Plantar Fasciitis, Heel Spurs, Heel Pain

Plantar fasciitis usually develops gradually. Heel pain may only occur when taking the first steps after getting out of bed or when taking the first steps after sitting for a long period of time. If the plantar fascia ligament is not rested, the inflammation and heel pain will get worse. Other conditions or aggravating factors, such as the repetitive stress of walking, standing, running, or jumping, will contribute to the inflammation and pain. In some cases, the inflamed ligament may not heal because many people who have plantar fasciitis do not completely stop the aggravating activity.

Most people develop irritation and inflammation of the plantar fascia because of “overuse” of their feet by excessive running, jumping, jogging or twisting of the feet, resulting in excessive pronation (inner turning of feet). The injury may also result in small tears of the plantar fascia.

The pain is described as being dull aching or sharp and can be reproduced by flexing the toes upwards (dorsiflexion) and tensing the fascia. Symptoms tend to worsen after standing and walking, in the morning, after awaking or after prolonged sitting. This happens because the fascia is being stressed again after a protracted rest. As the person walks, the fascia “warms up” and lengthens slightly, reducing the tension and the associated pain.

The repetitive stretch of the fascia over years can also irritate the insertion site of the fascia to the heel bone and lead to the ingrowth into the soft tissue of the heel of a hook-shaped spur of the heel bone. A common misconception is that the heel pain is mostly due to the bone spur. The truth is that the pain is due primarily or exclusively to the inflammation of the fascia (plantar fasciitis) and not to the bone spur because significant heel pain occurs in the absence of spurs, and large bone spurs can be detected by X-rays in people with no heel pain.

Plantar Fasciitis Risk Factors:

Risk factors that may increase the chance of developing plantar fasciitis include:
Being middle-aged.
Having an abnormal step or abnormal foot biomechanics, such as high arches or flat feet.
Having a sudden weight gain, or being overweight.
Having tightness in the Achilles tendon, which attaches the calf muscle to the heel bone.
(Also see Achilles Tendonitis)

Certain habits or activities:

Wearing shoes with poor cushioning.

Walking or running without being conditioned for these activities.
Changing a walking or running surface, for example, from grass to concrete.
Having a job that involves prolonged standing on hard surfaces.

The greatest risk factors for plantar fasciitis are being middle-aged and having an abnormal step or abnormal foot biomechanics that stress the plantar fascia ligament when walking or standing.

Athletes, especially runners, are at increased risk for plantar fasciitis. In athletes, a number of factors are associated with development of plantar fasciitis. These factors can lead the athlete to change his or her gait (the way the feet strike the ground), which can cause symptoms and injury. Risk factors for athletes include:

Biomechanical factors, such as decreased flexibility in the foot and ankle, imbalances in muscle strength (muscles in one leg or foot are weaker than the other), abnormal foot mechanics (when stepping down), and tightness in the Achilles tendon. (Also see Achilles Tendonitis)

The repetitive nature of sports activities and improper training.

Other specific risks for athletes include:

Rapidly increasing the number of miles run.
Running on steep hills.
Wearing running shoes that are worn out.
Wearing running shoes that do not have a cushioned sole or enough arch support.
Abruptly changing the intensity or duration of the running routine.

Other Forms Of Heel Pain:

Bruised Heels -

A bruised heel can occur when there is a tremendous amount of impact around the heel region of the foot. This can be associated with shoes that are worn out or shoes that offer very little protection to the bottom of the foot. The soft tissue around the heel gets bruised and inflamed. If you do not have a good heel cup for the foot to rest in, then the fat pad splays outwardly and reduces the amount of material directly underneath the heel bone. At that point, the foot has less shock absorbing capabilities.

Heel Pump Bumps -

Heel pump bump is associated with the style of shoe that is referred to as high heel pumps. Heel pump bump just designates its location, stating that it is on back of the heel bone. It may exist either on the left or right side. The pump bump is generally to the outside of the Achilles tendon. The bump generally starts out very small as soft tissue inflammation. As more friction and pressure continues in back of the heel bone, the soft tissue inflammation expands.

Achilles Tendon Pain -

Pain can be created in this tendon in a number of different situations. One of the causes of Achilles tendon pain can be associated with the foot pronating. As the foot pronates, collapses, and the heel bone begins to twist sideways, it stretches the Achilles tendon, very much like a guitar string, and puts stress on the tendon. Pain can be created in this tendon in a number of different situations. One of the causes of Achilles tendon pain can be associated with the foot pronating. As the foot pronates, collapses, and the heel bone begins to twist sideways, it stretches the Achilles tendon, very much like a guitar string, and puts stress on the tendon.

Always remember to ask your doctor as many questions as possible, and provide him or her with as much information about your heel pain, heel spurs, and plantar fasciitis.