Living With Plantar Fasciitis

From Dr . Tim Rindlisbacher of the National Post

Every sport has its signature injury. "Tennis elbow" is famous. But if it's true that life is a sort of sport, then heel pain seems to be its companion. It's a pesky ailment that can hang on for weeks and frustrate the professional athlete as much as the average couch potato.

"Heel pain is treatable," says Cleveland Clinic Canada chiropodist, Megan Grantham. "But it helps to know something about what causes it."

Most heel pain is of the type that goes by the name plantar fasciitis. It's named after the plantar fascia, a thick ligamentous structure that's stretches like a bowstring from heel to toes, and supports the arch of the foot. When the foot bears weight, this supportive tissue stretches and becomes taut in a movement that is called "pronation."

"We pronate with every step we take," Grantham says. "The trouble starts with excessive or awkward pronation."

A sudden increase in running, jumping or other high-impact activity can pull and twist the plantar fascia, causing tiny micro-tears, inflammation and searing pain. (People whose feet are "flat" are at particular risk for plantar fasciitis.)

The pain may extend along the bottom of the foot, but usually hurts most at the heel.

"Abnormal pronation pulls at the heel -- the plantar fascia's weak point of insertion," Grantham says. "In some cases, this may provoke the heel to grow extra bone in an attempt to reduce the tension. This extra bone is called a heel spur, and it can itself be painful."

Plantar fasciitis is almost always at its worst early in the morning as sleep causes it to stiffen and weight bearing suddenly stretches it with the first steps of the day. After a long day on your feet, the pain may return in the evening.

"At the bottom of every case of heel pain is a biomechanical problem," Grantham says. "This is something we can identify, analyze and solve."

Today, plantar fasciitis is more treatable than ever. Custom foot orthotics (special shoe inserts) can correct awkward pronation and redistribute weight away from the heel. Physiotherapy that addresses movement of the soft tissues of the foot and nearby leg muscles is also valuable.

"It's not unusual for patients to improve in as little as two weeks with a combination of orthotics and physiotherapy," says Grantham.

So don't let inflamed tissue turn you into a tenderfoot. Find the proper medical professionals and you will be able to walk away from your heel pain.

- Tim Rindlisbacher, BSc (PT), MD, Dip. Sport Med., is director of Sports Health at the Cleveland Clinic in Toronto.

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