Heel pain – adult/plantar “fasciitis”

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There is a very painful condition that seems to show up out of nowhere that attacks the inner-bottom part of the heel.

The tell-tale sign that you have this condition is that there is no pain when you are not standing on your foot, and there is pain when you first stand or begin to walk. This pain, for example, occurs when getting out of bed in the morning or after being off your feet for a while. The pain doesn’t last long, at first, but as this disease process progresses, the pain will last longer and longer.

This can be a very frustrating, never-ending condition. A quick online search will tell you it can take a year or longer for the pain to “go-away.” Some sites give advice just to “wait it out.” But does that make any sense? Do you want to limp in pain for up to a year or longer? Do they realize not only the negative impact on one’s activity level but what it means to live in constant pain? There is a tremendous negative impact on one’s mental health knowing that they are going to experience sharp shooting pain in the inner heel when they first get out of bed in the morning, or when they get out of their car after driving home.

The range of treatments of heel pain is numerous. There are many forms of conservative, non-surgical options to somewhat radical operations. Some may find relief from these treatments, but the majority of people suffering from chronic heel pain seem to never find a long-term solution, even after heel surgery. The reason why heel pain has historically been such a difficult condition to “fix” is because this diseased tissue occurred as a result of a pre-existing orthopedic deformity.

Pain is a warning signal that something is wrong. The nerve sensors have been activated as an alarm that tissue damage is occurring and it needs attention. Imagine the smoke detector making the loudest noise you ever heard because it detected smoke – a fire. What if you choose to ignore the fire and only try to stop the detector from making that annoying noise? You put earplugs in your ears, pillows over your head, or you just went and cut the wires to the smoke detector. That might stop the noise, but what caused the smoke? Was there a fire in the house? This is basically what is happening in treating heel pain. The majority of attention is directed to pain reduction while little to no attention is directed to eliminating the underlying cause of heel pain.

What is plantar “fasciitis”?

foot with visible plantar fascia

Plantar is the medical term for the bottom of the foot. The fascia (pronounced fa-she-ah) is a very strong, thick ligament-like tissue. The plantar fascia is a strong band of tissues that connects the bottom of the heel to the ball of the foot. Its purpose is to help support the arch and to put a slight spring in your step. There is a disease of the fascia tissue that unfortunately has been called “fasciitis.” The reason why it’s unfortunate is that the “itis” at the ends means it an inflammation problem. Doctors have been treating it like the fascia is inflamed. The only problem is that tissue analysis has shown this not to be the case. Rather, what is happening is that the fascia tissue is developing micro-ruptures just slightly in front of its attachment to the heel bone.

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Why does the plantar fascia develop micro-ruptures?

We’ve known for a very long time that this kind of heel pain is due to a faulty foot structure. There is excessive strain acting on plantar fascia tissue. There have been many other theories as to the cause of heel pain. One of the biggest myths is the old “heel spur.” Yes, that heel spur can look quite painful, but that myth was busted a long time ago. Many people are walking around with the biggest heel spurs you ever saw, but they’ve never had a second of heel pain. The reason why the spur grows is that the fascia has been pulling on the lining of the heel bone. A spur is a form of compensation to lessen the strain on the fascia tissue. The spur shortens the pull on the fascia band of tissue.

What is the source of plantar fascia strain?

There has been this mystery of what exactly causes plantar fascia strain. Many have said it is due to flat feet, yet many people have chronic heel pain but have a somewhat normal appearing arch. Most physicians agree that over-pronation is the key factor, but they don’t really understand what causes over-pronation. The real underlying cause that creates an excessive strain on the plantar fascia is the partial dislocation of the ankle bone. The problem is that when a physician orders x-rays of a person’s foot with heel pain, they are just making sure that there isn’t a broken heel bone. They are also looking to see if the heel spur is present. The focus is on the bottom of the heel where the plantar fascia attaches to the heel.

The source of the plantar fascia strain starts with the partial dislocation of the ankle bone on the heel bone. The ankle bone dislocates downward, forward, and inward pushing the bones of the forefoot away from the heel bone.

Let’s take a closer look

Now let’s see what’s happening on the outside of the foot.

Ankle bone dislocation has been occurring since childhood. In a 10-year time-frame, the average person will take over 18 million steps. In other words, the plantar fascia is being over-stretched 18 million times. Fast forward to the day when someone reaches their 40th birthday – at that point, the average person has taken over 72 million steps. Guess what the average age is when someone develops plantar fasciitis? Yep, they are around forty years old.

What is the best form of treatment of chronic heel pain?

The leading cause of strain to the plantar fascia is ankle bone instability. It makes sense that the prescribed treatment should include a measure to eliminate or reduce the strain to the plantar fascia. Ninety-nine percent of heel pain treatments are focused on the symptoms of heel pain, not the underlying cause. That is why the majority of conservative treatments are temporary. Yes, they can be effective for a little while but the problem is that the underlying cause of plantar fascia strain is still present. Every step that is taken places more strain onto the fascia. Unfortunately, many people are taken to the operating room to have the plantar fascia detached from the heel bone, plantar fasciotomy. This was thought to eliminate the pain but this is not always the case. Many published articles show that individuals still have pain after surgery. Even worse are the aftereffects of cutting the most powerful stabilizer of the arch. The ankle bone instability is still present exerting its strain on the foot. Other tissues will have an even greater amount of strain placed on them, specifically the posterior tibial tendon. Eventually, the foot/arch continues to collapse until it completely flattens. The best choice of treatment, if it is an option, is to internally stabilize the ankle bone with HyProCure. This is the ONLY treatment option that has been proven to decrease the strain on the plantar fascia while still allowing a natural ankle bone motion (DOI: 10.1053/j.jfas.2011.07.005). The plantar fascia strain is eliminated/reduced immediately and is left intact. Hopefully, the damaged fibers will heal, and the plantar fascia will be able to resume its job of stabilizing the arch of the foot. Before having your fascia detached from the heel, see if you are a candidate for HyProCure.

What happens if you don’t address ankle bone instability associated with heel pain?

There are many forms of treatment that are given to people suffering from plantar fasciitis. If by some miracle the heel pain goes away without stabilizing the ankle bone, that is great. However, you need to realize the excessive ankle bone motion is still present and it will continue to lead to excessive strain to other parts of the foot. When a ligament and tendon continue to be over-stretched with every step, it will either stretch out or partially rupture. The plantar fascia tissue is the same.

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