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Do you have heel pain that is not going away?

It may be Plantar Fasciitis. This can present as a sharp, stabbing pain under the heel and arch of your foot. It is often worse when you start to walk after a period of rest or if you are in a job in which you stand in one position a lot. The plantar fascia is a tight band of rope like tissue that attaches from your heel to your toes under your foot. Under normal circumstances your plantar fascia acts like a shock-absorbing bowstring supporting the arch in your foot. However, if tension and stress on that bowstring

become too great, degeneration of collagen fibers can arise in the fascia. Repetitive stretching and shearing motions can cause the fascia to become irritated or inflamed. It is important to note this can happen to people with all different types and shapes of foot arches. There is a misconception out there that this only happens to people with flat feet or fallen arches. This is wholly untrue, it affects people with high arches and low arches.

The pain can often be resolved through a guided rehab program of stretching and strengthening the foot and lower leg musculature, after a full biomechanical assessment. However, this may only work if your condition is true plantar fasciitis. There are several often overlooked conditions and peripheral neuropathies that can cause similar symptoms to that of plantar fasciitis, which I will discuss next. The most common of these neuropathies is called Tarsal Tunnel Syndrome and a Baxter's neuropathy or otherwise known Baxter’s nerve entrapment.

Tarsal Tunnel Syndrome and Baxter Nerve Entrapment

These are entrapments of the tibial nerve and lateral plantar nerve respectively. Tarsal tunnel syndrome is relatively uncommon though. More common however is Baxter’s nerve entrapment. One particular study (Chundru et al. 2008)showed the plantar fasciitis and Baxter’s nerve entrapment co-existed in 52% of cases where there was muscle wastage or atrophy of abductor digiti minimi muscle. The nerve runs through deep fascia and another muscle called the abductor hallucis longus. Pain and burning sensation can radiate inside and under the heel, some numbness can occur in this area and in other parts of the foot also.

Calcaneal Stress Fractures

The calcaneus bone is one of the most common locations of stress fractures in the foot, second only to the metatarsals. Calcaneal stress fractures occur most frequently in athletes, military trainees, and elderly patients with osteopenia. Patients with calcaneal stress fracture typically report intense, diffuse heel pain.

Heel Pad Atrophy

The fat pad of your heel, also known as the “corpus adiposum,” acts as a cushion and shock-absorber to protect your heel bone and arch. Each time you walk, run, or jump, your feet absorb and distribute your body weight combined with the force of impact–and usually, they do a great job! Heel pad atrophy typically begins in the fifth decade of life and likely is the result of loss of water, collagen, and elastic tissue. The heel pad becomes less elastic in both the elderly and in people with diabetes, and these patients are particularly prone to heel pad atrophy. Management may include NSAIDs, properly padded shoes, and customized orthoses or over-the-counter silicone heel cups. Invariably though you may need to off-load the area by reducing the activities that cause it to 'flare up'.

So, if you are struggling to get rid of your foot and heel pain make a call to us today. Also, if you know of anyone struggling with this injury please send them a link to this article or give us a call.

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