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Symptoms & Pathologies



Plantar Fasciitis:

Description:

The two most common causes of pain in the bottom of the heel and arch are heel spurs and plantar fasciitis. The plantar fascia is the thick ligamentous band in the bottom of the foot which is attached to the heel, and runs forward to insert into the ball of the foot. Plantar fasciitis is an inflammation of this band atPlanar fascia its attachment to the heel.

Symptoms:

Plantar fasciitis pain is usually located in the center or the inner side of the bottom of the heel. The pain is most intense when first standing, after any period of rest. Generally, people with this problem experience their greatest pain in the morning, with the first few steps after sleeping. After several minutes of walking, the pain becomes less intense and may disappear completely, only to return later with prolonged walking or standing. If a nerve is irritated due to the swollen plantar fascia, this pain may radiate into the arch or the ankle.

Causes:

Each time we take a step forward, all of our body weight first rests on the heel of one foot. As our weight moves forward, the entire foot begins to bear the body's weight, and the foot flattens and this places a great deal of pressure and strain on the plantar fascia. There is very little "give" to the plantar fascia, so as it stretches only slightly, it pulls on its attachment to the heel. If the foot is properly aligned this pull typically causes no problems. However, if the foot is "pronated" it causes an abnormal stretching of the relatively inflexible plantar fascia, which in turn pulls abnormally hard on the heel.

The same pathology occurs with "supination" (the rolling of the foot outward, causing a break down of the outer side of the shoe). Supinated feet are relatively inflexible, usually have a high arch, and a short or tight plantar fascia. Thus as weight is transferred from the heel to the remainder of the foot, the tight plantar fascia does not stretch at all, and pulls with great force on its attachment to the heel.

In both cases, the abnormal stress placed on the attachment of the plantar fascia to the heel usually causes pain, inflammation, and swelling. If this process continues, the plantar fascia partially tears away from the heel. The body will fill in this torn area with calcium; eventually it becomes bone, and a Pronationheel spur results.

Treatment:

Treatment must be directed towards realigning the foot as it goes through the gait cycle, and reversing the abnormal effects of pronation and supination on the plantar fascia and heel. In doing this, the abnormal pull of the plantar fascia on the heel will be made to disappear. This in turn, alleviates the pain and inflammation at the heel. Realignment, or proper postioning of the foot, is accomplished through the use of orthotics. Custom-made orthotics gently hold the foot in a proper or neutral alignment when it strikes the ground, preventing pronation or supination. Custom-made orthotics will also: reduce the pull of the plantar fascia on the heel, by supporting the arch; and cushion the heel, to provide an immediate decrease in pain. Custom-made orthotics will not only relieve the pain, but they will also prevent it from returning.

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