What Triggers Painful Heel

Painful Heel

Overview

Plantar fasciitis is one of the most common explanations of heel pain. It is caused by inflammation to the thick band that connects the toes to the heel bone, called the plantar fascia, which runs across the bottom of your foot. The condition is most commonly seen in runners, pregnant women, overweight people, and individuals who wear inadequately supporting shoes. Plantar fasciitis typically affects people between the ages of 40 and 70.




Causes

Repeated small injuries to the fascia (with or without inflammation) are thought to be the cause of plantar fasciitis. The injury is usually near to where the plantar fascia attaches to your heel bone. You are more likely to injure your plantar fascia in certain situations. For example, if you are on your feet for a lot of the time, or if you do lots of walking, running, standing, etc, when you are not used to it. (Plantar fasciitis may be confused with 'Policeman's heel', but they are different. Policeman's heel is plantar calcaneal bursitis - inflammation of the sack of fluid (bursa) under the heel bone. This is not as common as plantar fasciitis.) Also, people with a sedentary lifestyle are more prone to plantar fasciitis. If you have recently started exercising on a different surface, for example, running on the road instead of a track. If you have been wearing shoes with poor cushioning or poor arch support. If you are overweight this will put extra strain on your heel. If there is overuse or sudden stretching of your sole. For example, athletes who increase running intensity or distance; poor technique starting 'off the blocks', etc. If you have a tight Achilles tendon (the big tendon at the bottom of your calf muscles above your heel). This can affect your ability to flex your ankle and make you more likely to damage your plantar fascia. Often there is no apparent cause for plantar fasciitis, particularly in older people. A common wrong belief is that the pain is due to a bony growth or 'spur' coming from the heel bone (calcaneum). Many people have a bony spur of the heel bone but not everyone with this gets plantar fasciitis.




Symptoms

The most common symptom is pain and stiffness in the bottom of the heel. The heel pain may be dull or sharp. The bottom of the foot may also ache or burn. The pain is often worse in the morning when you take your first steps, after standing or sitting for awhile, when climbing stairs, after intense activity. The pain may develop slowly over time, or come on suddenly after intense activity.




Diagnosis

Diagnosis of plantar fasciitis is based on a medical history, the nature of symptoms, and the presence of localised tenderness in the heel. X-rays may be recommended to rule out other causes for the symptoms, such as bone fracture and to check for evidence of heel spurs. Blood tests may also be recommended.




Non Surgical Treatment

As with most soft tissue injuries the initial treatment is Rest, Ice, and Protection. In the early phase you’ll most likely be unable to walk pain-free. Our first aim is to provide you with some active rest from pain-provoking foot postures. This means that you should stop doing any movement or activity that provoked your foot pain in the first place. Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot. A frozen water bottle can provide you with a ice foot roller that can simultaneously provide you with some gentle plantar fascia massage. Anti-inflammatory medication (if tolerated) and natural substances eg arnica may help reduce your pain and swelling. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as a pain reducing medication. To support and protect your plantar fascia, you may need to be wear a plantar fascia brace, heel cups or have your foot taped to provide pain relief. As mentioned earlier, the cause of your plantar fasciitis will determine what works best for you. Your physiotherapist will guide you. Your physiotherapist will guide you and utilise a range of pain relieving techniques including joint mobilisations for stiff joints, massage, electrotherapy, acupuncture or dry needling to assist you during this pain-full phase.

Plantar Fasciitis




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.

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