Plantar fasciitis is the most common cause of heel pain.  This condition is simply inflammation of the plantar fascia, a strong strap-like tissue divided into three bands found on the bottom of the foot.  This tissue begins attached to the heel bone, and runs the length of the foot to the bottom of the toe bases.  The plantar fascia can become injured due to a variety of reasons.  The majority of the time, the fascia becomes injured simply as a result of walking or being active while having a certain foot structure.  People with flat feet commonly get this condition because the foot becomes strained with every step when flat.  The resulting strain over many years results in eventual microscopic damage and inflammation to the plantar fascia, which stretches as the foot flattens.  This is accelerated when some minimal injury occurs, like stepping off a curb or onto a ladder awkwardly.  After awhile, the inflammation can become significant enough that pain is actually felt.  People with high arches can develop plantar fasciitis, but for a different reason.  High arches do not flatten much with walking and standing.  Unfortunately, some level of flattening is needed to effectively absorb shock when walking.  Since high arched feet do not absorb shock well, the tissues on the bottom of the foot and heel take the brunt of the pressure of the foot pressing actively on the ground with the weight of the body behind it.  This shock eventually irritates the plantar fascia, either at the point it begins from the heel bone, or somewhere in the middle of the arch.

Plantar fasciitis can also develop when one damages it directly in an injury.  One can injure their plantar fascia by either stepping on a protruding object that bruises the heel or arch (like a root, stone, high door threshold, toy, or other hard object), or by directly straining the tissue after excessive use of a ladder or shallow stairs.  Injuries that force the foot upward suddenly can strain the fascia, and can even cause the fascia to rupture or tear across its width.

Plantar fasciitis can have several different symptoms depending on the individual, but most commonly is felt as heel or arch pain that begins as soon as one arises from bed or from a seated position.  After a few steps or a few minutes, the pain begins to decrease but eventually returns as activity increases.  It rarely ever hurts when one is at rest for awhile, and does not wake people up with pain in the middle of the night.  The pain can feel sharp, stabbing, throbbing, or simply aching.  Burning or tingling pain usually indicates involvement of nerves that are positioned near the fascia, or an entirely different condition (such as tarsal tunnel syndrome or lower back nerve problems).  Plantar fasciitis pain is usually worse when one is barefoot or in a less supportive shoe.  It is rare for one to be able to see actual swelling or bruising at the heel or arch, and when these are present this usually indicates a fascia rupture or tear.

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