Heel pain is a common physical complaint affecting about 10 percent of Americans. The pain may be mild or severe, making it difficult to perform the normal activities of daily life. While there can be several different sources of heel pain, the most common is a condition called plantar fasciitis.
The plantar fascia is a tough, flat band of connective tissue that runs underneath the foot, attaching the heel to the bones of the foot. It helps coordinate the motions of the foot and ankle, and may also work as a shock absorber for the body.
In plantar fasciitis, the fascia becomes swollen or irritated through injury or overuse, making it painful to walk. The band may shorten during the night, so symptoms are usually worst immediately upon arising in the morning and usually subside after activities that stretch it.
People describe the pain as sharp and stabbing, and they typically indicate that the pain is on the underside of the heel or in the arch of the foot. Walking – especially the first few steps after a lengthy period of inactivity or sleep – makes the pain worse.
Plantar fasciitis is not a simple problem; there may be many contributing factors.
An abrupt, traumatic injury may damage the fascia causing swelling and pain.
Long-distance runners are at greater risk since their feet repeatedly strike the ground with increased force, creating multiple small tears in the fascia. Another high-risk group is people with a sedentary lifestyle. Especially vulnerable are the “Weekend Warriors” who suddenly increase their level of physical activity after days or weeks of rest and inactivity.
If posture is poor or if feet and legs are not optimally positioned during activities like walking or running, it can also damage the fascia. For example, the feet may roll slightly inward (pronation) or outward (supination), putting unusual stresses on one side of the band. Similarly, the knees or hips may be misaligned during movement. Gait aberrations can have a major impact on the health of the underlying physical structures of the body, including the plantar fascia.
Have flat feet, or conversely, having high arches may predispose the foot to injury.
Jobs that require standing for long periods of time on hard surfaces can create excess stresses on the underside of the feet. One example of this type of occupation would be classroom teachers.
Age and obesity and both correlated with heel pain and plantar fasciitis. This makes sense because the connective tissue may lose its flexibility over time, and heavier weight compresses the fascia, which may damage it.
Of course, vitamins and minerals can also play a role. Shortages of iron, magnesium, calcium, or B vitamins may affect the health of the connective tissue.
One of the hallmarks of stress is muscle tension. When muscles are tense, they contract, becoming shorter and tighter. This contraction worsens plantar fasciitis.
Many other parameters may affect heel pain, for example, arthritis, circulatory problems, and endocrine disorders such as diabetes, which may damage the nerves.
Plantar fasciitis may be a chronic issue, and recommended treatment regimen varies by practitioner. Unfortunately, effectiveness is sporadic, and success is often only temporary. Some of the more common treatment modalities include: stretching exercises or devices, orthotics or other adjustments to footwear, steroid injections, acupuncture, acupressure or massage.
Therapy has traditionally been focused on the exact site of the heel pain. However, new approaches are beginning to address a wider region of the body, with the idea that the source of the pain may not be localized to the heel.
It may be useful to think of the body as a marionette with a string tied to the foot. The string goes up the back of the legs, through the spine and up to the neck and head. Just like the string in the marionette, the strings of connective tissue and muscle in the human body join to form a single continuous system. Pulling the string in one location affects the entire system.
Movement is a coordinated series of actions involving the whole body, which is why an aberrant gait can create pain in multiple locations. Instead of assuming that heel pain originates only in the heel, it makes sense to consider that there could be irritable spots anywhere along the integrated system. These hypersensitive spots in the skeletal muscle, called myofascial trigger points, may create dysfunction anywhere along the leg but may ultimately be experienced as heel pain.
Practitioners are beginning to pay attention to these trigger points and to manipulate them to treat plantar fasciitis. The results have been exciting. Case studies using both acupuncture and ischemic compression therapy suggest that treating trigger points along the muscle lines may have profound effects upon plantar fasciitis pain. In some cases, patients have reported immediate pain relief as well as a feeling of lightness.
Because plantar fasciitis is a complicated problem with many contributing factors, therapists cannot use a single-focus solution. Applying treatment along the entire line of integrated muscles and connective fibers holds great promise.
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