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Plantar Fasciitis: Inflammation of the plantar fascia is the most common cause
of deep pain on the bottom surface of the heel. The plantar fascia is a broad
band of connective tissue that originates from the heel bone and extends to the
toes. It is located just below the skin and subcutaneous fat and helps secure and
stabilize the arch of the foot. Increased tension at the point of origin (heel bone
or calcaneus) can lead to chronic inflammation. Over the course of time, the
attachment of the fascia may become calcified leading to the X-ray appearance
of a spur. For this reason, plantar fasciitis and heel spur syndrome have become
synonymous terms. A podiatrist should evaluate stubborn heel pain. Plantar
fasciitis may present anywhere along the sole of the foot, particularly along the
arch and just in front of the heel. It is important to realize that the spur itself is
not the cause of pain, and treatment is aimed at reducing inflammation and
supporting the plantar fascia.
Achilles Tendonitis: The Achilles tendon is the largest and strongest tendon in
the body and inserts into the back of the heel. The Achilles originates from two
muscles that form the calf: the gastrocnemius muscle begins above the knee and
the Soleus muscle begins below the knee. The Achilles tendon allows us to rise
up on our toes and helps propel the body forward. Pain can be felt along the
course of the tendon or even in the muscles. Insertional pain is felt directly in the
back of the heel. Sometimes a large bump of bone can develop on the back of
the heel as a result of a tight Achilles and is termed Haglund's deformity (pump
bump). Pain in the tendon itself is felt above the level of the hell and can be an
indication of damage or tearing within the substance of the Achilles. Pain can
also be felt just behind the ankle and is usually an indication of an inflamed
bursa, also typically from a tight Achilles. A bursa is a naturally occurring pad
between the tendon and bone and with increased wear and use can become
inflamed. Treatment of Achilles Tendonitis, as with plantar fasciitis, is aimed at
reducing inflammation and providing support.
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