A few weeks ago I got mail from a person saying that he had pain in the ankle/heel area. He told me that it might have been from “Haglund’s disease” and that he was seeking a doctor. I didn’t have a clue what Haglund’s disease was or how it would affect a patient. It might be the way I responded or it might be that the person who sent the mail was busy, but I never got a chance to encounter him in my office. So I decided that it was high time to mention the most common cause of ankle pain: the infamous Plantar Fasciitis.
When you see a ‘~itis’ at the end of a word, it means there’s some kind of inflammation. Plantar fasciitis means there is an inflammation on the plantar fascia. Now all you have to know is what a plantar fascia is; it is a band of connective tissue that starts from the heel bone and goes all the way to the toes. It is a structure that bears body weight.
An athlete doing a lot of running, a person that simply stands for a long time, or a person that is simply overweight (or an overweight athlete that stands for a long time...) may experience this painful state. Greater strain is put on the rather rigid fascias while standing or during continuous activity. This may lead to a small tear or inflammation on the fascia’s attachment site. A continued inflammation and tear to the attachment site may eventually lead to ‘calcification’ – the build up of calcium – of the area, which will lead to a heel spur – another common cause of heel pain.
You most likely have plantar fasciitis in the following cases. If after waking you experience great difficulty putting your foot on the floor due to the intense heel pain. If the heel of your foot is painful after or during a long walk, or if your pain increases with the dorsi-flexion of the foot. There are a lot of ways to diagnose this state. For instance, using state of the art MR scans or simple ultrasonography to the heel. But most diagnoses can be done by clinical measures alone.
Simple deep heat, manual therapy, local steroid injections to the inflamed site, and use of a prefabricated orthotic device can all be options for treatment depending on the severity and the extent of the fasciitis. Treatment must be applied individually, on a case by case basis.
Stretching of the calf muscles and the plantar fascia may be a conservative and rather cliché treatment, but is indeed one of the MOST important ways to approach heel pain. 1) Proper positioning, putting the foot on a neutral position (as shown), and stretching the calf muscles or 2) using a towel to dorsiflex the foot and the calf muscle are other options. This should be done 3 times a day, with each session lasting approximately 3 minutes.
Further info can be read on www.orthopt.org/ICF/Heel Pain-Plantar Fasciitis - JOSPT - April 2008.pdf Feedback to firstname.lastname@example.org will much be appreciated.
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