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The heel pain or injury at the fashion in the world of sports

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We see in our sports podiatry activity in a significant number of patients complaining of pain located in the heel and / or under the foot arch.
They represent on average 20% of the chief complaints.

The most common cause is inflammation of the plantar fascia (fasciitis), and in particular at its insertion on the heel bone (insertion fasciitis).
The fascia is a band of fibrous tissue that extends from the calcaneus to the metatarsal heads and by extension to the base of the phalanges.
Describes a superficial fascia and deep other which form a triangle, whose main function is to form a vault and keep a curvature of the foot.
The fascia also has the function of supporting the weight of the body to absorb shocks and protect from beneath the bones of the foot.
We also note, it plays a leading role in the movement of the foot ensuring stability.

The triggers are numerous, including pain can occur after intense exercise (running, walking ....) Or during the recovery early in the season for example sport.
But we can also associate this disease with different causes, including:
-r├ętraction posterior chain (excessive tension of the fascia by the phenomenon of the pulley)
- Short Achilles tendon
important -pronation
-Feet dishes
-or otherwise the hollow foot with very high dynamic supination
-foot irreducible hollow
weight -surcharge
-in├ęgalit├ę of leg length
-mauvaises shoes or shoes with too large corrections
inappropriate orthopedic -semelles including too high foot arch

The patient described the pain in the heel, and rarely at the rope of the fascia.
On palpation include pressure algetic an area located at the antero internal heel part.
This pain occurs on a regular basis, the morning upon awakening or after prolonged sitting.
The patient can not get up because the pain is intense and after a few minutes, especially walking it disappears.
In sport, the patient can not feel any pain but the next day to be completely impotent.
Doctor: - I walk like a little old

We find very rarely, cases of ruptures of the fascia with shooting pain, a snapping sensation, visual signs (hematoma) and especially an impotence as in the case of a rupture of the Achilles tendon total.
The diagnosis of fracture, even if it seems obvious to be confirmed by an MRI.

The treatment of fasciitis is often long and often been the interminable discussion forums on the miracle cure.
The first remedy is to avoid its appearance, and for this it is essential to work stretching.
RELAX it to be permanently posterior chain and plantar chain because in sport both drivers retract, and over the workouts are shorter.
Years also cause a decrease in elasticity.

Eliminate all other causes: bad shoes or old shoes
overweight ... ..

Finally, the main treatment is wearing orthotics, which aims to relax the plantar fascia and correct if necessary static and dynamic morphological disorders.
(The recess "hole" at the level of the sole is to be removed)

In addition and to treat inflammation that is to say, put out the fire, there is an array processing / Physiotherapy (massage and ultrasound)
Local anti-inflammatory
Mesotherapy
Shock waves
In all cases more than 90% of heel pain disappear between 6 and 9 months of conservative treatment.

Olivier HOMAGE. - 11 juin 2010.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.

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