot to the heel. When the plantar fascia becomes stressed due to over exertion or irritation,  Plantar Fasciitis can occur.

Those with flat feet often suffer from Plantar Fasciitis and experience pain in the heel and arch when the plantar fascia is stretched at the heel. An indicator of Plantar Fasciitis is heal or arch pain occurring in the morning or after long periods of rest.

Extreme discomfort is often the extent of the damage associated with this condition but in some cases, if not treated, heel spurs can occur. Heel spurs are bony protrusions from the heel.

Plantar Fasciitis and foot arch pain are easy to treat. The first line of defense is choosing proper shoes. Avoid high heels and look for shock absorbing soles. Custom Orthotics are a great method of treating Plantar Fasciitis especially when it’s due to flat feet. Orthoses will correct the instability in the foot and provide proper arch support.

When suffering from foot discomfort due to a strained arch it is recommended to seek out a custom fit orthotic and not when purchased over the counter at a drugstore or supermarket. A device that has not been cast from a 3-D mold of the foot will not correct the specific problems of the foot. Improper fitting inserts or insoles could result in damage to the foot or an increase in pain.

Foot Arch Pain

Foot Arch Pain

Foot Arch Pain Overview

Each foot contains 24 bones, which form two arches. The longitudinal arch runs the length of the foot, and the transverse arch runs the width. The bones of the arch are primarily held together by the shape with which they fit with each other and by fibrous tissues known as ligaments that serve to hold the bones to each other. The muscles of the foot, along with a tough, sinewy tissue known as the plantar fascia, provide secondary support to the foot. There are also fat pads in the foot to help with weight-bearing and absorbing impact. Arch pain can occur whenever something goes wrong with the function or interaction of any of these structures.

Foot Arch Pain Causes

The arches are the primary structures of the body that absorb and return force to and from the body to the outside world when we are on our feet. When something happens to these structures, pain and injury may result. Foot arch pain is a common problem that many suffer from.

There can be many causes of foot arch pain. Direct force trauma, ligament sprains, muscle strains, poor biomechanical alignment, stress fractures, overuse, or the tightness or lack of tightness of the joints in the foot may all cause pain in the arch.

Injury to the plantar fascia is a common cause of foot arch pain. The plantar fascia is a tough fibrous sheath that extends the length of the bottom of the foot and lends support to the arch. When the plantar fascia is damaged, the resulting inflammatory response may become a source of foot arch pain.

Sprains, strains, bruises, and fractures may be the result of a single stress or a combination of stresses to the foot. A blunt-force injury such as someone stepping on your foot may result not only in a bruise (contusion), but also in damage to the primary and secondary structures of the foot. Many of the muscles of the lower leg and foot attach on or near the arch. Injured or tight muscles may lead to incorrect biomechanics and in turn cause foot arch pain.

Injury to the bones of the foot can be caused by a single blow or twist to the arch or also by repetitive trauma, which can result in a stress fracture. A sprain of the arch occurs when the ligaments which hold the bones together are overstretched and the fibers tear. The muscles of the foot may be strained by overstretching, overuse, overloading, bruising, or being cut by stepping on a sharp object. Arthritis of the arch joints may also occur if the foot is subjected to repetitive movements that stress the arch.

Stress fractures, plantar fasciitis, and acute and chronic arthritis are most commonly the result of repetitive micro-trauma injuries. Micro-trauma injuries are caused when the structures of the body are stressed and re-stressed to the point that damage occurs in the tissues. Factors that commonly contribute to this injury can be running on uneven surfaces or surfaces that are too hard or too soft, shoes that have poor force-absorption qualities, or going too hard or too long during repeated exercise bouts.

Foot Arch Pain Symptoms

Foot arch pain and tenderness associated with plantar fascia strains are usually felt on the bottom of the foot and may manifest either as a specific or general area of tenderness. Plantar fascia pain may be increased or decreased by stretching of the arch. Generally, in mild cases of plantar fasciitis, the pain will decrease as the soft tissues of the foot “warm up”; however, pain may increase as use of the foot increases. In more severe cases of plantar fasciitis, pain may increase when the arch is stressed.

A more specific pain (point tenderness) is an indicator that something is wrong in that specific area. Pain with movement of the affected area is also an indicator of the particular body part affected.

