The elastic covering on the sole of the foot–the plantar fascia–runs the length of the foot and holds up the arch. When this shock-absorbing pad becomes inflamed, this is called plantar fasciitis, causing a dull ache along the length of the arch. The ache is due to over-stretching or partially tearing the arch pad. This happens most often to people with rigid, high arches. They feel the pain when they put weight on their foot or when pushing off for the next stride. Pain is particularly intense upon arising or after sitting for a long while. Plantar fasciitis is particularly common among middle-aged people who have been sedentary and who suddenly increase their level of physical activity. Runners are most susceptible, but almost any sport that keeps the athlete standing can lead to arch pain. Inappropriately fitting shoes or a weight gain of 10 to 20 pounds can also contribute to the condition.
Stress fractures, plantar fasciitis, and acute and chronic arthritis are most commonly the result of repetitive micro-trauma injuries. Micro-trauma injuries are caused when the structures of the body are stressed and re-stressed to the point that damage occurs in the tissues. Factors that commonly contribute to this injury can be running on uneven surfaces or surfaces that are too hard or too soft, shoes that have poor force-absorption qualities, or going too hard or too long during repeated exercise bouts.
The groups of muscles that support the arch can be divided into two groups. The muscles on the top of the arch start on the front lower leg and help to lift the arch, and the muscles that help pull the arch on the bottom of the foot are located the on back of the lower leg. Muscle injury may be indicated when pain is felt when the foot is fully extended, flexed, or turned in or out. Pain may also be felt when working the foot against resistance. Bruises are the result of a direct-force injury to the body. A bruise can occur to the foot by a variety of causes, such as having your foot stepped on or by stepping on a rock. The tissues that compose the arch do not provide that area of the body much protection. Blows to the foot that result in pain, discoloration, swelling, and changes in how you walk may indicate more serious damage.
Your doctor may order imaging tests to help make sure your heel pain is caused by plantar fasciitis and not another problem. X-rays provide clear images of bones. They are useful in ruling out other causes of heel pain, such as fractures or arthritis. Heel spurs can be seen on an x-ray. Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not routinely used to diagnose plantar fasciitis. They are rarely ordered. An MRI scan may be used if the heel pain is not relieved by initial treatment methods.
Non Surgical Treatment
Use corrective prophylactic measures. Purchase new shoes or replace the insoles of your current shoes. Athletic shoes lose the elastic properties of the soles through usage and age. A good rule of thumb is to replace your shoes every six months, more often if there is heavier usage. The use of after-market insoles can increase energy absorption and add support to the foot. Custom fabricated orthotics or off-the-shelf orthotics may also improve the biomechanics of the foot. Focus on muscle strengthening and flexibility. You may be given exercises to increase the strength and stability of the affected area and to correct muscles that may not be balanced. Exercises to increase flexibility will maintain or improve the length of a muscle. Flexibility helps to make a stronger muscle that is less likely to be injured.
A procedure that involves placing a metallic implant (most commonly) at the junction where the foot meets the ankle. This device causes the physical blockade that prevent the collapse. It is a procedure that is only indicated for mobile feet, and should not be used with rigid flat feet. Dr. Blitz finds this procedure better for younger patients with flexible flat feet where the bone alignment is still developing so that the foot can adapt to function in a better aligned position.
People with flexible feet who develop fallen arches may benefit from foot strengthening exercises, notes the Nicholas Institute of Sports Medicine and Athletic Trauma. Standing on a towel in bare feet and grasping the material with the toes is an easy foot-strengthening exercise that can be done at home. Standing on one leg while arching and releasing the foot may also prove useful. Doctors may prescribe gentle stretching exercises for the foot and ankle tendons.