What May Cause Painful Heel And Approaches To Prevent It

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

Identified risk factors for plantar fasciitis include excessive running, standing on hard surfaces for prolonged periods of time, high arches of the feet, the presence of a leg length inequality, and flat feet. The tendency of flat feet to excessively roll inward during walking or running makes them more susceptible to plantar fasciitis. Obesity is seen in 70% of individuals who present with plantar fasciitis and is an independent risk factor. Studies have suggested a strong association exists between an increased body mass index and the development of plantar fasciitis. Achilles tendon tightness and inappropriate footwear have also been identified as significant risk factors.




Symptoms

Patients with plantar fasciitis typically experience pain underneath the heel and along the inner sole of the foot. In less severe cases, patients may only experience an ache or stiffness in the plantar fascia or heel that increases with rest (typically at night or first thing in the morning) following activities which place stress on the plantar fascia. These activities typically include standing, walking or running excessively (especially up hills, on uneven surfaces or in poor footwear such as thongs), jumping, hopping and general weight bearing activity. The pain associated with this condition may also warm up with activity in the initial stages of injury. As the condition progresses, patients may experience symptoms that increase during sport or activity, affecting performance. In severe cases, patients may walk with a limp or be unable to weight bear on the affected leg. Patients with this condition may also experience swelling, tenderness on firmly touching the plantar fascia (often on a specific spot on the inner aspect of the heel) and sometimes pain on performing a plantar fascia stretch.




Diagnosis

Plantar fasciitis is one of many conditions causing "heel pain". Some other possible causes include nerve compression either in the foot or in the back, stress fracture of the calcaneus, and loss of the fatty tissue pad under the heel. Plantar fasciitis can be distinguished from these and other conditions based on a history and examination done by a physician. It should be noted that heel spurs are often inappropriately thought to be the sole cause of heel pain. In fact, heel spurs are common and are nothing more than the bone's response to traction or pulling-type forces from the plantar fascia and other muscles in the foot where they attach to the heel bone. They are commonly present in patients without pain, and frequently absent from those who have pain. It is the rare patient who has a truly enlarged and problematic spur requiring surgery.




Non Surgical Treatment

Cut back on walking, running or athletic weight bearing activities. Try the recommended stretches above. Shoes with a good arch support and heel cushioning or over-the-counter orthotics may help. Icing the area of pain or taking a short course of anti-inflammatory medications such as ibuprofen or acetaminophen will help with pain. If treatments do not help, a doctor can suggest other options.






Surgical Treatment

The most common surgical procedure for plantar fasciitis is plantar fascia release. It involves surgical removal of a part from the plantar fascia ligament which will relieve the inflammation and reduce the tension. Plantar fascia release is either an open surgery or endoscopic surgery (insertion of special surgical instruments through small incisions). While both methods are performed under local anesthesia the open procedure may take more time to recover. Other surgical procedures can be used as well but they are rarely an option. Complications of plantar fasciitis surgery are rare but they are not impossible. All types of plantar fasciitis surgery pose a risk of infection, nerve damage, and anesthesia related complications including systemic toxicity, and persistence or worsening of heel pain.




Stretching Exercises

The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 2 - 3 times daily and only provided they do not cause or increase symptoms. Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate and advanced exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms. Calf Stretch with Towel. Begin this stretch in long sitting with your leg to be stretched in front of you. Your knee and back should be straight and a towel or rigid band placed around your foot as demonstrated. Using your foot, ankle and the towel, bring your toes towards your head until you feel a stretch in the back of your calf, Achilles tendon, plantar fascia or leg. Hold for 5 seconds and repeat 10 times at a mild to moderate stretch provided the exercise is pain free. Resistance Band Calf Strengthening. Begin this exercise with a resistance band around your foot as demonstrated and your foot and ankle held up towards your head. Slowly move your foot and ankle down against the resistance band as far as possible and comfortable without pain, tightening your calf muscle. Very slowly return back to the starting position. Repeat 10 - 20 times provided the exercise is pain free.