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Heel pain is one of the commonest foot problems and it's caused by a variety of conditions. The most common is plantar fasciitis which you can treat yourself and often resolves spontaneously, but may require professional help to avoid future attacks.

The diagnosis and treatment of heel pain amounts to over a million visits to medical professionals annually in the USA.  And although a quarter of all injuries in runners involve heel pain, it is not confined to sports people but affects people with all levels of activity – including the sedentary.  The most common heel condition is called plantar fasciitis – inflammation of the plantar fascia.

What is the plantar fascia?

Fascia is a fibrous thin tissue which appears throughout the body.  It is mainly made up of collagen, a protein, and is not very stretchy i.e. it does not contain many elastic fibres. Like ligaments it forms an inelastic material linking bones and other structures.  

The plantar fascia is found in the sole (plantar area) of the foot, and runs from the heel into the base of the toes, so is a major component.  Importantly it spans the arch of the foot and plays a role in helping to maintain the arch.

What is plantar fasciitis?

This is where small tears appear in this tissue causing an inflammatory reaction to be set up, as the body repairs the damage.  This means that there is increased blood flow to the area bringing blood and other fluids and specialized cells. The increased fluid and chemicals to the area irritate nerve endings, causing pain.  This also serves to make people rest the foot, allowing healing to take place.

What does plantar fasciitis feel like?

Typically the pain can be anything from a dull ache to sharp pain and the location on the foot is equally variable.

Sometimes it is felt in the arch or centre of the sole, rather than in the heel. But on examination a foot specialist (podiatrist) will apply pressure over a bony protrusion of the heel (the medial tubercle) which is just at the start of the arch on the inner border of the foot.  In many cases of plantar fasciitis this will cause pain or discomfort for the sufferer.

The pain of plantar fasciitis is frequently felt most with the first steps after getting up from bed or from sitting, and also at the end of the day.  The reason is that in both situations inflammatory fluid will have collected in the foot – when you’re standing and walking this gets ‘pumped’ away.  There is not much room in the foot for additional fluid, so those first few steps force the fluid between the tissues which is - not surprisingly – rather uncomfortable. 

Also, when you first stand up you stretch the plantar fascia as you bear your bodyweight on your feet, and this pulls on the tears in it, causing pain.

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