Plantar Fasciitis: A Common Source of Heel Pain

By Dr. John A. Papa, DC, FCCPOR(C)

 

Plantar fasciitis is caused by injury to the plantar fascia, which is the tendon-like soft-tissue along the bottom of the foot that connects your heel bone to your toes.  This condition is a common source of heel pain that can be quite disabling.

 

Plantar fasciitis usually develops gradually, but it can also come on suddenly.  Sharp, knife-like pain on the inside-bottom part of the heel is often characteristic.  Pain and discomfort can also extend into the arch of the foot.  Heel pain tends to be worse with the first few walking steps in the morning, and after extended periods of sitting or inactivity.  If plantar fasciitis becomes severe or chronic, heel and/or arch pain will be present with all weight bearing activities, and may result in secondary areas of discomfort in the foot, knee, hip or back due to compensatory movements.

 

Under normal circumstances, your plantar fascia acts like a shock-absorbing rubber band, supporting the arch of your foot.  Excessive tension and repetitive stretching can create small tears in this soft-tissue fascia, causing it to become irritated or inflamed.  This may occur with activities that require running, jumping or prolonged walking and standing.  Improper footwear can make the plantar fascia more susceptible to stretch and strain during these activities.

 

Faulty foot mechanics may also contribute to the development of plantar fasciitis.  Individuals who excessively pronate (role feet inward) or are flat-footed will experience extra mechanical strain on their plantar fascia.  Old lower extremity injuries such as ankle sprains and fractures increase risk due to altered lower limb movements.  Heel and arch pain tends to be more common in middle and older aged people.  With aging, the arch of the foot begins to sag, putting stress on the plantar fascia.  Being overweight is also a risk factor.  Carrying extra pounds can break down the protective fatty tissue under the heel bone, causing heel pain and putting additional mechanical load on the plantar fascia.

 

Self-care strategies for reducing the pain of plantar fasciitis include: ice application; rolling a tennis ball or soup can from your heel and along the arch of your foot; and gentle stretching of the achilles tendon, calf muscles, and plantar fascia.  Gel or “donut pads” placed under the affected heel(s) in shoes may also provide relief.

 

Plantar fasciitis that does not respond to self-care strategies may require professional treatment.  This can include electrotherapy, manual and soft tissue therapy, and specific rehabilitative exercises.  A custom made orthotic may also be helpful by minimizing pronation, cushioning the heel, and supporting the arch.

 

It is important to establish an accurate diagnosis of plantar fasciitis.  Other causes of heel pain may include stress fractures, achilles tendonitis/bursitis, arthritis, gout, or nerve irritation.  If you are having difficulty with heel pain, a qualified health professional can determine the cause of your pain and prescribe appropriate therapy and rehabilitation strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.

 

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Tennis Elbow...Minus the Tennis!

By Dr. Greg Lusk, DC

"Tennis Elbow" is the common term for lateral epicondylitis, which refers to an overuse muscle strain injury of the tendons that attach to the outside of the elbow.  This is in contrast to "golfer's elbow" where pain is experienced on the inside of the elbow.  Despite its name, most cases of tennis elbow are not related to tennis but to other causes of stress and strain to the elbow.  Repetitive gripping or leveraging activities are common culprits as muscles involved in these activities attach to the bony bump on the outer elbow.  Occupations or activities with repetitive hand use, such as carpentry, weight training, and even constant computer mouse use can contribute to development of this condition.

The symptoms of tennis elbow may include pain at the bony bump on the outside of the elbow and possibly down the back of the forearm to the wrist.  Pain is often experienced with gripping activities and even things as simple as holding a cup of water can become quite painful, requiring the assistance of the other hand to support the load.

 

Early on (i.e. within the first few weeks), self care efforts such as icing, avoiding aggravating activities, and the use of pain medications may be sufficient to ease the pain.  However, if the pain persists, which is quite common, it would be appropriate to seek treatment to help get things under control.  In fact, the longer this condition lasts the less likely the pain is due to inflammation in the soft tissues but rather to degenerative changes in the tendon.  This is true for all tendon injuries and at least in part explains why long term ice and anti-inflammatory medication use may not be effective beyond their "pain killing" benefits.

Management of a degenerated tendon is different than that of an inflamed tendon as the tendon structure has become disorganized and scar tissue is present, in the absence of inflammatory markers.  Healing and regeneration of the tendon must be facilitated and conservative treatment to assist this may involve the following techniques and strategies. 

·        Manual or tool-assisted soft tissue therapies are effective at breaking up scar tissue, improving blood and lymph movement in the tissues, decreasing tissue tension, and improving relative movement of one tissue across another.  Also, the micro trauma caused by the soft tissue treatment itself helps to restart the healing process with the end goal being a healthier, more properly organized tendon structure.

·        Eccentric exercises.  This refers to the part of an exercise movement where the muscle is lengthening while maintaining control of the weight.  Research shows this increases protein production in the tendon which is important for healing.

·        Other treatments, such as acupuncture or electrotherapies, may help at promoting healing and managing the associated pain.

·        Adequate rest is important to let the structural damage to the tendon heal.

·        Looking at the aggravating activities and modifying things to decrease the load imposed on the tendon.  In the case of tennis, there may be swing or footwork improvements that can be made which will decrease strain at the elbow.

 On a final note, if the above ideas or other treatments directed at the elbow are not yielding positive results after a fair trial period, it would be worth having your shoulder and neck assessed as anatomy located here can cause pain at the elbow and may be the ultimate source of stubborn elbow pain.

This article is for general information purposes only and is not to be taken as professional medical advice.