The plantar fascia is a fibrous band of tissue on the bottom of the foot that connects the heel bone to the base of the toes. It forms and supports the arch of the foot. When tension on the fascia becomes too great, it swells and causes pain. This is what is known as plantar fasciitis (or plantar aponeurosis). It is the second most common cause of foot pain in Canadians and generally affects sports enthusiasts.
When plantar fasciitis develops into a chronic condition, meaning that it persists over an extended period of time, a heel spur may develop. A heel spur, also known as a calcaneal spur, is a small piece of bone that forms where the fascia meets the heel, under the foot. If large enough, a heel spur can be felt through the skin and will cause unpleasant localized pressure. The pain that one feels is not really due to the heel spur itself but rather the inflammation of the plantar fascia. Once the inflammation disappears, the heel spur remains (it is a bone) but does not generally cause any pain.
Plantar fasciitis and heel spurs are usually the result of excess weight on the feet. That being said, the most common risk factors include:
- Sports such as running, jumping, tennis, aerobics, etc.
- Walking or standing on hard surfaces for extended periods;
- A foot injury such as falling or landing on one's heels;
- Flat feet, high arches or mechanical misalignment;
- Age - over time, the plantar cushions become less effective at absorbing shocks;
- Inadequate or ill fitting footwear.
Plantar fasciitis, with or without a heel spur causes heel pain, especially on the inside part of the bottom of the heel. The pain is more intense first thing in the morning or after an extended period of inactivity and tends to disappear during the day. The pain typically reappears as soon as one engages in physical activity.
Plantar fasciitis is a disorder that is diagnosed by a physician. It is important to see a physician as soon as symptoms appear since the healing process takes several weeks. The faster you see your healthcare practitioner, the easier it will be to treat the condition. The physician may ask for additional tests since heel spurs show up on X-rays.
Plantar fasciitis is mainly characterized by inflammation. Treatment is therefore focused on resting the foot and allowing it to heal. Sufferers can take over the counter anti-inflammatories such as aspirin or ibuprophen (ex. Advil™, Motrin™). To relieve more intense pain, the physician may prescribe cortisone injections in the heel. Such treatments are quite painful but offer longer-lasting relief.
To stimulate blood flow in the foot, light stretching exercises are also recommended. To reduce discomfort when walking, orthotics or insoles that provide added cushioning in the heel can be worn. Such products may offer additional relief during flare-ups or when the heel spur is very pronounced. Although these types of insoles may help, they do not treat the disorder and may even worsen and aggravate the situation in some.