Heel Soreness

Overview

Heel Discomfort

Millions of people each year suffer from heel pain. Many of those don?t understand heel pain causes and will often not seek proper Heel Pain treatment. Heel pain is often directly related to plantar fasciitis. Plantar fasciitis is an inflammation of the plantar fascia that, when addressed early, can be easily treated.

Causes

To understand the cause of the pain one must understand the anatomy of the foot and some basic mechanics in the function of the foot. A thick ligament, called the plantar fascia, is attached into the bottom of the heel and fans out into the ball of the foot, attaching into the base of the toes. The plantar fascia is made of dense, fibrous connective tissue that will stretch very little. It acts something like a shock absorber. As the foot impacts the ground with each step, it flattens out lengthening the foot. This action pulls on the plantar fascia, which stretches slightly. When the heel comes off the ground the tension on the ligament is released. Anything that causes the foot to flatten excessively will cause the plantar fascia to stretch greater that it is accustom to doing. One consequence of this is the development of small tears where the ligament attaches into the heel bone. When these small tears occur, a very small amount of bleeding occurs and the tension of the plantar fascia on the heel bone produces a spur on the bottom of the heel to form. Pain experienced in the bottom of the heel is not produced by the presence of the spur. The pain is due to excessive tension of the plantar fascia as it tears from its attachment into the heel bone. Heel spur formation is secondary to the excessive pull of the plantar fascia where it attaches to the heel bone. Many people have heel spurs at the attachment of the plantar fascia with out having any symptoms or pain. There are some less common causes of heel pain but they are relatively uncommon. There are several factors that cause the foot to flatten and excessively stretching the plantar fascia. The primary factor is the structure of a joint complex below the ankle joint, called the subtalar joint. The movement of this joint complex causes the arch of the foot to flatten and to heighten. Flattening of the arch of the foot is termed pronation and heightening of the arch is called supination. If there is excessive pronation of the foot during walking and standing, the plantar fascia is strained. Over time, this will cause a weakening of the ligament where it attaches into the heel bone, causing pain. When a person is at rest and off of their feet, the plantar fascia attempts to mend itself. Then, with the first few steps the fascia re-tears causing pain. Generally, after the first few steps the pain diminishes. This is why the heel pain tends to be worse the first few steps in the morning or after rest. Another factor that contributes to the flattening of the arch of the foot is tightness of the calf muscles. The calf muscle attaches into the foot by the achilles tendon into the back of the heel. When the calf muscle is tight it limits the movement of the ankle joint. When ankle joint motion is limited by the tightness of the calf muscle it forces the subtalar joint to pronate excessively. Excessive subtalar joint pronation can cause several different problems to occur in the foot. In this instance, it results in excessive tension of the plantar fascia. Tightness of the calf muscles can be a result of several different factors. Exercise, such as walking or jogging will cause the calf muscle to tighten. Inactivity or prolonged rest will also cause the calf muscle to tighten. Women who wear high heels and men who wear western style cowboy boots will, over time, develop tightness in the calf muscles.

Symptoms

See your doctor immediately if you have Severe pain and swelling near your heel. Inability to bend your foot downward, rise on your toes or walk normally. Heel pain with fever, numbness or tingling in your heel. Severe heel pain immediately after an injury. Schedule an office visit if you have. Heel pain that continues when you’re not walking or standing. Heel pain that lasts more than a few weeks, even after you’ve tried rest, ice and other home treatments.

Diagnosis

Depending on the condition, the cause of heel pain is diagnosed using a number of tests, including medical history, physical examination, including examination of joints and muscles of the foot and leg, X-rays.

Non Surgical Treatment

Curing posterior heel pain requires calming the inflammation, resting the foot and increasing calf flexibility. Ice therapy and anti-inflammatory medications can be used to reduce the inflammation. Stopping exercises that stress the calf and Achilles is important. This includes walking, running and the use of stair climbers and elliptical machines. Placing a heel lift in each shoe can reduce some of the excess strain on the back of the heel. Stretching exercises to increase calf flexibility are important in curing this problem and preventing its recurrence. Wearing running shoes also provides good foot support and helps with this condition. Sometimes a walking boot is used to immobilize the ankle and let the area completely rest. Physical therapy is sometimes ordered to help reduce the inflammation and pain and to help improve the flexibility of the calf muscles. Occasionally these measures fail to relieve the pain and surgery may be needed. The surgical procedure involves removing bone spurs and repairing any damage to the tendon.

