Up to 2 million Americans describe symptoms of heel pain every year, accounting for an estimate of up to $400 million in medical bills. Regardless, not much is known about the pathophysiology and etiology of plantar heel pain. By emphasizing on the causes of plantar fasciitis as well as discussing other common mechanical issues behind heel pain, including plantar fascia tears/rupture, heel pain of neural origin, calcaneal stress fractures and atrophy of the heel pad, individuals can learn to understand the diagnostic criteria and possible treatment options of plantar heel pain.
The plantar fascia is a fibrous aponeurosis which extends from the calcaneal tuberosity in the heel, to the proximal phalanges in the toe. Plantar fasciitis most commonly occurs as a result of mechanical overload due to either bio-mechanical faults, obesity and work habits.
The plantar fascia functions to support the medial longitudinal arch, acting as a shock absorber, through both passive tensioning of the plantar fascia, known as the Windlass mechanism, and through the active tension of the plantar intrinsic foot muscles, including the flexor hallicus brevis, the adductor hallicus and the plantar interossei, as well as the tibialis posterior. It has been suggested that intrinsic foot muscle weakness can lead to increased loads on the plantar fascia. Because testing the strength of these muscles can be very difficult, researchers have utilized volume estimates of the intrinsic foot muscles and the tibialis posterior muscles to identify whether there’s a distinction in volume between these muscles in people with plantar heel pain. There was no particular difference in the volume of the tibialis posterior and there was only a 5 percent variation in the forefoot volume of the intrinsic foot muscles in comparison with the asymptomatic foot.
Plantar heel pain is frequently diagnosed by healthcare professionals, including chiropractors and sports clinicians, as a result of mechanical, neurologic, traumatic or other complications. Plantar fasciitis is the most common pathology in sports. However, other causes of heel pain may be considered when evaluating an athlete with heel pain. For more information, please feel free to ask Dr. Jimenez or contact us at (915) 850-0900.