One of the most common conditions seen by podiatrists is plantar fasciitis heel pain, which is a common debilitating symptom whose frequency and incidence are not fully known.
However, according to the most recent statistics, 10% of the American population over the age of 65 experience some sensitivity in the heel area.
Plantar fasciitis is a common musculoskeletal condition in active people. Although perceived as an inflammatory process, plantar fasciitis is more of a condition characterized by degenerative changes in the fascia, which can resemble tendinopathy. Therefore, the term heel pain seems more appropriate to describe this kind of condition.
SYMPTOMS of plantar heel pain
Plantar fasciitis is diagnosed based on a history of pain during first steps in the morning, worsening pain with prolonged support or walking, pain and tenderness on palpation of the internal tuberosity. Of course, the pain doesn't have to be constant. In fact, it often happens that temporary relief occurs, but the pain returns as soon as the person resumes walking or standing for a long time, or after intensive training.
To diagnose plantar fasciitis, a podiatrist will examine a person's feet by looking at how they stand up and walk. He will ask questions based on the following:
General health, including previous illnesses or injuries.
Symptoms the person is experiencing, such as where the pain is and when of the day it is most present.
How active the person is, as well as the forms of physical activity they engage in.
Afterward, an X-ray of the person's foot can be taken if it is suspected that there is a problem with the bones in the foot, such as a stress fracture, for example.
To active people, the incidence of plantar fasciitis has been reported to be around 5%, behind internal tibia stress syndrome (10%), patellofemoral syndrome (10%), internal meniscus injury (9 %), and Achilles tendinopathy (7%).
This high impact is not surprising considering that each step is subjected to three times the weight and the foot is mainly in motion to facilitate adaptation and absorb shock. Since the plantar fascia is one of the structures potentially affected, it plays an important role in maintaining the dynamic structure of the arch of the foot.
CAUSES (MOST COMMON CAUSES OF HEEL PAIN)
The causes are not well known, but the risk factors for the general population are as follows:
- advanced age
- prolonged walking, running, jumping, or standing (especially on hard surfaces)
- reduced range of motion in the ankle and the first metatarsophalangeal joint
- Some studies have identified risk factors for active people, such as runners, and have broken them down into two types of risk factors:
- Intrinsic cause:
- Extrinsic cause:
- excessive use
- inadequate training
- inappropriate shoes
ANATOMICAL RISK FACTORS
This includes anything related to the patient's anatomy, such as flat feet, hollow feet, overpronation, the difference in leg length, excessive lateral tibial twist, excessive femoral anteversion, or overweight.
FUNCTIONAL RISK FACTORS
These risk factors refer to disorders related to the functioning of the body, to what affects the muscles and tendons, among others. This can include tightness of the gastrocnemius and solar muscles (calf muscle), Achilles tendonitis, and intrinsic calf and foot muscle weakness.
DEGENERATIVE RISK FACTORS
These include aging of the fat pad, atrophy of the heel fat pad, stiffness of the plantar fascia.
EXCESSIVE USE OF FEET
In case of overuse, especially in athletes, even slight biomechanical imperfections of the foot prove to be decisive and can result in plantar fasciitis. This is the case with running.
By inadequate training, implies too rapid an increase in the distance, intensity, duration, or frequency of activities that cause repetitive load on the feet.
This risk factor may seem trivial, but it is not. Indeed, wearing shoes that are worn, ill-fitting, too tight, or poorly padded can aggravate heel pain. For people with plantar fasciitis, wearing elevated shoes may be convenient. Otherwise, putting a heel in the shoe is just as effective.
- LANDORF, K. B. Plantar heel pain and plantar fasciitis. BMJ Clin Evid, v. 2015, Nov 2015. ISSN 1752-8526. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/26609884
- LANDORF, K. B.; MENZ, H. B. Plantar heel pain and fasciitis. BMJ Clin Evid, v. 2008, Feb 2008. ISSN 1752-8526. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/19450330
- PETRAGLIA, F.; RAMAZZINA, I.; COSTANTINO, C. Plantar fasciitis in athletes: diagnostic and treatment strategies. A systematic review. Muscles Ligaments Tendons J, v. 7, n. 1, p. 107-118, 2017 Jan-Mar 2017. ISSN 2240-4554. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/28717618