Painful Arch and Heel – Understanding Your Plantar Fasciitis and Fasciosis
A painful arch, a burning sensation in the heel and the arch of the foot making it almost impossible to stand and walk, often sends patients to DeLoor Podiatry in a hurry. And that’s good, because this condition is easily treated, and SHOULD be treated before it gets worse.
What does the arch of the foot do?
What we call the arch of the foot is composed of the plantar fascia, a set of strong connective tissues and ligaments that support your foot arch. The plantar fascia is a broad band of collagen fibers. The foot arch, or the plantar fascia ligament, helps the bones of your foot absorb gait-related shock during walking. Your weight and every step’s contact with the ground is absorbed in the arch of the foot.
The plantar fascia tightens like a cable during the toe-off or push-off part of walking, increases the arch and shortening your foot to create the rigid lever we need to propel ourselves forward. Like most parts of the body, we don’t notice this tremendously important function until we lose it when we injure our foot.
This is why fallen arches due to injury, and inborn flat feet, causes gait abnormality and pain. It throws your whole foot’s biomechanical system out of balance. DeLoor Podiatry has several solutions for these. Read our articles to find out more.
“Soft or thin soles and walking in them for far longer than you should is enough to inflame and even tear your plantar fascia.”
Plantar fasciopathy: plantar fasciitis and plantar fasciosis
Plantar fasciopathy is a blanket term for all injuries of overuse or degeneration to the plantar fascia, causing pain in the arch and heel. There are two terms commonly used when the plantar fascia is injured:
Fasciitis denotes heel pain caused by the inflammation of the plantar fasciia. This inflammation is more of an accidental (caused by an accident) or continual tearing on the plantar fascia (caused by overuse). The latter often occurs in people with degeneration in the plantar fascia, athletes with previous tears, or older people. Plantar fasciitis is also a natural result of ageing.
This denotes a non-inflamed type of plantar fasciopathy. The arch pain is caused by repetitive stress and the plantar fascia is deteriorated or worn down (degenerated) from repetitive stress.
Dr. Jose Loor says, “Plantar fasciitis is inflammation and damage. When left untreated, it leads to plantar fasciosis, which is degeneration and cell death.”
Here’s a breakdown:
You strain your plantar fascia and the inflammation starts. Walking is painful. This is plantar fasciitis. Go to DeLoor Podiatry immediately for diagnosis and repair. After treatment and proper support, the healing process starts and your fasciitis heals within weeks.
You strain your plantar fascia, the inflammation starts, but you don’t go to a podiatrist. You bear the pain. The fasciitis goes untreated and your plantar fascia gets re-injury on top of injury. Healing and repair keeps getting interrupted by repeated strain. Here, your plantar fascia starts to degenerate. This is plantar fasciosis.
With plantar fasciosis, collagen fibers and cellular tissue begin to be fragmented and die. A semi-solid gel forms and comes in between the collagen fibers, thickening your fascia and decreasing its strength and oxygen and blood supply, further slowing down the healing process due to the decrease in nutrients and growth factors.
If plantar fasciopathy is left untreated, and the arch continues to receive excessive stress and strain without support and relief, a heel spur develops. A heel spur is a growth of extra bone on the heel bone. It develops when the plantar fascia pulls on the heel too much. As the heel spur develops, you get even more pain.
If you ignore it, the foot adjusts and gets used to it. “But the presence of a heel spur tells us your plantar fascia has been using excessive force on your heel bone,” says Dr. Jose Loor. “They can be painful at first, and as time goes by, they become evidence of what’s been going on in your foot.”
Who are affected?
Athletes, runners and dancers, of course, because of prolonged and repetitive stress on the fascia, especially when in conjunction with poor foot posture and non-supportive footwear. And people in occupations that require long hours of standing and walking.
Painful arch and heel happens to those with a sedentary lifestyle when they have a sudden increase in their activity level. This often happens in tandem with NOT wearing supportive shoes. An unexpected long walk or hike, or perhaps standing in a long line.
Those who frequently wear high-heeled shoes, or have high or low arches in the feet, or have tight calf muscles or a tight Achilles tendon (the tendon that attaches the calf muscles to the heel bone).
You should always help your feet keep up with your level of activity.
What causes arch pain?
