What Triggers Pain In The Heel And Ways To Treat It

Plantar Fascia

Overview

Plantar fasciosis is a foot condition characterized by heel pain and pain in your plantar fascia-a strong and dense connective tissue structure on the sole of your foot that supports your foot arch. This condition has historically been called plantar fasciitis because it was believed that plantar fascia inflammation was the principle underlying cause. Plantar fasciosis is a more accurate name for this condition because it involves degeneration-microtears, cell death-of your plantar fascia, not inflammation. Active men between the ages of 40 and 70 are most commonly affected by this health problem.


Causes

Plantar Fasciitis often leads to heel pain, heel spurs, and/or arch pain. The excessive stretching of the plantar fascia that leads to the inflammation and discomfort can be caused by the following: Over-pronation (flat feet) which results in the arch collapsing upon weight bearing A foot with an unusually high arch A sudden increase in physical activity Excessive weight on the foot, usually attributed to obesity or pregnancy Improperly fitting footwear Over-pronation (flat feet) is the leading cause of plantar fasciitis. Over-pronation occurs in the walking process, when a person’s arch collapses upon weight bearing, causing the plantar fascia to be stretched away from the heel bone. With Plantar Fasciitis, the bottom of your foot usually hurts near the inside of the foot where the heel and arch meet. The pain is often acute either first thing in the morning or after a long rest, because while resting the plantar fascia contracts back to its original shape. As the day progresses and the plantar fascia continues to be stretched, the pain often subsides.


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

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

Sometimes physical therapy modalities are helpful. The most frequently used modalities include ultrasound (high frequency sound vibrations that create a deep heat and reduce inflammation) and galvanic electrical stimulation ( a carefully applied intermittent muscular stimulation to the heel and calf that helps reduce pain and relax muscle spasm, which is a contributing factor to the pain). This treatment has been found most effective when given twice a week. Repeated taping and padding is sometimes used. The felt pads that will be strapped to your feet will compress after a few days and must be reapplied. While wearing them they should be kept dry, but may be removed the night before your next appointment. Resistant cases of heel pain caused by plantar fasciitis, heel spurs or cases of stress fracture of the calcaneus often need to be placed in a removable below knee cast boot. It is important to be aware of how your foot feels over this time period. If your foot is still uncomfortable without the strapping, but was more comfortable while wearing it, that is an indication that the treatment should help. Remember, what took many months or years to develop can not be eliminated in just a few days.

Pain At The Heel


Surgical Treatment

In very rare cases plantar fascia surgery is suggested, as a last resort. In this case the surgeon makes an incision into the ligament, partially cutting the plantar fascia to release it. If a heel spur is present, the surgeon will remove it. Plantar Fasciitis surgery should always be considered the last resort when all the conventional treatment methods have failed to succeed. Endoscopic plantar fasciotomy (EPF) is a form of surgery whereby two incisions are made around the heel and the ligament is being detached from the heel bone allowing the new ligament to develop in the same place. In some cases the surgeon may decide to remove the heel spur itself, if present. Just like any type of surgery, Plantar Fascia surgery comes with certain risks and side effects. For example, the arch of the foot may drop and become weak. Wearing an arch support after surgery is therefore recommended. Heel spur surgeries may also do some damage to veins and arteries of your foot that allow blood supply in the area. This will increase the time of recovery.


Prevention

Plantar fasciitis can be a nagging problem, which gets worse and more difficult to treat the longer it’s present. To prevent plantar fasciitis, run on soft surfaces, keep mileage increases to less than 10 percent per week, and visit a specialty running shop to make sure you’re wearing the proper shoes for your foot type and gait. It’s also important to stretch the plantar fascia and Achilles tendon.

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