Surgical Treatment

If treatment hasn’t worked and you still have painful symptoms after a year, your GP may refer you to either an orthopaedic surgeon, a surgeon who specialises in surgery that involves bones, muscles and joints or a podiatric surgeon, a podiatrist who specialises in foot surgery. Surgery is sometimes recommended for professional athletes and other sportspeople whose heel pain is adversely affecting their career. Plantar release surgery is the most widely used type of surgery for heel pain. The surgeon will cut the fascia to release it from your heel bone and reduce the tension in your plantar fascia. This should reduce any inflammation and relieve your painful symptoms. Surgery can be performed either as open surgery, where the section of the plantar fascia is released by making a cut into your heel or endoscopic or minimal incision surgery – where a smaller incision is made and special instruments are inserted through the incision to gain access to the plantar fascia. Endoscopic or minimal incision surgery has a quicker recovery time, so you will be able to walk normally much sooner (almost immediately), compared with two to three weeks for open surgery. A disadvantage of endoscopic surgery is that it requires both a specially trained surgical team and specialised equipment, so you may have to wait longer for treatment than if you were to choose open surgery. Endoscopic surgery also carries a higher risk of damaging nearby nerves, which could result in symptoms such as numbness, tingling or some loss of movement in your foot. As with all surgery, plantar release carries the risk of causing complications such as infection, nerve damage and a worsening of your symptoms after surgery (although this is rare). You should discuss the advantages and disadvantages of both techniques with your surgical team.

Prevention

Painful Heel

The following steps will help prevent plantar fasciitis or help keep the condition from getting worse if you already have it. The primary treatment is rest. Cold packs application to the area for 20 minutes several times a day or after activities give some relief. Over-the-counter pain medications can help manage the pain, consult your healthcare professional. Shoes should be well cushioned, especially in the midsole area, and should have the appropriate arch support. Some will benefit from an orthotic shoe insert, such as a rubber heel pad for cushioning. Orthotics should be used in both shoes, even if only one foot hurts. Going barefoot or wearing slipper puts stress on your feet. Put on supportive shoes as soon as you get out of bed. Calf stretches and stretches using a towel (place the towel under the ball of your feet and pull gently the towel toward you and hold a few seconds) several times a day, especially when first getting up in the morning. Stretching the Achilles tendon at the back of the heel is especially important before sports, but it is helpful for nonathletes as well. Increasing your exercise levels gradually. Staying at a healthy weight. Surgery is very rarely required.

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What Leads To Heel Discomfort And The Way To Overcome It

Heel Discomfort

Overview

If your first few steps out of bed in the morning cause severe pain in the heel of your foot, you may have plantar fasciitis, an overuse injury that affects the sole of the foot. A diagnosis of plantar fasciitis means you have inflamed the tough, fibrous band of tissue (fascia) connecting your heel bone to the base of your toes.


Causes

It usually starts following an increase in activity levels. Increase in weight. Standing for long periods. Poor footwear. Tight muscle groups. Abnormal pressure on the plantar Fascia can be caused by any of the above. The plantar fascia becomes inflamed and tiny rips can occur where it attaches into the inside of the heel bone. The area becomes inflamed and swollen, and it is the increase in fluid to the area that accumulates when weight is taken off the area that then causes the pain on standing.


Symptoms

Pain is the main symptom. This can be anywhere on the underside of your heel. However, commonly, one spot is found as the main source of pain. This is often about 4 cm forward from your heel, and may be tender to touch. The pain is often worst when you take your first steps on getting up in the morning, or after long periods of rest where no weight is placed on your foot. Gentle exercise may ease things a little as the day goes by, but a long walk or being on your feet for a long time often makes the pain worse. Resting your foot usually eases the pain. Sudden stretching of the sole of your foot may make the pain worse, for example, walking up stairs or on tiptoes. You may limp because of pain. Some people have plantar fasciitis in both feet at the same time.


Diagnosis

Your doctor will check your feet and watch you stand and walk. He or she will also ask questions about your past health, including what illnesses or injuries you have had. Your symptoms, such as where the pain is and what time of day your foot hurts most. How active you are and what types of physical activity you do. Your doctor may take an X-ray of your foot if he or she suspects a problem with the bones of your foot, such as a stress fracture.


