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Heel Pain Affects Millions of Americans -- AlsoKnown as Plantar Fasciitis 
Heel pain is the fourth most common reason for patients to visit their family doctor's office.The most common cause of heel pain is plantar fasciitis.There are other causes of heel pain such as rheumatoid arthritis and gout but plantarfasciitis probably makes up about 95 percent of the causes of heel pain.The plantar fascia is a broad, flat ligament that runs along the bottom of the foot lending thefoot support. It is shaped like a trapezoid, being narrower at its attachment to the heel bonethen widening as it courses forward toward its insertion at the base of the toes.Patients often present with pain of insidious onset, gradual progression and culminating to apoint in which medical attention is sought.The plantar fascia serves to support the foot so anything that is increasing the demand forsupport on the foot increases strain of the plantar fascia. Common reasons for increasedstrain on the plantar fascia include overpronation which is a rolling in of the foot.Overpronation is often confused with a flat foot but the two are very different.The height of the arch has little to do with the mechanical integrity of the foot but it is howthe arch functions as we walk (gait) that determines how much strain is placed on theplantar fascia. A foot that rolls inward too much after the foot strikes the ground is a footthat overpronates and is a foot which strains the plantar fascia.A couch potato probably takes 1000 to 3000 steps per day while an active person may take10,000 to 30,000 steps per day. Imagine the plantar fascia being over strained or overstretched with each step and that over stretch taking place 30,000 times a day. Thecumulative, repetitive stretching of the plantar fascia begins to take its toll and the plantarfascia reacts by thickening and becoming painful.The key to releiving plantar fasciitis in the long term is to stop the repeated over stretchingof the fascia in gait. This can be accomplished by a foot specialist making a specializeddevice called an orthotic that is made from a mold of the foot and functions to hold the footin a position of minimal stress on the plantar fascia. There are a number of other treatmentslike cortisone shots but they are for temporary releif only and can have side effects if usedincorrectly. A prescription for physcial therapy or massage therapy can also providetemproary releif in a safer fashion.A precription orthotic is like a prescription eyeglass in that it's efficacy depends on theaccuracy of the prescription. Placing one's foot in a foam box to capture its shape onlyserves to capture the foot in the wrong position. It is up to the foot specialist to position thefoot in the corrected position, the position that minimizes strain on the plantar fascia andthen capturing that corrected shape with a plaster of Paris mold or with newer technology, athree dimensional optical scanner.The mold or "capture" of the corrected foot shape is then sent to a prescription orthoticlaboratory where the orthotic is made. The mold is called a negative cast so the lab has to
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