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Chronic Heel Pain Myth Buster

Chronic Heel Pain Myth Buster

Chronic heel pain can be debilitating for many adults. In fact, 10% of the population will experience some sort of heel pain in their life.(1) A majority of the time, heel pain is due to a condition called plantar fasciopathy that is the result of degeneration of the connective tissue under the arch of your foot. The connective tissue called your plantar fascia extends across your arch and connects to your heel which is usually the most common site of pain and dysfunction. The pain may be worse with prolonged standing or walking and is often the most painful when you first get out of the bed in the morning.

IT’S NOT “itis”

Historically, plantar fasciopathy has been referred to as plantar fasciitis. Today, many in the medical community still use this term when describing this condition. But why should we care so much about a few letters at the end of the word? I would argue that this subtle distinction makes a drastic difference on how we should treat this condition. The suffix “itis” indicates an inflammatory process is occurring. Therefore, conventional management and treatment have involved methods to reduce inflammation such as injections, ibuprofen, and rest. However, current research indicates that this condition of the tissue is the result of degeneration of the plantar fascia and not the result of inflammation. (2)

TISSUE DEGENERATION – aka A FRAYED ROPE

Your fascia is composed of a dense network of highly organized collagen fibers, which gives the tissue the strength necessary to support the extraordinary amount of force placed through the arch when walking and is why it is called your arch support. When too much loading or force occurs to your arch and exceeds the strength of the fascia, tearing occurs.(3) Small tears occur each time the fascia is placed under excess stress. These small tears within the plantar fascia weaken the structural integrity of the tissue and create this viscous cycle of further tearing and pain. Think of the fascia looking like a frayed rope as a result. One of the main reasons why this condition is so painful when you take your first few steps in the morning is because this tissue tightens up overnight. As a result, your first few steps are too intense of a stretch on the tissue and cause further micro tearing of the plantar fascia.

SO HOW DO I FIX IT?

We learned that plantar fasciiopathy results from excessive tension on the plantar fascia so treatment should involve reversing the factors that lead to this excessive strain. Sounds simple enough. However, the reason for the excessive strain is dependent on each individual’s unique biomechanical compensations. For example, individuals with higher-arched feet lack the mobility needed to assist in absorbing ground reaction forces. This results in an inability to dissipate the forces once they place their foot on the ground placing this excessive load on the plantar fascia.(4)(5) On the other hand, individuals with lower arches have problems with force distribution from too much motion.(5)(6) Furthermore, if your gluteal muscles are weak, the ability of these muscles to assist with distributing the forces from the ground is reduced placing excessive stress and loading on the fascia.(7)

Therefore, a cookie cutter treatment approach by healthcare professionals is often ineffective. These treatment methods are often futile because effective treatment for this condition depends on how each individual compensates when they move.

If you have been dealing with chronic heel pain that has not been responsive to other methods in the past, React Physical Therapy can help. Each patient is thoroughly assessed to determine how each specific faulty biomechanical movement is contributing to your pain. This allows you to address the cause of your pain instead of just providing symptom relief.

Bibiolography

(1) Crawford F, Thomson C. Interventions for treating plantar heel pain. Cochrane Database Syst Rev. 2003;
(2) Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003;93:234-237.
(3) Fuller EA. The windlass mechanism of the foot: a mechanical model to explain pathology. J Am Podiatr Med Assoc. 2000;90:35–46
(4) Cornwall MW. Common pathomechanics of the foot. Athl Ther Today. 2000;5(1):10–16.
(5) Aquino A, Payne C. Function of the plantar fascia. Foot. 1999;9:73–78.
(6) Kwong PK, Kay D, Voner PT, White MW. Plantar fasciitis: mechanics and pathomechanics of treatment. Clin Sports Med. 1988;7:119–126. [PubMed]
(7) Backstrom KM, Moore A. Plantar fasciitis. Phys Ther Case Rep. 2000;3:154–162.

Kevin Martin

Kevin stresses patient education from day one so that his patients may gain a deeper understanding of how their body works and ultimately develop the self-management techniques necessary for avoiding re-injury.

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