Non Surgical Treatment

Your GP or podiatrist may advise you to change your footwear. You should avoid wearing flat-soled shoes, because they will not provide your heel with support and could make your heel pain worse. Ideally, you should wear shoes that cushion your heels and provide a good level of support to the arches of your feet. For women wearing high heels, and for men wearing heeled boots or brogues, can provide short- to medium-term pain relief, as they help reduce pressure on the heels. However, these types of shoes may not be suitable in the long term, because they can lead to further episodes of heel pain. Your GP or podiatrist can advise on footwear. Orthoses are insoles that fit inside your shoe to support your foot and help your heel recover. You can buy orthoses off-the-shelf from sports shops and larger pharmacies. Alternatively, your podiatrist should be able to recommend a supplier. If your pain does not respond to treatment and keeps recurring, or if you have an abnormal foot shape or structure, custom-made orthoses are available. These are specifically made to fit the shape of your feet. However, there is currently no evidence to suggest that custom-made orthoses are more effective than those bought off-the-shelf. An alternative to using orthoses is to have your heel strapped with sports strapping (zinc oxide) tape, which helps relieve pressure on your heel. Your GP or podiatrist can teach you how to apply the tape yourself. In some cases, night splints can also be useful. Most people sleep with their toes pointing down, which means tissue inside the heel is squeezed together. Night splints, which look like boots, are designed to keep your toes and feet pointing up while you are asleep. This will stretch both your Achilles tendon and your plantar fascia, which should help speed up your recovery time. Night splints are usually only available from specialist shops and online retailers. Again, your podiatrist should be able to recommend a supplier. If treatment hasn’t helped relieve your painful symptoms, your GP may recommend corticosteroid injections. Corticosteroids are a type of medication that have a powerful anti-inflammatory effect. They have to be used sparingly because overuse can cause serious side effects, such as weight gain and high blood pressure (hypertension). As a result, it is usually recommended that no more than three corticosteroid injections are given within a year in any part of the body. Before having a corticosteroid injection, a local anaesthetic may be used to numb your foot so you don’t feel any pain.

Feet Pain


Surgical Treatment

In cases that do not respond to any conservative treatment, surgical release of the plantar fascia may be considered. Plantar fasciotomy may be performed using open, endoscopic or radiofrequency lesioning techniques. Overall, the success rate of surgical release is 70 to 90 percent in patients with plantar fasciitis. Potential risk factors include flattening of the longitudinal arch and heel hypoesthesia as well as the potential complications associated with rupture of the plantar fascia and complications related to anesthesia.


Prevention

Stretching the plantar fascia and the calf muscle area can help to prevent inflammation. Slowly increasing the amount or intensity of athletic activities by graded progression can also help to prevent injury. Recommended Stretches: Taking a lunge position with the injured foot behind and keeping your heels flat on the floor, lean into a wall and bend the knees. A stretch should be felt in the sole and in the Achilles tendon area. Hold the stretch for 20-30 seconds. Also try this stretch with the back leg straight.

What Is Heel Pain And How One Can Overcome It

Pain Of The Heel

Overview

Plantar fasciitis is the most common cause of heel pain. The plantar fascia is the flat band of tissue (ligament) that connects your heel bone to your toes. It supports the arch of your foot. If you strain your plantar fascia, it gets weak, swollen, and irritated (inflamed). Then your heel or the bottom of your foot hurts when you stand or walk. Plantar fasciitis is common in middle-aged people. It also occurs in younger people who are on their feet a lot, like athletes or soldiers. It can happen in one foot or both feet.


Causes

Plantar fasciitis is one of those injuries that magically seems to appear for no apparent reason. However, plantar fasciitis is caused by one of two methods. They are either traction or compression injuries. Plantar fasciitis is most often associated with impact and running sports, especially those that involve toe running rather than heel running styles. It is also commonly diagnosed in individuals with poor foot biomechanics that stress the plantar fascia. Flat feet or weak foot arch control muscles are two common causes of plantar fasciitis.


Symptoms

The symptoms of plantar fasciitis are pain on the bottom of the heel, pain in the arch of the foot, pain that is usually worse upon arising, pain that increases over a period of months. People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they’ve been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people the pain subsides but returns after spending long periods of time on their feet.


