What Is Heel Pain And How One Can Fix It

Pain In The Heel

Overview

Plantar fasciitis is sometimes mixed up with a heel spur although they are not the same. A heel spur is a calcium deposit that occurs where the plantar fascia is attached to the heel bone (calcaneus). In many cases a heel spur is found on a foot with no pain or other symptoms at all. And in many painful heels there is no sign for a heel spur. Heel spur and painful heal does not necessarily go together. For many years plantar fasciitis was believed to be an inflammatory condition. It is thought now to be inaccurate because there were many cases of the disorder with no inflammatory signs observed within the fascia. The heel pain cause is now believed to be damage to the collagen fibers of the fascia. This damage, caused by stress injury, sometimes may include inflammatory cells.




Causes

Currently no single factor has been reliably identified as contributing to the development of plantar fasciitis. The two risk factors with the most support from current research. Decreased ankle dorsiflexion. Increased Body Mass Index (BMI) in non-athletic populations. These factors are related in that both lead to increased strain on the arch, both lead to increased compression on the heel. When dorsiflexion range of motion (ankle flexibility) is lacking, the body compensates by increasing movement of the arch. In this way, decreased ankle dorsiflexion influences pronation and places strain on the underside of the foot. Similarly, having a high BMI causes strain because it places a load on the foot that may be in excess of what the foot can support. As mentioned earlier, overpronation is thought to be a contributing factor, but studies on this have so far produced mixed results. The second way these factors relate to each other is in the way people stand. A lack of ankle flexibility and a high BMI can both cause increased pressure on the heel in standing. Keeping weight on the heels causes compression under the heel. But it also means the muscles and ligaments in the arch are not being used to balance your body weight. Lack of use, I suspect, is a greater danger than overuse. Looking beyond these potential contributors to heel pain though, there is one major factor that overshadows them all-the way footwear alters the normal function of the foot.




Symptoms

Plantar fasciitis generally occurs in one foot. Bilateral plantar fasciitis is unusual and tends to be the result of a systemic arthritic condition that is exceptionally rare among athletes. Males suffer from a somewhat greater incidence of plantar fasciitis than females, perhaps as a result of greater weight coupled with greater speed and ground impact, as well as less flexibility in the foot. Typically, the sufferer of plantar fasciitis experiences pain upon rising after sleep, particularly the first step out of bed. Such pain is tightly localized at the bony landmark on the anterior medial tubercle of the calcaneus. In some cases, pain may prevent the athlete from walking in a normal heel-toe gait, causing an irregular walk as means of compensation. Less common areas of pain include the forefoot, Achilles tendon, or subtalar joint. After a brief period of walking, the pain usually subsides, but returns again either with vigorous activity or prolonged standing or walking. On the field, an altered gait or abnormal stride pattern, along with pain during running or jumping activities are tell-tale signs of plantar fasciitis and should be given prompt attention. Further indications of the injury include poor dorsiflexion (lifting the forefoot off the ground) due to a shortened gastroc complex, (muscles of the calf). Crouching in a full squat position with the sole of the foot flat on the ground can be used as a test, as pain will preclude it for the athlete suffering from plantar fasciitis, causing an elevation of the heel due to tension in the gastroc complex.




Diagnosis

Plantar fasciosis is confirmed if firm thumb pressure applied to the calcaneus when the foot is dorsiflexed elicits pain. Fascial pain along the plantar medial border of the fascia may also be present. If findings are equivocal, demonstration of a heel spur on x-ray may support the diagnosis; however, absence does not rule out the diagnosis, and visible spurs are not generally the cause of symptoms. Also, infrequently, calcaneal spurs appear ill defined on x-ray, exhibiting fluffy new bone formation, suggesting spondyloarthropathy (eg, ankylosing spondylitis, reactive arthritis. If an acute fascial tear is suspected, MRI is done.




Non Surgical Treatment

Most health care providers agree that initial treatment for plantar fasciitis should be quite conservative. You'll probably be advised to avoid any exercise that is making your pain worse. Your doctor may also advise one or more of these treatment options. A heel pad. In plantar fasciitis, a heel pad is sometimes used to cushion the painful heel if you spend a great deal of time on your feet on hard surfaces. Also, over-the-counter or custom-made orthotics, which fit inside your shoes, may be constructed to address specific imbalances you may have with foot placement or gait. Stretching: Stretching exercises performed three to five times a day can help elongate the heel cord. Ice: You may be advised to apply ice packs to your heel or to use an ice block to massage the plantar fascia before going to bed each night. Pain relievers: Simple over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often helpful in decreasing inflammation and pain. If you have stomach trouble from such drugs, your health care provider may prescribe an alternative. A night splint: A night splint is sometimes used to hold your foot at a specific angle, which prevents the plantar fascia from shortening during sleep. Ultrasound: Ultrasound therapy can be performed to decrease inflammation and aid healing. Steroid injections: Anti-inflammatory steroid injections directly into the tissue around your heel may be temporarily helpful. However, if these injections are used too many times, you may suffer other complications, such as shrinking of the fat pad of your heel, which you need for insulation. Loss of the fat pad could actually increase your pain, or could even rupture the plantar fascia in rare cases. Walking cast: In cases of long-term plantar fasciitis unresponsive to usual treatments, your doctor may recommend that you wear a short walking cast for about three weeks. This ensures that your foot is held in a position that allows the plantar fascia to heal in a stretched, rather than shortened, position. Shock wave therapy, Extracorporeal shock wave therapy which may be prescribed prior to considering surgery if your symptoms have persisted for more than six months. This treatment does not involve any actual incisions being made rather it uses a high intensity shock wave to stimulate healing of the plantar fascia.

Heel Discomfort




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.




Stretching Exercises

Calf stretch. Lean forward against a wall with one knee straight and the heel on the ground. Place the other leg in front, with the knee bent. To stretch the calf muscles and the heel cord, push your hips toward the wall in a controlled fashion. Hold the position for 10 seconds and relax. Repeat this exercise 20 times for each foot. A strong pull in the calf should be felt during the stretch. Plantar fascia stretch. This stretch is performed in the seated position. Cross your affected foot over the knee of your other leg. Grasp the toes of your painful foot and slowly pull them toward you in a controlled fashion. If it is difficult to reach your foot, wrap a towel around your big toe to help pull your toes toward you. Place your other hand along the plantar fascia. The fascia should feel like a tight band along the bottom of your foot when stretched. Hold the stretch for 10 seconds. Repeat it 20 times for each foot. This exercise is best done in the morning before standing or walking.

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