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Continuing with our look at the "10 most common orthopaedic injuries", today we focus on plantar fasciitis... a painful condition affecting the bottom of the foot. It is a common cause of heel pain and is sometimes called a heel spur. Plantar fasciitis is usually just on one side. In about 30 percent of all cases, both feet are affected. Plantar fasciitis can develop from a number of underlying causes. Finding the precise reason for the heel pain is sometimes difficult.

As you can imagine, when the foot is on the ground a tremendous amount of force (the full weight of the body) is concentrated on the plantar fascia. This force stretches the plantar fascia as the arch of the foot tries to flatten from the weight of your body. This leads to stress on the plantar fascia where it attaches to the heel bone. Small tears of the fascia can result. These tears are normally repaired by the body.

As this process of injury and repair repeats itself over and over again, a bone spur (a pointed outgrowth of the bone) sometimes forms as the body tries to firmly attach the fascia to the heel bone. Bone spurs occur along with plantar fasciitis but they are not the cause of the problem.

As we age, the very important fat pad that makes up the fleshy portion of the heel becomes thinner and degenerates (starts to break down). This can lead to inadequate padding on the heel.

The symptoms of plantar fasciitis include pain along the inside edge of the heel near the arch of the foot. The pain is worse when weight is placed on the foot. This is usually most pronounced in the morning when the foot is first placed on the floor. Prolonged standing can also increase the painful symptoms. It may feel better after activity but most patients report increased pain by the end of the day. Pressing on this part of the heel causes tenderness. Pulling the toes back toward the face can be very painful.

Most patients get better with the help of nonsurgical treatments. Stretches for the calf muscles on the back of the lower leg take tension off the plantar fascia. A night splint can be worn while you sleep. Supporting the arch with a well-fitted arch support, or orthotic, may also help reduce pressure on the plantar fascia. Shock wave therapy is a newer form of nonsurgical treatment. It uses a machine to generate shock wave pulses to the sore area.

Surgery is a last resort in the treatment of heel pain. Physicians have developed many procedures in the last 100 years to try to cure heel pain. Most procedures that are commonly used today focus on one of the following: removing the bone spur (if one is present); releasing the plantar fascia (plantar fasciotomy); releasing pressure on the small nerves in the area.

Suggestions that may help prevent suffering from plantar fasciitis in the first place include wearing sturdy shoes with good arch suport for athletic activites; avoid running to lose weight, especially if you've recently gained over a short period of time (start with walking and be sure to stretch your feet and calves thoroughly, then progress to faster walking and running); resting from your activity if you experience pain in the heel. If your pain persists, be sure to see an orthopaedic specialist.