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Burton J. Katzen, DPM
"Heeling" Foot Pain
Metro Foot Care Centers
. http://www.marylandfootdoctor.com

"Heeling" Foot Pain

During normal walking, the heel is the first part of the foot that makes contact with the ground. Beneath the thickened skin of the heel is a fat pad that absorbs shock during heel strike. Located underneath the fat pad is a large elastic band (ligament) that runs from the heel bone (calcaneous) through the arch area and divides into thin bands inserting into the toes. This ligament, the plantar fascia, helps support and maintain the integrity of the arch during ambulation.

If undue pressure is placed upon the plantar fascia, partial or complete tearing can occur. This can happen acutely (during exercise or a misstep), or it can happen gradually due to an abnormally functioning foot or gradual weight gain. The term heel spur syndrome is often used to describe anyone with plantar heel pain (plantar fasciitis, rupture of the plantar fascia, or a true heel spur, which is a projection of bone protruding forward from the heel bone).

Characteristically, the patient with heel pain syndrome complains of pain when weight bearing. If left untreated, a plantar fasciitis is more likely to develop into a chronic problem such as a heel spur. This is due to the constant tension of the ligament pulling against its attachment to the heel bone. This repeated tension, over a period of time, might produce microscopic avulsing of bone from the heel along the line of pull of the ligament where it attaches to the heel bone.

Treatment of heel spur syndrome consists of conservative measures in almost all cases of plantar fasciitis and about 90% of heel spur cases. Non-operative treatment usually consists of short-term local or oral anti-inflammatory medications, physical therapy, strappings, orthotics, and, later on, stretching exercises. Heel pads and cushions usually do not work for long periods of time because they are not getting to the underlying etiology of the problem, which is tension on the plantar fascia. There is tension and therefore a pulling force on the ligament with every step you take. This tension must be neutralized for complete healing to take place while still being able to ambulate and carry on normal activities.

It is extremely important to treat a plantar fasciitis early. Remember, you are stretching and damaging the ligament with every step you take. A fasciitis left untreated for many months may take many more months to cure, and in many instances will become a permanent problem limiting your activities and enjoyment permanently.

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