Anatomy of the Plantar Fascia.
The most common cause of heel pain is called plantar fasciitis. The plantar fascia is a thick band of gristle that runs from the heel to the ball of the foot, just behind the big toe. Unlike a tendon or a muscle, the fibres that make up a fascia are completely non-stretch. When your foot is sitting properly, the band stretches across the arch, travelling a particular distance. Looking at the line drawing below, you can see that both triangles have the two upper arms of the same length. The more arched one has a shorter bottom arm. The same is true in the foot. If the arch of the foot drops (flatfoot, pronation, dropped arches) the distance that the plantar fascia has to cross increases. Because the band cannot stretch, it will pull on its weakest attachment which for most people is directly under the heel. It can also be around the rim of the heel or through the arch. The area becomes inflamed and, if present for long enough, the body may lay down extra bone to try to bring the two attachment points closer together. This is called a spur.
It is important to know that spurs don’t cause the pain. It is the pulling that causes the spur to grow and the pulling that causes the pain but the spur does not itself cause pain. Spurs almost never need to be cut out and surgery is very rare these days. Also, pads commonly for sale to cushion the heel are not very useful, as the problem is not downward pressure on the heel (although it feels like it is) but elongation pressure along the length of the foot. The pain is usually bad for the first couple of minutes of standing after rest or sleep. It will then often improve before worsening again with ongoing use. Standing still may be as bad as, or worse, for pain than walking. For more information, please browse to our Plantar Fasciitis Info Sheet. Alternatively, click the following link to return to the Podiatry FAQs Blog.
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