Bones and ligaments work together to form joints, and bones are joined together by ligaments. Strains occur in ligaments. In the arch, there are ligaments that are located at the ends of each bone. These ligaments connect the bones to other bones on both ends and on the sides. Point tenderness and looseness of a joint are indicators of a sprain.

Fractures are indicated by point tenderness that may be severe over the area of bone that is affected. There may be a distinguishable lump or gap at the site of the fracture. A rotated toe or forefoot may also be a sign of a fracture.

The groups of muscles that support the arch can be divided into two groups. The muscles on the top of the arch start on the front lower leg and help to lift the arch, and the muscles that help pull the arch on the bottom of the foot are located the on back of the lower leg. Muscle injury may be indicated when pain is felt when the foot is fully extended, flexed, or turned in or out. Foot arch pain may also be felt when working the foot against resistance.

Bruises are the result of a direct-force injury to the body. A bruise can occur to the foot by a variety of causes, such as having your foot stepped on or by stepping on a rock. The tissues that compose the arch do not provide that area of the body much protection. Blows to the foot that result in pain, discoloration, swelling, and changes in how you walk may indicate more serious damage.

Foot Arch pain may have a variety of different causes. Proper evaluation and diagnosis of arch pain is essential in planning treatment. A good general guideline is to compare the injured side to the uninjured side. Injury may present itself as a distinguishable lump, a gap felt at that location, or a “crunchy” feeling on that spot caused by inflammation. The type, causes, and severity of pain are also good indicators of the severity of the injury.

Four grades can be used to describe foot arch pain:

• Pain during activity only
  

• Pain before and after activity, and not affecting performance
  

• Pain before, during, and after athletic activity affecting performance
  

• Pain so severe that performance is impossible

Exams and Tests

The doctor will take a brief history to determine how the injury occurred. If necessary, a thorough physical exam may be conducted to evaluate for any other injuries. Taking your workout shoes to the exam may also provide valuable information to the medical practitioner.

• Both feet will be physically and visually examined by the medical practitioner. The foot and arch will be touched and manipulated possibly with a lot of pressure and inspected to identify obvious deformities, tender spots, or any differences in the bones of the foot and arch.
  

• The medical practitioner will examine how the muscles of your foot function. These tests may involve holding or moving your foot and ankle against resistance; you may also asked to stand, walk, or even run. Pain caused by movements may indicate the cause of the pain.
  

• The nerves in the foot will be tested to make sure no injury has occurred there.
  

• An x-ray, MRI, or bone scan of the foot and arch may be taken to determine if there are changes in the makeup of the bone.

Foot Arch Pain Treatment

Self-Care at Home

When you first begin to notice discomfort or pain in the area, you can treat yourself with rest, ice, compression, and elevation (RICE). Over-the-counter medications may also be used to reduce discomfort and pain.

Rest will allow the tissues to heal themselves by preventing any further stress to the affected area.

Ice should be applied no longer than 20 minutes. The ice may be put in a plastic bag or wrapped in a towel. Commercial ice packs are not recommended because they are usually too cold.

Compression and elevation will help prevent any swelling of the affected tissues.

There are two types of over-the-counter medication that may help with the pain and swelling of arch pain. Acetaminophen (Tylenol) will help with the pain, and a nonsteroidal anti-inflammatory such as aspirin, ibuprofen, or naproxen will help with the pain and battle the inflammatory response. Caution should be taken when using these drugs, and dosage should not exceed the labeled directions. Those who have chronic medical conditions or who are taking other medications should consult with their doctor regarding the most appropriate type of pain and/or anti-inflammatory medications. Arch supports or foot orthotics may also help to ease arch pain.

Medical Treatment

Once the severity and cause of arch and foot pain is determined, a course of corrective and rehabilitative actions can be started.

• Therapists may use machines and/or manual therapies to reduce pain and increase circulation to the area to promote healing.
  

• Maintenance of fitness levels via modification of activity may be prescribed.
  

  • Substitute activities that may aggravate the pain and soreness with other activities; for instance, running causes the body to have multiple impacts with the ground, but the use of bicycling, elliptical trainers, step machines, swimming, or ski machines eliminates impact and allows you to continue to maintain and improve your fitness levels.
    

• Use corrective prophylactic measures.
  

  • Purchase new shoes or replace the insoles of your current shoes.
    

