Plantar fasciitis is an inflammation of the plantar fascia (thick band of fibrous tissue) at the insertion into the bottom surface of the heel bone. In a small percent of people a spur develops at the insertion of the plantar fascia. The pain is due to the plantar fasciitis and not the spur.
Cause
Plantar fasciitis is caused by excessive pulling and tearing of the plantar fascia. This is usually due the following:
Faulty foot mechanics such as abnormal pronation (feet rolling in). This causes inflammation and pain.
Very high arched foot (pes cavus)
Dropped arches
Direct impact injury
Tight calf muscles and plantar fascia
Signs and Symptoms
Pain in the bottom surface of the heel
Sometimes pain in the arch of the foot
Often the Pain is intense upon standing after long periods or sitting or lying down
Sharp stabbing pain
Dull ache
X-rays may show a heel spur. Plantar fasciitis causes the spur. The spur itself does not produce the pain.
Treatment
Orthoses/Innersoles - The orthotics prescribed and designed by our Newcastle podiatrists at Beyond Podiatry are made to align the foot in the correct posture. This will reduce excessive pulling and tearing on the plantar fascia and heal the tear and inflammation at the insertion into the heel bone.
Strapping and padding - We incorporate a strapping technique specifically for plantar fasciitis, which combines the use of padding and sports tape.
Anti-inflammatory medications - only if this does not have adverse results with the patient's current medication.
Rest or Reduced Activity - All weight bearing activity including sport, walking, standing for long periods should be reduced until you are pain free.
Ice (apply on heel for 15 to 20 minutes every day)
Supportive Footwear - We work with many shoe shops that specialise in shoes for painful feet and orthotics.
Cortisone Injections - The local injection of corticosteroids can give temporary or permanent relief. The injection should be performed under ultrasound guidance to ensure accuracy of the insertion of the needle. Patients should be aware that local cortisone injections weaken tissue and can result in further tearing of the plantar fascia. Cortisone injections will be organised as a last resort.
Surgery - Modern and minimally invasive surgical procedures should only be used to treat recalcitrant plantar fasciitis. Surgery will only be offered after we have exhausted all conservative treatments.
What is a heel spur? A heel spur is a bony growth under the heel bone. Heel spurs result from excessive pulling and tearing along the plantar fascia (thick band of fibrous tissue) that inserts into the bottom surface of the heel bone. This results in plantar fasciitis (inflammation at the insertion of the plantar fascia) and is the cause of the heel pain. This is usually caused by a biomechanical imbalance in the foot. Therefore, a spur is the end result of excessive pulling on the plantar fascia and not the cause of the heel pain.
Achilles tendonitis is an inflammation of the Achilles tendon which attaches the calf muscles to the heel bone.
Cause
Excessive stress on the Achilles tendon can cause micro tears and inflammation in the tendon. In some people this stress can lead to a rupture or complete tear of the tendon.
Excessive stress on the Achilles tendon can be caused by one or more of the following:
Overuse injury. This is often seen in runners, and basketball, netball and football players
Tight calf muscles are a contributing factor
Over pronation (feet roll inwards) is the most common cause of Achilles tendonitis. It causes the lower leg to excessively internally rotate, placing an excessive strain on the calf muscle. This inturn over stretches the Achilles tendon resulting in inflammation and pain
Over supination (feet roll outwards)
Signs and Symptoms
Pain and tenderness in the Achilles tendon region. The pain could be on the lateral (outside), medial (inside) and/or centre of the tendon
Orthotics - The orthotics prescribed and designed by the podiatrists at Beyond Podiatry in Newcastle are made to align the foot in the correct posture. This will reduce excessive pulling and tearing on the Achilles tendon and heal the tear and inflammation in the tendon
Sever's Disease (Calcaneal Aphophysitis) is not a disease, but a repetitious strain injury common in children between the ages of 8 and 14 years old.
It is a common cause of heel pain, particularly in the very active child. Patients with Sever's disease complain of pain in the bottom surface region of the back of the heel. This is where the growth plate is located, and is not fully developed or calcified in a child's foot.
Cause
Sever's Disease is a repetitive strain injury caused by the following:
High impact injury activities and sport like netball, football, soccer, hockey, basketball, running, jumping and tennis
Tight calf muscles
Poor mechanics, structure and function of the foot
Excessive pronation
Rapid growth spurt
The above causes tension, inflammation and pain where the Achilles tendon inserts onto the calcaneus (Back/bottom surface of the heel bone).
It is important that this problem is treated and monitored until the growth plate ossifies in the heel. This could occur between the ages of 14 and 16 years of age.
In extreme cases the growth plate can become separated from the calcaneus.
Signs and Symptoms
Pain in the bottom surface and at the back of the heel
Extreme pain when the child places their heel on the ground
The pain is aggravated when running or jumping on hard surfaces
The pain is reduced when the child walks or runs on their toes
Treatments
Orthotics - The orthotics prescribed and designed by the podiatrists at Beyond Podiatry in Newcastle are made to align the foot in its correct foot posture. This will reduce stress and force at the site of the growth plate of the heel bone
Rest and Ice the heel 20 minutes before and after sporting activity
Our Newcastle Podiatrists have extensive knowledge and expertise in all areas of Podiatric treatment and are registered with the Australian Health Practitioner Regulation Agency. Our clinics are compliant with and exceed Australian Standards for sterilisation of all instruments used.
