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Heel /Arch Pain: Plantarfasciosis

Do you suffer from heel or arch pain? Rest assured you're not alone. There are several different conditions that result in often disabling pain associated with the heel. Unfortunately such conditions begin with insidious morning heel pain or pain after being seated for a period of time, which if neglected can lead to constant pain and often irreparable damage to the various structures within the heel. If you have any such pain, help is available. Stonnington Podiatry, specialising in diagnosing and treating conditions associated with the foot and ankle, advises, manages and treats people with such conditions. Our Podiatry team is able to differentiate this injury from other conditions such as stress fractures, bruising and referred pain syndromes.

Definition:

 

Enthesopathy or heel spur syndrome is the condition affecting the heel. It is an inflammatory condition affecting the plantar fascia (a ligament type band running under the foot) at its attachment to the heel (called the enthesis).  Pain can also extend through the inside arch, up into the forefoot depending on the person’s activities and foot mechanics.

Symptoms:

It begins as morning heel pain following exercise or damage in the previous 48-72 hours the pain decreasing the more walking or activity you do. Unfortunately such walking or activity is actually further damaging the area in question, eventually leading to constant heel pain over the following weeks if intervention is not sought.

Cause:

Pain is due to a build up of inflammation around the attachment, and along the ligament. The inflammation is often the result of poor lower limb and foot biomechanics - that is, the way we walk. Biomechanical assessment by our Podiatry team, often with the use of video gait analysis, can reveal the extent of the individual’s gait cycle and/or static mechanics have in contributing to the condition. Traumatic injuries either a single episode, or continuous low grade stresses (eg work related) are some other causes. Poor footwear is also a major factor that can stress the structures within the foot.

Treatment:

Is dependant on the location, and cause of the injury. The podiatrist will thoroughly assess the area, and assess your gait to determine the cause, and treat the condition accordingly. Treatment may involve taping, massage, and correction of poor biomechanics via various orthoses (insoles). Advice regarding footwear may be indicated. Muscle stretching and night splinting are also often required to offload the structures within the foot. Rest is also required in conjunction with the above management, however alone will not make any significant change. For further information or bookings contact Stonnington Podiatry or refer to our “Contact us” link. 

TIBIALIS POSTERIOR DYSFUNCTION

Tibialis posterior dysfunction is a inflammatory disorder affecting the tibialis posterior muscle on the inside of the leg and foot. This muscle is primarily responsible for the maintenance of arch height and for stiffening and stabilising the foot during the propulsive phase of gait.

This disorder is caused by:

  • Tight tibialis posterior muscle/tendon
  • Weak tibialis posterior muscle
  • Abnormal foot position
  • Poor footwear that does not provide enough support.

Tibialis posterior dysfunction can present as a ‘flat foot’ or one with a reduced arch height. There is often pain when walking on the inside of the foot that can travel up the inside of the leg. There is usually a ‘bulging’ on the inside of the foot, when observed from behind.

Treatment of this condition is usually therapy to reduce the inflammation such as ice and anti inflammatories; massage and stretching to reduce tightness in the muscle and strengthening exercises to build up weak muscles. Orthoses are also a key to support the muscle, increase arch height and allow normal muscle function of the foot during gait without damaging the tibialis posterior muscle and tendon.