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Massage Today
March, 2002, Vol. 02, Issue 03

Heel Pain

By Ben Benjamin, PhD

Question: Pain felt at the anterior portion of the underside of the heel of the foot, especially when a person gets out of bed to walk in the morning, is indicative of what injury?

Answer: Plantar Fasciitis.

Plantar fasciitis.
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- Copyright – Stock Photo / Register Mark"> Plantar fasciitis. When the plantar fascia (A) is injured, you may feel pain at point B, and/or under the arch of the foot. Plantar fasciitis is the most common cause of pain at the anterior heel when walking. There are two closely related structures between the heel and forefoot: the plantar ligament and the plantar fascia (which is superficial to the plantar ligament). Injury to either of these structures is referred to as plantar fasciitis.

Someone suffering from plantar fasciitis feels pain on walking after a night's sleep, or even after being still for several hours. This pain is caused by the tearing of brand-new scar tissue that has just formed in the plantar ligament, plantar fascia, or both. Adhesive scar tissue forms 24 hours a day, seven days a week, and this newly formed scar tissue is weak and paper-thin. In the case of plantar fasciitis, this weak scar tissue is almost immediately torn again through use, and therefore the person suffers daily heel pain.

For any treatment to be effective, standing pressure cannot be applied directly on the fascia for several months. This can easily be accomplished by wearing a shoe with a higher heel -- usually one and a half to two inches. For about three months, the person should never go barefoot. Shoes must be worn at all times, even when getting up in the middle of the night to go to the bathroom. This can be an effective treatment by itself if the person is diligent in wearing heeled shoes. More efficient healing will take place if massage or friction therapy is applied to the anterior heel two or thee times a week. If those methods fail, proliferant injection therapy is often an effective and quicker treatment option.

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