Diagnosis

If you see a doctor for heel pain, he or she will first ask questions about where you feel the pain. If plantar fasciitis is suspected, the doctor will ask about what activities you’ve been doing that might be putting you at risk. The doctor will also examine your foot by pressing on it or asking you to flex it to see if that makes the pain worse. If something else might be causing the pain, like a heel spur or a bone fracture, the doctor may order an X-ray to take a look at the bones of your feet. In rare cases, if heel pain doesn’t respond to regular treatments, the doctor also might order an MRI scan of your foot. The good news about plantar fasciitis is that it usually goes away after a few months if you do a few simple things like stretching exercises and cutting back on activities that might have caused the problem. Taking over-the-counter medicines can help with pain. It’s rare that people need surgery for plantar fasciitis. Doctors only do surgery as a last resort if nothing else eases the pain.


Non Surgical Treatment

Although there is no single cure, many treatments can be used to ease pain. In order to treat it effectively for the long-term, the cause of the condition must be corrected as well as treating the symptoms. Rest until it is not painful. It can be very difficult to rest the foot as most people will be on their feet during the day for work. A plantar fasciitis taping technique can help support the foot relieving pain and helping it rest. Plantar fasciitis tapingApply ice or cold therapy to help reduce pain and inflammation. Cold therapy can be applied for 10 minutes every hour if the injury is particularly painful for the first 24 to 48 hours. This can be reduced to 3 times a day as symptoms ease. Plantar fasciitis exercises can be done if pain allows, in particular stretching the fascia is an important part of treatment and prevention. Simply reducing pain and inflammation alone is unlikely to result in long term recovery. The fascia tightens up making the origin at the heel more susceptible to stress. Plantar fasciitis night splint. Plantar fasciitis night splint is an excellent product which is worn overnight and gently stretches the calf muscles preventing it from tightening up overnight.

Feet Pain


Surgical Treatment

Surgery is rarely used in the treatment of plantar fasciitis. However it may be recommended when conservative treatment has been tried for several months but does not bring adequate relief of symptoms. Surgery usually involves the partial release of the plantar fascia from the heel bone. In approximately 75% of cases symptoms are fully resolved within six months. In a small percentage of cases, symptoms may take up to 12 months to fully resolve.


Prevention

Maintain a healthy weight. This minimizes the stress on your plantar fascia. Choose supportive shoes. Avoid high heels. Buy shoes with a low to moderate heel, good arch support and shock absorbency. Don’t go barefoot, especially on hard surfaces. Don’t wear worn-out athletic shoes. Replace your old athletic shoes before they stop supporting and cushioning your feet. If you’re a runner, buy new shoes after about 500 miles of use. Change your sport. Try a low-impact sport, such as swimming or bicycling, instead of walking or jogging. Apply ice. Hold a cloth-covered ice pack over the area of pain for 15 to 20 minutes three or four times a day or after activity. Or try ice massage. Freeze a water-filled paper cup and roll it over the site of discomfort for about five to seven minutes. Regular ice massage can help reduce pain and inflammation. Stretch your arches. Simple home exercises can stretch your plantar fascia, Achilles tendon and calf muscles.

What Exactly May Cause Plantar Fasciitis

Feet Pain

Overview

The American College of Sports and Medicine (1) estimates that the average adult takes between 5,000 and 10,000 steps per day. The brunt of this activity is borne by the bones, muscles and ligaments of the foot. Healthy feet have strong, wonderfully flexible ligaments which are designed to support standing, walking and running. Plantar Fasciitis (pronounced “plantar fash-ee-eye-tis”) is defined as inflammation of, or damage to, one of the most important ligaments in the foot – the plantar fascia. The plantar fascia ligament is located along the sole of your foot. It is made up of fibrous tissue that stretches outward from the heel bone, like a strong piece of elastic, and then branches out across the arch and through the ball area of the foot toward the toes.


