Plantar fasciitis, One of the Foremost Causes of Heel Pain

Plantar fasciitis is one of the most common causes of heel pain. Both heel pain and heel spurs are frequently associated with an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. The inflammation is called plantar fasciitis. It is common among athletes who run and jump a lot, and it can be quite painful.

The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where it attaches to the heel bone.

When excessive force is applied to the arch of the foot, that force is transferred to the plantar fascia, which can become irritated and inflamed.  The cause of the irritation involves multiple factors.  A combination of over pronation in the feet, unsupportive footwear and overuse can cause microscopic tears in the plantar fascia that begin an irritation and inflammatory process.  In turn, the inflammation causes pain where the plantar fascia inserts on the heel bone.  This condition is prevalent in runners, overweight individuals, and pregnant women with inadequate support from shoes.  Commonly felt in the morning while taking the first couple of steps out of bed, plantar fasciitis causes pain described as feeling like a sharp dagger, stone bruise, deep throbbing or dull ache.

Conservative treatment therapies for plantar fasciitis include icing, stretching, heel lifts, supportive shoes, weight loss, orthotic devices and night splints.  Stretching is one of the most important therapeutic measures that should be performed multiple times a day, especially before stepping out of bed.  Having supportive footwear is also a critical measure.  A shoe which is too soft and flexible will strain the plantar fascia while weight bearing.  Orthotic inserts can be placed in a shoe in order to control abnormal foot motion and prevent arch collapse, both of which stress and tear the plantar fascia.  Individuals with tight calf muscles causing an early heel lift during gait could benefit from a heel lift.  Finally night splints can provide valuable healing time when resting as they help keep the plantar fascia stretched out. The calf and plantar fascia contract and tighten while sleeping.  When full body weight is applied to the foot when stepping out of bed, the plantar fascia overstretches and tears.

Conquering Morton’s Neuroma: Conservative and Surgical Treatment

Do you ever feel like you are walking on a bruise? Maybe you are experiencing shooting pain or numbness between your toes, particularly when you have your shoes/sandals on? These symptoms are common in a condition known as Morton’s Neuroma. While the exact cause is unknown, this condition is typically exacerbated by wearing shoes that don’t fit you properly. This condition is most commonly seen in between the third and fourth toes, but can occur in between any of the toe interspaces in the foot. Most importantly, you need to make sure that your shoes have enough room in the toe box. Therefore, a wide shoe with good support is most appropriate.

Your podiatric physician will first assess your condition with a physical exam. X-rays will be taken to rule out more serious bone problems and if needed, MRI or diagnostic ultrasound will be used to assess the nerves and surrounding soft tissues. Morton’s neuroma will appear as a thickening or enlargement of the nerve tissue which is complicated by the repetitive movements of walking or squeezing your feet into shoes that are too small. Symptoms will vary among patients however it is not uncommon to experience burning and shooting pain in the toe area.

The first goal is to get you some immediate pain relief and attempt to stop it from reoccurring. This is accomplished through ‘conservative treatment’. There are a number of options regarding conservative care that are available including; Orthotics, change of shoes and Physical Therapy that Dr. Garvin can do before moving on to more invasive treatments, such as injections or surgery. Orthoses treatment consists of fitting your shoes with a custom made moldable device that will alleviate the areas of highest pressure, which in turn alleviates the symptoms caused by the painful neuroma.  If one of these conservative treatments does not eliminate the problem, your podiatric physician will discuss the more invasive surgical treatment with you. This type of treatment is usually considered a ‘last resort’ as there is the chance of complications with any surgical treatment. If the problem progresses to this stage, the damaged nerve will be removed while you are under sedation and effectively eliminate the pain.

Just remember, a trip to your specialist does not have to involve surgery. Our goal here at Foot and Ankle Specialist of the Treasure Coast is to keep you healthy and walking comfortably. There are often many conservative options for treatment with surgery typically the last one implemented. So stay healthy and keep your feet pain free!