What Is Painful Heel

Heel Discomfort

Overview

Plantar Fasciitis is a chronic pain in the heel that can just appear from nowhere but it is actually a long standing mechanical condition caused by prolonged stress on your foot. In most cases Plantar Fasciitis is a common, but very treatable, mechanical condition of the foot and responds positively to orthotics. A heel pain caused by prolonged stress on a ligament like structure in the arch that is very important in weigh-bearing activities. The tissue becomes damaged and needs to be helped to repair in order for the pain to go or subside to a manageable level. Orthotics for your feet can achieve this necessary healing for pain relief. It can be very painful, and even debilitating for sufferers.




Causes

Plantar fasciitis is the most common injury of the plantar fascia and is the most common cause of heel pain. Approximately 10% of people have plantar fasciitis at some point during their lifetime. It is commonly associated with long periods of standing and is much more prevalent in individuals with excessive inward rolling of the foot, which is seen with flat feet. Among non-athletic populations, plantar fasciitis is associated with obesity and lack of physical exercise.




Symptoms

Symptoms of the plantar fasciitis include a gradual onset of pain under the heel which may radiate into the foot. Tenderness is usually felt under and on the inside of the heel which is initially worse first in the morning but eases as the foot warms up only to return later in the day or after exercise. Stretching the plantar fascia may be painful.




Diagnosis

Physical examination is the best way to determine if you have plantar fasciitis. Your doctor examines the affected area to determine if plantar fasciitis is the cause of your pain. The doctor may also examine you while you are sitting, standing, and walking. It is important to discuss your daily routine with your doctor. An occupation in which you stand for long periods of time may cause plantar fasciitis. An X-ray may reveal a heel spur. The actual heel spur is not painful. The presence of a heel spur suggests that the plantar fascia has been pulled and stretched excessively for a long period of time, sometimes months or years. If you have plantar fasciitis, you may or may not have a heel spur. Even if your plantar fasciitis becomes less bothersome, the heel spur will remain.




Non Surgical Treatment

A number of conservative measures can help take stress off the plantar fascia and encourage healing, including Icing, Taping the arch and bottom of the foot, Stretching, especially the calf, Avoiding walking with bare feet, especially on hard surfaces, Wearing orthotics or arch supports, Taking over-the-counter anti-inflammatories. If these methods fail, we generally try one of two things, A cortisone injection can help reduce swelling. Often a single injection will do the trick, but occasionally a second injection may be needed. Alternatively, we can try extracorporeal pulse activation therapy, or EPAT. This method uses sound waves to penetrate to the plantar fascia and stimulate the body’s healing response. We typically do one treatment a week for three weeks, with complete healing taking between nine to 12 weeks.

Foot Pain




Surgical Treatment

Plantar fasciotomy is often considered after conservative treatment has failed to resolve the issue after six months and is viewed as a last resort. Minimally invasive and endoscopic approaches to plantar fasciotomy exist but require a specialist who is familiar with certain equipment. Heel spur removal during plantar fasciotomy has not been found to improve the surgical outcome. Plantar heel pain may occur for multiple reasons and release of the lateral plantar nerve branch may be performed alongside the plantar fasciotomy in select cases. Possible complications of plantar fasciotomy include nerve injury, instability of the medial longitudinal arch of the foot, fracture of the calcaneus, prolonged recovery time, infection, rupture of the plantar fascia, and failure to improve the pain. Coblation (TOPAZ) surgery has recently been proposed as alternative surgical approaches for the treatment of recalcitrant plantar fasciitis.




Prevention

The following steps will help prevent plantar fasciitis or help keep the condition from getting worse if you already have it. Take care of your feet. Wear shoes with good arch support and heel cushioning. If your work requires you to stand on hard surfaces, stand on a thick rubber mat to reduce stress on your feet. Do exercises to stretch the Achilles tendon at the back of the heel. This is especially important before sports, but it is helpful for non-athletes as well. Ask your doctor about recommendations for a stretching routine. Stay at a healthy weight for your height. Establish good exercise habits. Increase your exercise levels gradually, and wear supportive shoes. If you run, alternate running with other sports that will not cause heel pain. Put on supportive shoes as soon as you get out of bed. Going barefoot or wearing slippers puts stress on your feet. If you feel that work activities caused your heel pain, ask your human resources department for information about different ways of doing your job that will not make your heel pain worse. If you are involved in sports, you may want to consult a sports training specialist for training and conditioning programs to prevent plantar fasciitis from recurring.

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