What Is Heel Pain

Feet Pain

Overview

Plantar fasciitis is a common cause of heel pain in adults. The pain is usually caused by collagen degeneration (which is sometimes misnamed “chronic inflammation”) at the origin of the plantar fascia at the medial tubercle of the calcaneus. This degeneration is similar to the chronic necrosis of tendonosis, which features loss of collagen continuity, increases in ground substance (matrix of connective tissue) and vascularity, and the presence of fibro-blasts rather than the inflammatory cells usually seen with the acute inflammation of tendonitis. The cause of the degeneration is repetitive microtears of the plantar fascia that overcome the body's ability to repair itself.




Causes

This is a problem of either extreme, so people with high arches or those that have very flat feet are at risk of developing pain in this region. This is because of the relative stress the plantar fascia is put under. In people with excessive pronation, the plantar fascia is put under too much stretch, as their range flattens and strains it. People with a stiff, supinated (high-arched) foot lack the flexibility to appropriately shock absorb, so this too puts extra strain on the plantar fascia. Clinically, we see more people presenting with plantar fascia pain who have excessive pronation than those with stiff, supinated feet. But while the foot type is the biggest risk factor for plantar fasciitis, the whole leg from the pelvis down can affect how the foot hits the ground. A thorough biomechanical assessment will determine where in the kinetic chain things have gone wrong to cause the overload.




Symptoms

Plantar fascia usually causes pain and stiffness on the bottom of your heel although some people have heel spurs and suffer no symptoms at all. Occasionally, heel pain is also associated with other medical disorders such as arthritis (inflammation of the joint), bursitis (inflammation of the tissues around the joint). Those who have symptoms may experience ‘First step’ pain (stone bruise sensation) after getting out of bed or sitting for a period of time. Pain after driving. Pain on the bottom of your heel. Deep aching pain. Pain can be worse when barefoot.




Diagnosis

X-rays are a commonly used diagnostic imaging technique to rule out the possibility of a bone spur as a cause of your heel pain. A bone spur, if it is present in this location, is probably not the cause of your pain, but it is evidence that your plantar fascia has been exerting excessive force on your heel bone. X-ray images can also help determine if you have arthritis or whether other, more rare problems, stress fractures, bone tumors-are contributing to your heel pain.




Non Surgical Treatment

Treatment for heel pain usually involves using a combination of techniques, such as stretches and painkillers, to relieve pain and speed up recovery. Most cases of heel pain get better within 12 months. Surgery may be recommended as a last resort if your symptoms don't improve after this time. Only 1 in 20 people with heel pain will need surgery. Whenever possible, rest the affected foot by not walking long distances and standing for long periods. However, you should regularly stretch your feet and calves using exercises such as those described below. Pain relief. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be used to help relieve pain. Some people also find applying an ice pack to the affected heel for 5-10 minutes can help relieve pain and inflammation. However, do not apply an ice pack directly to your skin. Instead, wrap it in a towel. If you do not have an ice pack, you can use a packet of frozen vegetables.

Plantar Fasciitis




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.




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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