What Is Painful Heel

Pain Under The Heel

Overview

Plantar Fasciitis is actually, in most cases, plantar fasciosis but it’s a bit like pen/biro or hoover/vacuum. The term ‘-itis‘ means ‘inflammation’. This is a term we use for this problem in the early stages of damage because it usually is quite literally an inflammation of part of the plantar fascia. So, what is commonly known as ‘plantar fasciitis’ is really ‘plantar fasciosis’ - a degradation or degeneration of the collagen fibres because of prolonged (most of your adult life) unsustainable stress being applied to the fascia. So, we call it plantar fasciitis but it usually hasn’t been an ‘-itis‘ for years and that is why in many cases anti-inflammatory drugs do not help ease the pain of walking. This is also why most sufferers experience pain first thing in the morning. If inflammation was the source of discomfort then why would it hurt after a nights rest and the good old drugs pumping through your system.




Causes

Plantar fasciitis is a painful disorder in the lower part of your foot usually around the heel. That pain usually hurts as you get up in the morning when you try to stand on your feet, or after any periods of inactivity. It is a disorder of a tough and strong band that connects the heel bone to the toes. Plantar Fasciitis is caused by injuring that tough band on the bottom of the foot. The following may be the causes of plantar fasciitis. Tight calf muscles or tight Achilles tendon produces repetitive over-stretching of the plantar fascia. Gait and balance Problem may be a dominant cause of this disorder. Many people have a special style of walking, with something unique that causes some kind of imbalance in their body. It might be something like locked knees, feet that turn-out, a weak abdomen etc. This imbalance may place some pressure on the fascia, which eventually causes plantar fasciitis. Weak foot muscles don’t give enough support to the plantar fascia. The small muscles in the foot give the foot its shape by keeping the bones in place and by expanding and contracting to make a movement. Weak foot muscles will allow greater stress on the fascia. Foot anatomical problems such as flat feet or high arches can make the fascia ligament work or stretch abnormally. Flattening of the fat pad at the sole of the feet under the heels is a Degeneration process that is caused by poor footwear or by age. Shoes that have no proper heel cup can flatten that fat pad quite quickly and cause this disorder. Walking in shoes which do not have good arch support is considered to be a cause of plantar fasciitis. Wearing inadequate or worn out shoes may place more stress on the fascia ligament. If you wear shoes that don't fit you by size or width, you may put your feet under excessive stress. Overweight Men and women are more vulnerable to developing the condition because of the excess weight on the foot. Pregnant women are at risk due to gaining weight through pregnancy and due to the pregnancy hormones that make ligaments loosen and relax. Sudden increase of activity like starting to run long distance or complete change of daily activity can cause heel pain and this disorder. Practice of repetitive athletic activities, like long distance running, playing a ball game, dancing or jumping, is a common cause for the disorder. Actually it is considered as one of the most common running injuries. Spending long periods of time on your feet everyday can cause plantar fasciitis. Working on your feet a few hours a day evey day may be the reason for your heel pain.




Symptoms

A very common complaint of plantar fasciitis is pain in the bottom of the heel. Plantar fasciitis is usually worse in the morning and may improve throughout the day. By the end of the day the pain may be replaced by a dull aching that improves with rest. Most people suffering from plantar fasciitis also complain of increased heel pain after walking for a long period of time.




Diagnosis

During the physical exam, your doctor checks for points of tenderness in your foot. The location of your pain can help determine its cause. Usually no tests are necessary. The diagnosis is made based on the history and physical examination. Occasionally your doctor may suggest an X-ray or magnetic resonance imaging (MRI) to make sure your pain isn't being caused by another problem, such as a stress fracture or a pinched nerve. Sometimes an X-ray shows a spur of bone projecting forward from the heel bone. In the past, these bone spurs were often blamed for heel pain and removed surgically. But many people who have bone spurs on their heels have no heel pain.




Non Surgical Treatment

About 90% of plantar fasciitis cases are self-limited and will improve within six months with conservative treatment and within a year regardless of treatment. Many treatments have been proposed for the treatment of plantar fasciitis. First-line conservative approaches include rest, heat, ice, calf-strengthening exercises, techniques to stretch the calf muscles, achilles tendon, and plantar fascia, weight reduction in the overweight or obese, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. NSAIDs are commonly used to treat plantar fasciitis, but fail to resolve the pain in 20% of people. Extracorporeal shockwave therapy (ESWT) is an effective treatment modality for plantar fasciitis pain unresponsive to conservative nonsurgical measures for at least three months. Corticosteroid injections are sometimes used for cases of plantar fasciitis refractory to more conservative measures. The injections may be an effective modality for short-term pain relief up to one month, but studies failed to show effective pain relief after three months. Notable risks of corticosteroid injections for plantar fasciitis include plantar fascia rupture, skin infection, nerve or muscle injury, or atrophy of the plantar fat pad. Custom orthotic devices have been demonstrated as an effective method to reduce plantar fasciitis pain for up to 12 weeks. Night splints for 1-3 months are used to relieve plantar fasciitis pain that has persisted for six months. The night splints are designed to position and maintain the ankle in a neutral position thereby passively stretching the calf and plantar fascia overnight during sleep. Other treatment approaches may include supportive footwear, arch taping, and physical therapy.

Painful Heel




Surgical Treatment

The majority of patients, about 90%, will respond to appropriate non-operative treatment measures over a period of 3-6 months. Surgery is a treatment option for patients with persistent symptoms, but is NOT recommended unless a patient has failed a minimum of 6-9 months of appropriate non-operative treatment. There are a number of reasons why surgery is not immediately entertained including. Non-operative treatment when performed appropriately has a high rate of success. Recovery from any foot surgery often takes longer than patients expect. Complications following this type of surgery can and DO occur! The surgery often does not fully address the underlying reason why the condition occurred therefore the surgery may not be completely effective. Prior to surgical intervention, it is important that the treating physician ensure that the correct diagnosis has been made. This seems self-evident, but there are other potential causes of heel pain. Surgical intervention may include extracorporeal shock wave therapy or endoscopic or open partial plantar fasciectomy.




Prevention

To reduce your risk of getting plantar fasciitis take these steps. Wear appropriate and well-fitted footwear during sports and exercise. Do stretching exercises for the Achilles tendon and plantar fascia. Increase the intensity and duration of exercise gradually. Maintain an appropriate weight.

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