Aside from fasciitis or fasciosis, certain types of arthritis can cause painful arch and heel, on the site where your plantar fascia meets bone. DeLoor Podiatry would evaluate your physical history and use imaging techniques to correctly diagnose the cause of your arch and heel pain. X-rays also rule out fracture and other possible (but rarer) causes of arch and heel pain, like tumors.
Dr. Jose Loor says, “When we walk, the most tension and pressure is on the plantar fascia at the inner base of the heel. When the force of each step exceeds the strength of the fascia, the fascia tears, and tearing happens and continues to worsen every time you stress the fascia too much, beyond its ability. You should always help your feet keep up with your level of activity.”
“If you know you’re going to be walking, wear good shoes,” adds Dr. Loor, “Soft or thin soles and walking in them for far longer than you should is enough to inflame and even tear your plantar fascia.”
The following activities leads to, or aggravates, plantar fasciitis or fasciosis:
- Excess weight puts stress on the feet.
- Poorly-cushioned footwear, especially when used in hard, uneven surfaces.
- Conditions that change how the feet work (biomechanical factors). Abnormal inward twisting or rolling of the foot (pronation), high arches, flat feet, tight calf muscles, or tight tendons at the back of the heel (Achilles tendons)
- Prolonged standing and walking. If you have a job that has you on your feet for most of the day, you need good shoes.
- Prolonged standing, running and high-impact sports that land in sports that require it, like running, tennis, etc.
- Ageing: Plantar fasciitis is most common in the middle-aged
The plantar fascia is tough. It takes weeks and even months for wear and tear to develop. But every microtear within the plantar fascia weakens the tissue and increases the chances of more tearing. DeLoor Podiatry has also seen cases where acute injuries and complete fascial ruptures have happened, when the structural integrity of the plantar fascia is weakened and stressed enough.
Painful arch: solutions for fasciitis and fasciosis
The best treatment for a painful arch is to prevent it. Inappropriate footwear is the biggest cause of arch and heel pain.
Prevention and support measures:
- Avoid high-heels. Calf muscle shortening, caused by wearing high heels, places even more stress on your arch and heel.
- Avoid shoes with tapered toes. When squashed together, your toes lose the ability to provide support for the rest of your foot.
- Always choose shoes with shock-absorbing soles and space inside for well-cushioned insoles. You can buy them and insert them into any pair of shoes.
- Choose shoes that keep your feet in their natural position, with neither a high toe spring or a high heel. Ask DeLoor Podiatry specialists for recommendations and shoe modification inserts, sleeves and orthotics.
- If you have flat feet or fallen arches, DeLoor Podiatry would fit you with orthotics designed with proper arch support for pain relief and reduction of over-pronation (flat-footedness).
- If you are overweight, water aerobics work great to strengthen your body and work off calories, without putting extra strain on your feet.
- A physio program for targeted stretches and exercises
- Acupuncture and massage
New York platelet-rich plasma injection and shockwave therapy for arch pain
Plantar fasciitis is easily remedied with rest and proper footwear. In the case of plantar fasciitis, more is needed to rehabilitate the muscle and tissues. Remember that cellular death has already occurred. This is where platelet-rich plasma (PRP) injections and shockwave therapy come in. Injecting growth factors through the platelets, and using the warmth and electricity in shockwave therapy, restarts the healing process in the plantar fascia.
We’ve written about PRP injections in many of our articles. It has a highly-favorable outcome among patients.
Shockwave therapy is less invasive, with no injections at all. At low-energy system, there is no need for anesthesia and no risk of heel contusion compared to high-energy levels. Treatments vary in number from three to five, depending on your response and the extensiveness of your fasciosis.
Which treatment should you have?
DeLoor Podiatry specialists look at the extent of the damage, how much pain you are in, and the thickening of the fascia, to decide on which treatment is best. If you have more pain and a thicker scarring in your fascia, you’d do better with PRP injection therapy, or both.
Sometimes shockwave therapy works, but not PRP injection, or vice versa. Or both treatments together provide the relief for the patient. DeLoor Podiatry has seen recovery periods of 4 to 8 weeks.
We can’t emphasize the importance of treatment more, to avoid even more invasive surgery that involves ‘releasing’ the fascia when it has become too damaged, too thickened to function.