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HEEL PAIN _Plantar Fasciitis_

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									                    HEEL PAIN (Plantar Fasciitis)

In a previous article in October last year, we discussed Sever’s disease, a
condition caused, in the growing child, by the rapid growth in the bones
of the lower leg, and failure of the calf muscles to keep pace with the
growth. The resulting pain is felt in the back of the heel, but this time we
are discussing pain under the heel and sometimes also under the arch of
the foot.

So what does it feel like and more importantly……What is causing it?
Under the soles of our feet is a fan-shaped sheet of fibrous connective
tissue attached at one end to the calcaneum (heel bone), and fanning
out across the ball of the foot to attach to the undersurface of the toes.
This is known as the plantar fascia. Its main function is to support the
longtitudinal arches of the feet.




If this becomes inflamed, your child may complain of the following
symptoms:-

   •   Pain on the undersurface of the heel and/or under the arch of the
       foot, on weight-bearing
   •   Almost all sufferers complain of pain in the mornings with the first
       few steps and may complain of pain after prolonged walking or
       standing, particularly in flat shoes such as flip-flops with no arch
       support
   •   Pain on pressing the undersurface of the heel, often one exquisitely
       painful spot which really makes him / her jump when pressed. This is
       the point where the plantar fascia attaches to the heel bone
   •   Often pain on pressure under the arch of the foot, with a slightly
       “crunchy” feeling to the tissue when you run your finger along it

Why is this happening?
  • As well as the plantar fascia, the arch is supported by small muscles
      inside the foot. Weakening of these leads to lowering of the natural
      longtitudinal arch (Flattening of the foot)
  • Lowering of the arch, in turn, stresses the supporting plantar fascia
  • Microscopic tears in the tissue occur, with subsequent inflammation
      and pain

Are some people more likely to get this than others? This is more common
in adults than in children, but if it does occur in a child, it is very important
to have the problem properly assessed and treated. The alteration in the
child’s body biomechanics by the gradual flattening of one or both of the
arches of the feet can lead to knee, hip and back problems in the future

Here are some predisposing factors
   • High arched rigid feet (Pes cavus). If your child was born with very
      high arches, then the plantar fascia will be shorter than in someone
      with naturally rather flat feet, so any flattening of the arch will cause
      excessive tugging on the heel bone, and lead to pain
   • Flat / over-pronated feet. If your child has flat feet which roll inwards
      (over-pronation) while walking and running, the plantar fascia is,




       again subjected to unacceptable stress
   •   Poor or inappropriate footwear. Wearing the right shoes for the right
       sport is very important. Shoe technology has advanced
       considerably in the last decade, and wearing a running shoe on the
       tennis court for example, can lead to injury. Running shoes are
       made for stability, while tennis shoes are designed for agility.
       Similarly, cross-country running in tennis shoes is equally risky. If your
       child is involved in several sports, a pair of cross-trainers is probably
       a good idea.
       Worn out shoes which give no support to the feet are potential
       causes of injury. Did you know that marathon runners replace their
       running shoes every 3 months during their training periods?
   •   Overuse in runners and athletes. Pressure to compete and win
       sometimes forces children to do too much. Everything in
       moderation is advisable. Although exercise is good for us, too
       much, too intensively sometimes leads to long term problems
   •   Poor running style, e.g. running on toes. If you notice that your child
       is running on his / her toes, it may be that they have tight calves.
       When we run, the heel should strike the ground first before our body
       weight is transferred onto the toes. Running on the toes leads to
       undue tension on the plantar fascia
   •   Running up hills or on soft, yielding surfaces (e.g. sand) Summer is
       here, with all it’s heat and humidity, and it seems like a good idea
       to head for the beach. Running along the water’s edge in bare feet
       is mentally very therapeutic, but your child’s feet may not like it, as
       the yielding, uneven surface of the sand can exert excessive stress
       on the plantar fascia, as can running uphill. Beach volleyball in bare
       feet is equally stressful
   •   Advancing age. We’re not talking about children here!

So what can be done about this?
Ask your doctor to refer your child to a physiotherapist. If, despite
physiotherapy treatment, the pain persists, your doctor may later
prescribe anti-inflammatory medication either in the form of a gel or to be
taken by mouth.

The physiotherapist will treat the painful area using ice, massage,
ultrasound and may even tape the arch of the foot to relieve the tension
on the plantar fascia.

Your child will be taught stretching exercises for the plantar fascia and the
calf muscles and strengthening exercises for the small muscles inside the
foot.

It’s advisable for your child to scale down all sporting activities, avoiding
running, and switching instead to low impact exercise such as swimming
and cycling until given the go ahead by your physiotherapist.

Shoewear may need to be modified to provide support for the arch, and
cushioned heel inserts can be used to soften the impact over the
inflamed area.

As the symptoms settle down. Your child will be shown how to strengthen
the calf muscles and encouraged to continue with the previous exercises.
In addition, once the pain has subsided, self massage by rolling the arch
of the foot backwards and forwards over a golf or squash ball can help to
keep the plantar fascia supple.

A Gait analysis / running assessment to identify over-pronation or poor
running style may be recommended, and prescription of corrective shoe
inserts (orthotics) if necessary, or recommendation of more appropriate
shoes for running / sporting activities




If your child is overweight, this is an added burden on the plantar fascia,
so some dietary changes to lose weight would be helpful

Once there is no longer any pain, a gradual return to former higher
impact sporting activities under the guidance of your child’s
physiotherapist is permitted, provided no pain occurs during or after the
activity.

If pain persists, your child will be referred back to the doctor for further
management, which may include an anti-inflammatory injection.

In some cases, if the problem is not addressed early enough, the tugging
of the plantar fascia on the calcaneum (heel bone) over a prolonged
period (usually many years), can cause a bony spur to develop. This is
diagnosed by X-ray and may require surgical intervention if pain persists.


Janice Morton
Physiotherapy Director
Sportsperformance




For further information please contact:
The Physiotherapy department              Sportsperformance
8th Floor AON China Building
29 Queen’s Road Central
Hong Kong

Telephone +852 25216381
Facsimile +852 2521 6381
Email info@sp.hk
www.sp.hk

								
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