Heel and arch pain are the most common foot complaints of individuals over the age of 40. The group that most commonly experiences heel and arch pain consist of middle-aged women. In addition, active athletes and people working on hard surfaces or walking great distances are susceptible to plantar fascitis and developing heel spurs or sore arches. The pain can progressively get worse so that activities of daily living are adversely affected.
Plantar Fascia Defined
The plantar fascia connects to the calcaneus or heel bone on the undersurface of the foot to the bones of the toes. Its purpose is to support the large arch of the foot. When the fascia becomes injured or inflamed, it’s called plantar fascitis.
What Can Cause Plantar Fascitis
Plantar fascitis begins with injury to the ligaments and fascia. The fascia helps to maintain the large arch on the inside of the foot. It may affect one or both feet. In most cases, it begins gradually and may be made worse by the following:
- Poorly Fitting Shoes – Shoes lacking firm shanks and counters allow the foot to override the shoe so it appears like the foot has slid off the sole of the shoe. This is commonly called “running over the shoe”.
- Pronation and Pes Planus – “Flat feet” is a rolling inward of the arch.
- Prolonged Standing on Hard Surfaces Such as Concrete
- Walking, Dancing or Running Great Distances – These result in repetitive strain on the bottom of the foot.
- Being Overweight – Extra weight on the arches is stressful.
- Sex – Females over age 40 are more susceptible.
Symptoms of Plantar Fascitis
The presentation of complaints to the doctor includes heel pain upon arising first thing in the morning. The first dozen steps or so are very painful until the fascia loosens up and becomes more flexible. The pain seems to subside only to get worse as the day progresses.
Diagnosis of Plantar Fascitis
The diagnosis of plantar fascitis is arrived at from a combination of history and physical examination of the foot and lower leg. A classic complaint is heel pain when getting out of bed and beginning to walk. Compression of the calcaneus or heel bone on the sides of the heel is painful. X-rays may be necessary if the doctor suspects a stress fracture to one of the small bones of the foot. Many of the causes of plantar fascitis may contribute to a stress fracture in the foot.
Pain and numbness in the foot at night may also be attributed to a condition called tarsal tunnel syndrome. This is a nerve entrapment in the ankle that may produce similar symptoms as those found with plantar fascitis. Both conditions can bother at night when trying to sleep. Other conditions including arthritis, gout and other systemic problems can also contribute to foot pain.
Chiropractic Treatment of Plantar Fascitits
The immediate treatment goal is to reduce the swelling and inflammation to the soft tissue in the foot. Ice treatment to the foot is initially prescribed. Wearing shoes with a firm counter and shank to prevent bowing of the shoe as well as “running over the side of the shoe” is recommended. Discontinuing running and sports activities reduces stress on the foot. The use of orthotics can be very helpful in restoring the arch (flat foot) and correcting pronation (turning in of the foot). Restoring the arch reduces the stress on the knee, hip and spine. Specific exercises will be given for the foot. The use of Graston Technique, ultrasound or other soft tissue techniques may be helpful. Difficult cases may need a night brace to gently stretch the plantar fascia. In a few instances injections or surgery may be needed, but these are the last procedures to be tried.
It’s difficult for any one treatment protocol to resolve or control plantar fascitis. The combination of proper footwear, treatment, exercise and modification of activity can be successful. Patient compliance is essential to help in the care and treatment. It may take from a few weeks to several months to resolve the problem. Re-injury and aggravation play a large role in the recovery process. The importance of compliance cannot be stressed enough.
If plantar fascitis is ignored and not treated, it may complicate or contribute to ankle, knee, hip and spinal complaints. The biomechanics of gait may be altered.
The doctors at Coon Rapids Chiropractic Office have experience in the care and treatment of plantar fascitis and heel spurs.