Causes

Factors which may contribute to plantar fasciitis and heel spurs include a sudden increase in daily activities, increase in weight (not usually a problem with runners), or a change of shoes. Dramatic increase in training intensity or duration may cause plantar fasciitis. Shoes that are too flexible in the middle of the arch or shoes that bend before the toe joints will cause an increase in tension in the plantar fascia. Even though you may have run in shoes that are flexible before, now that you have developed plantar fasciitis, make certain that your shoe is stable and does not bend in the midfoot. Check and be certain that your shoes are not excessively worn. Shoes that do not sufficiently control excessive pronation combined with an increase in training can lead to this condition. A change in running style or parameters, such as starting speed work, running on the ball of your foot or sudden increase in hill workouts may lead to problems. All changes should be gradual and not abrupt. Gait changes such as altering your foot strike, switching shoe style, running barefoot or in minimalist shoes should all be made gradually and not abruptly. The “terrible too’s” of too much, too soon, too often with too little rest also applies to “too many changes with too little adaptation”. Make your changes gradually and allow your muscles, bones, and other body structures to adapt to the alterations you may be attempting.


Symptoms

Among the symptoms for Plantar Fasciitis is pain usually felt on the underside of the heel, often most intense with the first steps after getting out of bed in the morning. It is commonly associated with long periods of weight bearing or sudden changes in weight bearing or activity. Plantar Fasciitis also called “policeman’s heel” is presented by a sharp stabbing pain at the bottom or front of the heel bone. In most cases, heel pain is more severe following periods of inactivity when getting up and then subsides, turning into a dull ache.


Diagnosis

Your doctor will perform a physical exam to check for tenderness in your foot and the exact location of the pain to make sure that it’s not caused by a different foot problem. The doctor may ask you to flex your foot while he or she pushes on the plantar fascia to see if the pain gets worse as you flex and better as you point your toe. Mild redness or swelling will also be noted. Your doctor will evaluate the strength of your muscles and the health of your nerves by checking your reflexes, your muscle tone, your sense of touch and sight, your coordination, and your balance. X-rays or a magnetic resonance imaging (MRI) scan may be ordered to check that nothing else is causing your heel pain, such as a bone fracture.


Non Surgical Treatment

Stabilize the foot by using uniquely placed wedges, deep heel cups, and “posts” (stabilizers). When the foot is stabilized, it is brought back to a neutral or normal alignment. When the foot is in its normal alignment, pronation and supination are reduced or completely corrected, and the abnormal pull on the Plantar Fascia is alleviated. This will allow the Plantar Fascia to begin to heal. When healing occurs, the pain and inflammation gradually subside. Provide the specific amount of arch support that your foot requires. Our custom-made orthotics support not only the arch as a whole, but each individual bone and joint that forms the arch. Whether your arch is flat or abnormally high, our custom-made orthotics will provide the support that you need. When the arch is properly supported, the Plantar Fascia is protected and healing can begin. Aid in shock absorption. The primary shock absorbers of our feet, and therefore our body, are the Plantar Fascia and the arch. To aid these structures, we construct our custom-made orthotics so that they provide semi-flexible support to the arch by “giving” to absorb the shock of each step, rather than our foot absorbing the shock (our orthotics act in the same way a shock absorber does on an automobile). When your weight is removed from the orthotic, the arch returns to its original height since the material we use has a built-in “memory.” This action will help to keep the Plantar Fascia and arch healthy and pain free. Cushion the heel. Our custom-made orthotics use thin, cushiony, durable, materials to cushion and protect the heel. This helps to alleviate painful heels.

Feet Pain


Surgical Treatment

Surgery may be considered in very difficult cases. Surgery is usually only advised if your pain has not eased after 12 months despite other treatments. The operation involves separating your plantar fascia from where it connects to the bone; this is called a plantar fascia release. It may also involve removal of a spur on the calcaneum if one is present. Surgery is not always successful. It can cause complications in some people so it should be considered as a last resort. Complications may include infection, increased pain, injury to nearby nerves, or rupture of the plantar fascia.

What Exactly May Cause Plantar Fasciitis

Feet Pain

Overview

The American College of Sports and Medicine (1) estimates that the average adult takes between 5,000 and 10,000 steps per day. The brunt of this activity is borne by the bones, muscles and ligaments of the foot. Healthy feet have strong, wonderfully flexible ligaments which are designed to support standing, walking and running. Plantar Fasciitis (pronounced “plantar fash-ee-eye-tis”) is defined as inflammation of, or damage to, one of the most important ligaments in the foot – the plantar fascia. The plantar fascia ligament is located along the sole of your foot. It is made up of fibrous tissue that stretches outward from the heel bone, like a strong piece of elastic, and then branches out across the arch and through the ball area of the foot toward the toes.


