Joint N-11

by Rosaria Wetzell (12.10.2020)

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When ever a patient comes Joint N-11 Review into the office complaining of heel pain my first question is, "Is the pain worse with the first few steps in the morning and then again when you first get up and walk after sitting a while?" These are the classic symptoms for a condition known as plantar fasciitis. The bottom of the foot is called the plantar surface of the foot. Fascia refers to a strong fibrous band of tissue, similar to a ligament. The term "itis" refers to inflammation. For instance, appendicitis is inflammation of the appendix, fasciitis is inflammation of the fascia. The plantar fascia (which I will refer to as PF) is a fibrous band of tissue that connects the heel to the base of all five toes. The PF acts like a spring and is responsible for maintaining the height of the arch of your foot. As you take a step, the plantar fascia permits the arch to pronate (rotate toward the floor) and flatten out a bit to allow the foot to adapt to what ever terrain it happens to be walking. At the end of the step the plantar fascia helps the foot to supinate (rotate away from the floor) and become rigid again so that a forceful push-off can be achieved. The plantar fascia becomes inflamed if the foot pronates or rolls over too much and stretches out the PF too much. This causes inflammation where the PF is attached to the heel. The PF actually starts to pulls away from the bone and this is what causes the pain. One way that the body protects itself against this pulling away from the bone is to build up more bone in that area. The resulting build-up of bone is called a bone spur. A bone spur in-and-of-itself sounds painful but usually it is not what is causing the pain. If you have ever seen a bone spur on an x-ray it looks like a horn of bone growing out from the bottom of the heel. When you see this on an x-ray you wonder how anybody can walk with a heel spur. However many people have heel spurs on x-ray but have no heel pain. The heel pain associated with plantar fasciitis comes from the tearing away of the fascia from the bone and not the bone spur itself. Why is the pain worse first thing in the morning or when you start walking after sitting for a while? I mentioned previously that the heel pain is due to the PF tearing away from the bone. The human body is a rapid healer. When you go to bed or even if you just sit down for a while the attachment between the bone and the PF begins to heal. However, when you get up and start walking again ...ouch! You just tore away the newly repaired attachment.

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