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PLANTAR FASCIITIS & HEEL SPUR SYNDROME
By: Wayne Dunetz, DPM

The plantar fascia, or aponeurosis, is the main supportive ligament of the longitudinal arch and may be thought of as a “Bowstring” across the bottom of the arch and foot. It is the longest and the strongest ligament in the body, originating from the inner aspect of the calcaneus (Heel Bone) extending to the base of each toe. The plantar fascia, along with the plantar calcaneo-navicular, or “Spring” ligament, constitute the main, soft tissue Buttresses of the arch. As such, they are subject to high repetitive strain.

This strain may be increased in both the Pes Planus “flat” foot and Pes Cavus “high arch” foot. In the former, weight-bearing over the unlocked or the overly flexible foot forces abnormal elongation and widening of the foot, pulling on the plantar fascia. The Cavus foot begins life with a tight and shortened plantar fascia, and it is more vulnerable to any increase in tension that often occurs as the arch drops with aging. These tension increases, in both cases, may cause the plantar fascia to inflame since the force is mainly focused at that point. This is especially true after major changes in weight-bearing activity. At night, when pressure is off the foot, the inflammation causes swelling. Walking on this first thing in the morning is usually the most painful time of the day. Normal activity “milks” the swelling out of the tissue, so pain usually subsides as the day progresses. Over time, the periosteum at the beginning of the plantar fascia may be drawn away from the underlying bone, creating a space that becomes filled with inflammation. The periosteum continues to create new bone, which eventually appears as a “heel spur” on x-ray. While the resultant “heel spur” is often then the focus of medical treatment, it is just an artifact of chronic fascial inflammation and tension.

The patient may complain the whole bottom of the foot may be tender to palpation or, more likely, the most tenderness is felt at the beginning point of the plantar fascia, which is the calcaneus. A complaint of pain with palpation may worsen with passive lifting of the toes. Presence of heel spur on x-ray confirms chronicity of condition.

Treatment is based on calming down the inflammation. In my clinical experience, the best approach is a multi-facet therapeutic approach.

• Stretching exercises of the plantar fascia and Achilles tendon.
  
• Physical therapy-Phonophoresis, US, TENS...
  
• Cortisone injection
  
• NSAIDS-(NONSTEROIDAL ANTI-INFLAMATORIES)
  
• Foot Strappings

Wayne Dunetz, DPM
Tropicana Podiatry
Podiatric Medicine & Surgery
Reconstructive Surgery
Sports Medicine