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 plantar fasciitis 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 the foot support. It is shaped like a trapezoid, being narrower at its attachment to the heel bone then 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 a point in which medical attention is sought.

The plantar fascia serves to support the foot so anything that is increasing the demand for support on the foot increases strain of the plantar fascia. Common reasons for increased strain 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 how the arch functions as we walk (gait) that determines how much strain is placed on the plantar fascia. A foot that rolls inward too much after the foot strikes the ground is a foot that 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 take 10,000 to 30,000 steps per day. Imagine the plantar fascia being over strained or over stretched with each step and that over stretch taking place 30,000 times a day. The cumulative, repetitive stretching of the plantar fascia begins to take its toll and the plantar fascia reacts by thickening and becoming painful.

The key to releiving plantar fasciitis in the long term is to stop the repeated over stretching of the fascia in gait. This can be accomplished by a foot specialist making a specialized device called an orthotic that is made from a mold of the foot and functions to hold the foot in a position of minimal stress on the plantar fascia. There are a number of other treatments like cortisone shots but they are for temporary releif only and can have side effects if used incorrectly. A prescription for physcial therapy or massage therapy can also provide temproary releif in a safer fashion.

A precription orthotic is like a prescription eyeglass in that it's efficacy depends on the accuracy of the prescription. Placing one's foot in a foam box to capture its shape only serves to capture the foot in the wrong position. It is up to the foot specialist to position the foot in the corrected position, the position that minimizes strain on the plantar fascia and then capturing that corrected shape with a plaster of Paris mold or with newer technology, a three dimensional optical scanner.

The mold or "capture" of the corrected foot shape is then sent to a prescription orthotic laboratory where the orthotic is made. The mold is called a negative cast so the lab has to pour plaster into the negative cast to make a model of the foot. plastic or graphite is then heat molded to the model to make the orthtotic.

How does one know if a lab making a quality product? The labs self-police themselves through an organization called the Professional Foot Orthotic Lab of America (PFOLA).

Many patients have the impression that they will recieve the prescription orthotic and that is it. That is actually the start of treatment as the patient becomes accustomed to the beneficial changes in gait and the plantar fasciitis gradually fades into oblivion.