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Topic of the Month -
February 2009
Heel Pain - Plantar Fasciitis
Also known as Policemans Heel
or Policemans Foot
Plantar fasciitis is a painful condition that usually comes on without much warning. It is often called "heel spur", or "policeman's heel" and it is easy to imagine that there is something digging in to your heel.
If you take off your shoes and socks and examine the sole of your foot you will feel a thick band of flesh that connects the ball of your foot to the inside edge of your heel. You can feel it more easily if you pull your toes back with one hand while you palpate the sole of your foot with your other hand. This is the plantar fascia.
As you can feel, the plantar fascia is quite thick and tough. It needs to be strong to cope with your bodyweight when walking or standing. If anything does go wrong it tends to be where the fascia attaches to the heel bone.
The typical symptoms of plantar fasciitis are stabbing pain first thing in the morning when you get up, it then eases off and becomes a milder ache for the rest of the day. Then the same thing happens the next morning, and so on. It may stay the same for a long time, it may get better on its own or it may get worse.
The sharp pain is caused by fibres tearing near the heel bone. At night when you are lying in bed the injured fibres start to heal and then in the morning when you get up they are torn apart again.
So why does this happen
Why does the sole of your foot suddenly decide to cause problems?
I think the reason can be found by looking at how the plantar fascia is constructed. Like all connective tissue in the body there are two main components: elastin and collagen. Elastin is springy but not very stretch resistant, collagen is strong but not very stretchy. Together they give a good mix of strength and flexibility. All living tissue in the body is continually replaced, old cells die and new cells take their place. As we age unfortunately the quality of collagen tends to reduce and our tissues get weaker (this is why wrinkles appear and why healing takes longer when we get older). When the plantar fascia can no longer cope with the force it has to bear it starts to break down and the thinnest part is near the heel so that is where it gets injured most easily.
Who is most likely to suffer
Middle aged and older people who stand a lot or who are on their feet all day seem to be affected most. It is unusual for young people to get plantar fasciitis. If you have flat feet and/or tight calf muscles you will be more susceptible.
What can I do to help
Three things:
- Specific stretches to calf muscles if they are part of the problem
- Acupuncture to relieve the pain
- Referral to a Podiatrist for a biomechanical examination to find out if dropped arches or other foot problems are causing the condition. If necessary I will recommend you to Sue Ferguson, Chiropodist and Podiatrist, www.sueferguson.co.uk who can provide custom made orthotics and advice on day and night splints. See also Superfeet insoles for ready made insoles
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