Plantar fasciitis/heel spurs

Plantar fasciitis is a degeneration or microscopic tear of the plantar fascia in your foot. Plantar fasciitis is the most common cause of heel pain. A heel spur is a bony growth protruding from the heel that sometimes accompanies plantar fasciitis.


Anatomy
The heel bone is a major weight-bearing bone of the foot. Attached to the heel bone is the plantar fascia, which is the tight band of connective tissue that runs along the bottom of your foot to help maintain the foot's bony arch. The fascia extends between your heel and the base of your toes. The heel pad is the tissue that cushions and protects your heel's underlying structures.

Causes/associated factors
Although the conditions that lead to plantar fasciitis are not completely understood, weight-bearing activities such as running, jogging or prolonged standing are sometimes to blame. Plantar fasciitis can develop almost anywhere between your heel and toes, but it's most common at the bottom of the foot near your heel.
Heel spurs can develop painlessly as a result of repetitive minor injuries to the heel. They can accompany plantar fasciitis and are more common the longer you have symptoms of plantar fasciitis. Although heel spurs were once blamed for heel pain, only very large heel spurs are now thought to be painful. Typically, plantar fasciitis is responsible for the pain.

Plantar fasciitis and heel spurs can affect people of all ages. The risk increases with:

obesity, weight gain and pregnancy
aging (Heel pads absorb less shock and your ligaments become less elastic as you age.)
sudden changes in typical weight-bearing activities, especially if you switch from being physically inactive to vigorous walking or running activities
changes in running style, such as increasing your mileage too quickly or adding hills to your workouts
improper footwear, such as shoes that are worn out, poorly cushioned or inappropriate for certain activities
certain foot conditions, such as flat feet, high arches, tight calf muscles or a previous heel injury
regularly wearing high heels
walking barefoot on hard surfaces
standing for long periods of time
excessive pronation, an abnormal movement in which the foot rolls too far inward when you're walking or running

Signs/symptoms
The heel pain caused by plantar fasciitis is worse when you first get up after sitting or lying down. It may subside after you've walked for awhile, but it may return later or get worse with prolonged standing, walking or running. The pain may also be worse at the beginning of a workout, but then slowly diminish as you continue to exercise. Other symptoms include swelling and tenderness in the heel.

Diagnosis
The doctor will ask questions about your medical history and do a physical exam. X-rays may be taken, but they're not always helpful. The doctor may recommend a bone scan, in which you're given an injection of a special radio-pharmaceutical preparation. Pictures are taken once this substance is absorbed by the bone, usually within several hours.

Treatment
If you have heel pain, discuss treatment options with your doctor. It's important to begin treatment as soon as possible -- early intervention may lead to a faster, more successful recovery. Patience is key, however. Recovery may take six to 18 months.
Your doctor may recommend resting and staying off your feet as much as possible or avoiding any painful weight-bearing activities. He or she may also suggest taking medication to ease your discomfort (such as ibuprofen) and applying ice several times a day. Physical therapy may help as well. During therapy, youwith supportive arches and cushioned heels or shoes with heel pad inserts, may also be helpful. Itic injections may be prescribed. Steroids are sometimes given by iontophoresis, which uses electrical impulses to deliver the medication through the skin and into the tissues. Surgery is a last resort and is rarely needed.


Pregnancy-specific information
Again, pregnancy can increase the risk of developing plantar fasciitis and heel spurs.

Senior-specific information
Heel pads absorb less shock and ligaments become less elastic with age. Both factors can contribute to plantar fasciitis and heel spurs.

Prevention
Normal physical activity may cause heel spurs and plantar fasciitis to develop. To help prevent heel pain conditions, lose any excess weight and stretch your calf muscles and Achilles tendon several times a day. It's especially useful to stretch after exercising. It's also helpful to wear supportive footwear, such as shoes with good arches and cushioned heels. Replace athletic shoes when the soles begin to wear down. If you do a lot of running or walking, increase distances slowly. Avoid running or walking on hard surfaces, such as concrete. Opt for softer surfaces instead, such as grass or dirt, and limit the time you spend on hilly terrain. If heel pain becomes a continual problem, you may want to consider an alternate form of exercise.