The heel spur or plantar fasciitis is a very occurring syndrome, mainly in men aged 40 and 70, as well as athletes, especially runners.
The painful syndrome in the heel region had its first description in 1812 and the causes are not yet fully defined, although some factors can contribute, such as inflammation of the plantar fascia caused by traumatic event involving tensile forces (LAPIDUS and GUIDOTTI, 1965), avulsion plantar fascia, stress fracture of the calcaneus, compressive neuropathy of the plantar nerves (TANZ, 1963) spur calcaneal and senile atrophy of the fat footpads.
The plantar fasciitis is the main cause of pain in the heel area, where it is estimated that one in 10 people have this discomfort during life (CRAWFORD and THOMSON, 2003). During the course of the stance phase compression occurs on the sole and a tensile force is generated along the fascia. During the walk, every step of the fascia is subjected to repetitive tensile forces. When these forces are applied successively with increased frequency and intensity, there may be progressive degeneration of the origin of the plantar fascia.
Probably the heel spur is a result of chronic inflammation caused by repetitive traumatic pull the origin of the plantar fascia and the short flexor muscle of the fingers.
Some authors believe that the cause of heel pain is associated with the fat pad of the heel. It is an important structure responsible for shock absorption during heel strike the ground. With aging, degenerative changes associated with the gradual reduction of collagen and liquid cause a reduction in the elasticity of the fat pad.
After about 40 years fatty footpad begins to deteriorate, with the loss of collagen, elastic tissue and water, which causes reduction in thickness and height. These changes result in reducing its ability to absorb impact and reduce its protective action of the tuberosity of the calcaneus plant (JAHSS, KUMMER and MICHELSON, 1992).
Several studies have linked the body weight as a cause of subcalcânea pain and observed a high incidence in obese patients or overweight (GILL and KIBSAK, 1996).
In patients with pain subcalcânea, should investigate the possibility of other causal factors such as: rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, Reiter’s syndrome and stress fracture of the calcaneus.
In diabetic patients, one should research the possibility of deep abscess in the soft parts. In young children, the most common cause of pain is apophysitis subcalcânea calcaneus (Sever’s disease) (Baxter and Pfeffer, 1992).
Patients usually complain of pain on the inner side of the heel. On rare occasions can occur intense pain, with sudden onset, caused by traumatic avulsion of the plantar fascia at its insertion by the calcaneal tuberosity. Regardless of how the symptoms begin, the clinical course is usually similar. The pain is worse in the morning, to support the foot on the ground for the first time and becomes less intense after starting the first steps. At the end of the day the pain becomes more intense and is relieved by foot from home. When the pain becomes more intense, the patient can not support the body weight on the heel.
Symptoms may persist for a few weeks or even a few years. In cases where there is entrapment of the first branch of the nerve lateral plantar (nerve to the fifth toe abductor muscle), pain also radiates proximally and distally along the foot and follows the nerve pathway (ACEVEDO and BESKIN, 1998).
The strength of the muscles that cross the area where the patient reports pain should be investigated to see if the symptoms are reproduced with muscle contraction.