Causes

Factors which may contribute to plantar fasciitis and heel spurs include a sudden increase in daily activities, increase in weight (not usually a problem with runners), or a change of shoes. Dramatic increase in training intensity or duration may cause plantar fasciitis. Shoes that are too flexible in the middle of the arch or shoes that bend before the toe joints will cause an increase in tension in the plantar fascia. Even though you may have run in shoes that are flexible before, now that you have developed plantar fasciitis, make certain that your shoe is stable and does not bend in the midfoot. Check and be certain that your shoes are not excessively worn. Shoes that do not sufficiently control excessive pronation combined with an increase in training can lead to this condition. A change in running style or parameters, such as starting speed work, running on the ball of your foot or sudden increase in hill workouts may lead to problems. All changes should be gradual and not abrupt. Gait changes such as altering your foot strike, switching shoe style, running barefoot or in minimalist shoes should all be made gradually and not abruptly. The “terrible too’s” of too much, too soon, too often with too little rest also applies to “too many changes with too little adaptation”. Make your changes gradually and allow your muscles, bones, and other body structures to adapt to the alterations you may be attempting.


Symptoms

Among the symptoms for Plantar Fasciitis is pain usually felt on the underside of the heel, often most intense with the first steps after getting out of bed in the morning. It is commonly associated with long periods of weight bearing or sudden changes in weight bearing or activity. Plantar Fasciitis also called “policeman’s heel” is presented by a sharp stabbing pain at the bottom or front of the heel bone. In most cases, heel pain is more severe following periods of inactivity when getting up and then subsides, turning into a dull ache.


Diagnosis

Your doctor will perform a physical exam to check for tenderness in your foot and the exact location of the pain to make sure that it’s not caused by a different foot problem. The doctor may ask you to flex your foot while he or she pushes on the plantar fascia to see if the pain gets worse as you flex and better as you point your toe. Mild redness or swelling will also be noted. Your doctor will evaluate the strength of your muscles and the health of your nerves by checking your reflexes, your muscle tone, your sense of touch and sight, your coordination, and your balance. X-rays or a magnetic resonance imaging (MRI) scan may be ordered to check that nothing else is causing your heel pain, such as a bone fracture.


Non Surgical Treatment

Stabilize the foot by using uniquely placed wedges, deep heel cups, and “posts” (stabilizers). When the foot is stabilized, it is brought back to a neutral or normal alignment. When the foot is in its normal alignment, pronation and supination are reduced or completely corrected, and the abnormal pull on the Plantar Fascia is alleviated. This will allow the Plantar Fascia to begin to heal. When healing occurs, the pain and inflammation gradually subside. Provide the specific amount of arch support that your foot requires. Our custom-made orthotics support not only the arch as a whole, but each individual bone and joint that forms the arch. Whether your arch is flat or abnormally high, our custom-made orthotics will provide the support that you need. When the arch is properly supported, the Plantar Fascia is protected and healing can begin. Aid in shock absorption. The primary shock absorbers of our feet, and therefore our body, are the Plantar Fascia and the arch. To aid these structures, we construct our custom-made orthotics so that they provide semi-flexible support to the arch by “giving” to absorb the shock of each step, rather than our foot absorbing the shock (our orthotics act in the same way a shock absorber does on an automobile). When your weight is removed from the orthotic, the arch returns to its original height since the material we use has a built-in “memory.” This action will help to keep the Plantar Fascia and arch healthy and pain free. Cushion the heel. Our custom-made orthotics use thin, cushiony, durable, materials to cushion and protect the heel. This helps to alleviate painful heels.

Feet Pain


Surgical Treatment

Surgery may be considered in very difficult cases. Surgery is usually only advised if your pain has not eased after 12 months despite other treatments. The operation involves separating your plantar fascia from where it connects to the bone; this is called a plantar fascia release. It may also involve removal of a spur on the calcaneum if one is present. Surgery is not always successful. It can cause complications in some people so it should be considered as a last resort. Complications may include infection, increased pain, injury to nearby nerves, or rupture of the plantar fascia.