VIEWS: 4 PAGES: 6 POSTED ON: 9/14/2011
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 firstname.lastname@example.org www.sp.hk
"HEEL PAIN _Plantar Fasciitis_"