  • Athletic shoes lose the elastic properties of the soles through usage and age. A good rule of thumb is to replace your shoes every six months, more often if there is heavier usage. The use of insoles can increase energy absorption and add support to the foot.
    

  • Corrective foot orthotics may also improve the biomechanics of the foot.
    

• Focus on muscle strengthening and flexibility.
  

  • You may be given exercises to increase the strength and stability of the affected area and to correct muscles that may not be balanced.
    

  • Exercises to increase flexibility will maintain or improve the length of a muscle. Flexibility helps to make a stronger muscle that is less likely to be injured.
    

• Take medications to help reduce foot arch pain and inflammation as prescribed by your doctor.
  

• Follow up with your doctor until you are better.

Heel Pain? Arch Pain?

Heel spurs are one of more common problems faced by Podiatric Physicians.  A heel spur is a point of excess bone growth on the bottom of the heel.  Heel spurs are visible by x-rays.  The spur formation usually starts at the heel bone and extends towards the toes.

An even more common problem that is faced by Podiatric Physicians is Plantar Fasciitis.  This common heel problem is caused by a partial tearing of the plantar fascia (a dense fibrous connective tissue that connects the heel to the toes) usually at the attachment of the fascia to the heel bone.  This partial tear can result in a heel spur, fasciitis, or both.

The most frequent cause of heel pain is an abnormal motion of the foot called pronation.  Normally while walking your foot will strike the ground on the heel, then roll forward toward your toes and inward to the arch.  Your arch should only dip slightly during this motion.  If your heel is rotating outwards too much and your arch is lowering too much then you have excessive pronation.  The excess pronation leads to the arch of your foot stretching excessively.  It is this extra stretch in the arch that causes the partial tearing of the plantar fascia and the possibility of spur formation.

Other factors that may contribute to plantar fasciitis and heel spurs include a sudden increase in daily activity, increase in weight, or a change in shoes.  Dramatic increases in training intensity or duration may cause plantar fasciitis.  Shoes that are too flexible in the middle of the arch or shoes that do not bend in the correct location will also increase the amount of tension on the plantar fascia, as will an increase in weight.  And it is this increase in tension that leads to the partial tearing of the plantar fascia.

Plantar fasciitis is usually controlled with conservative treatments.  About 90% or more of the patients with plantar fasciitis will be controlled with conservative treatments.  Conservative treatments consist of: strapping of the feet, combined with a physical therapy program, and anti-inflammatory.  One of the main things a patient can do is stretching of the calf muscles and icing to the painful areas on the heels.  If the patient improves with the temporary strapping, then the patient would most likely also benefit from an arch support.  There are many types of arch supports on the market today.  The best arch support is a custom made orthotic which will control the excessive pronation and also support the arch taking the tension off the plantar fascia.The orthotics can then worn in a variety of shoes.

If the patients continue to have pain a physician could choose to do injection therapy, which consist of injecting a small amount of cortisone into the painful area trying to decrease the amount of inflammation present.  The patient could receive several injections while still performing the conservative treatment also over a period of several weeks or months.

If the pain still continues for a time period of 6 months or more, despite treatment, the patient may be choose to have a new treatment which uses shock waves.  This new treatment is called, Extracorporeal Shock Wave Therapy (ESWT).   This innovative, non-surgical treatment involves the delivery of sound energy or shock waves to affected areas of the body triggering the body’s own natural repair mechanisms and stimulating healing.  ESWT can be done in the office (low energy) and without the need for anesthetic.

ESWT is a safe and effective treatment option for many kinds of chronic pain associated with tendonitis.  The recovery period is shorter than traditional invasive surgery and the procedure eliminates many of the risks associated with traditional surgery.   Insurance may cover these treatments; however, it would be best to check with your specialist.

For the remaining small percentage of patients who fail to be relieved of the pain, the patient may choose to have surgical correction.  Surgical corrections consist of releasing the part of the plantar fascia from the attachment to the heel bone.  This is done to stop the pull of the fascia on the heel bone, thus stopping the pain.  The physician may also choose to remove the heel spur at this time also. Following surgical correction it will require the patient to be immobilized for a period of time.  The patient will then have the need for rehabilitation later.

In summary heel pain, heel spurs, and plantar fasciitis are common problems that are faced by many patients.  It is a problem that can be controlled and managed without surgery for the majority of the patients suffering from heel pain.

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