What is Plantar Fasciitis? Hint: It’s not Caused by a Bone Spur in The Foot.
Plantar Fasciitis is a condition mostly described as heel pain with the first step in the morning and with walking. Runners frequently experience this pain in the back of the heel. This traditionally was often thought to be caused by a bone spur in the foot but this isn’t generally the case. The leading, most popular theory on major medical resources states; Plantar fasciitis is a chronic local inflammation of the “bowstring-like” ligament stretching underneath the sole, also referred to as the plantar fascia, that attaches at the heel.
What is The Plantar Fascia?
This plantar fascia is a fibrous strong band that spans from the heel of the foot (calcaneous), and then spreads like a fan to firmly attach to each one of your metatarsal heads (base of the toes). This gives your foot stability and prevents poorly controlled pronation, flat feet and of course heel pain with running.
Plantar Fasciitis Symptoms and Heel Pain Causes.
It’s generally believed that the tight overstressed plantar fascia pulls on the calcaneous and thus creates a bone spur in the foot. The connection point between the bone spur and the plantar fascia is where inflammation is believed to occur and thus causing heel pain.
Symptoms of Plantar Fasciitis:
- Foot pain first thing in the morning after getting out of bed
- Heel pain with squezzing the heels fat pad (squeeze test)
- Foot pain while walking barefoot
- Swelling and tenderness of the heel
Does a Bone Spur in the foot (Calcaneal spur) cause pain?
Current research doesn’t support this argument and the presence of the bone
spur on x-ray is not thought to be causative, but just shows that the patient has had plantar fasciitis for 6-12 months. So in most causes we need to look beyond the heel spur to figure out what’s causing the heel pain.
Heel Pain isn’t getting better with Treatment? Maybe it’s not Plantar Fasciitis!
Plantar Fasciitis is generally a “one size fit’s all” diagnosis if you make a visit to your neighborhood foot doctor, podiatrist or foot clinic. This means that if you have heel pain it’s labeled as plantar fasciitis and often thought to be caused by a bone spur in the foot as previously discussed.
Other Common Causes of Heel pain
- Heel fat pad atrophy
- Calcaneal stress fractures
- Entrapment of the tibial nerve
- Medial calcaneal nerve
- Lateral plantar nerve (Baxter’s nerve).
- Saphenous Nerve
- Global Myofascial Tension
- Pain referral from the Low back from a herniated lumbar disc.
- Poor Foot Stability- See blog post I did with Kabuki Strength Lab. The Foot: The Final Frontier in Training.
In my work with Professional and Olympic athletes I’ve found that the Saphenous Nerve and tibial are often the cause of heel pain and are mimicking Plantar fasciitis. I’ll do a much more in depth blog post in the future on each of these subjects.
If you have heel pain that’s not responding to traditional treatment then these nerves may need to be addressed.
Check out Dr. Justin Dean at the Sports and Spine Rehabilitation Center in Studio City or next time you search Chiropractor near me.