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What Exactly Triggers 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. Plantar fasciitis commonly causes a stabbing pain in the heel of the foot, which is worse during the first few steps of the day after awakening. As you continue to walk on the affected foot, the pain gradually lessens. Usually, only one foot is affected, but it can occur in both feet simultaneously. To diagnose plantar fasciitis, your doctor will physically examine your foot.


Causes

Plantar fasciitis generally occurs over time, rather than being the result of a single event. Micro trauma from repetitive stress to the tissue often combines with a biomechanical deficiency of the foot to produce the condition. In addition, arthritic and metabolic factors may contribute to the development of this injury, (though they are unlikely to affect young athletes). A variety of training errors commonly lead to plantar fasciitis, particularly a rapid increase in either volume or intensity of athletic activity. Volume refers to the distance or time an athlete performs, while intensity refers to the pace of activity and/or the recovery time allowed following performance.


Symptoms

Pain is the main symptom. This can be anywhere on the underside of your heel. However, commonly, one spot is found as the main source of pain. This is often about 4 cm forward from your heel, and may be tender to touch. The pain is often worst when you take your first steps on getting up in the morning, or after long periods of rest where no weight is placed on your foot. Gentle exercise may ease things a little as the day goes by, but a long walk or being on your feet for a long time often makes the pain worse. Resting your foot usually eases the pain. Sudden stretching of the sole of your foot may make the pain worse, for example, walking up stairs or on tiptoes. You may limp because of pain. Some people have plantar fasciitis in both feet at the same time.


Diagnosis

Most cases of plantar fasciitis are diagnosed by a health care provider who listens carefully to your description of symptoms. During an examination of your feet, your health care provider will have to press on the bottom of your feet, the area most likely to be painful in plantar fasciitis. Because the pain of plantar fasciitis has unique characteristics, pain upon rising, improvement after walking for several minutes, pain produced by pressure applied in a specific location on your foot but not with pressure in other areas, your health care provider will probably feel comfortable making the diagnosis based on your symptoms and a physical examination. Your health care provider may suggest that you have an X-ray of your foot to verify that there is no stress fracture causing your pain.


Non Surgical Treatment

There are several things you can do to self-treat your heel or arch pain. The first thing is to wear better shoes and consider adding arch supports or custom foot orthotics to your shoes. Stretching the calf muscles can also often be helpful. Try to stretch when you first get up in the morning and before you go to bed at night. Another good exercise is to “roll” your arch and heel. This is done by placing a tennis ball, golf ball, or lacrosse ball on the floor and rolling your foot on top of it. Some people get extra benefit by “rolling” on a frozen water bottle. You should also carefully evaluate your fitness program as you may be overdoing it. You may want consider backing of new or recently added exercises or increases in training until your heel pain improves. If you work at a standing job try to take more time to walk around during the day and avoid standing in one place for too long.

Pain Under The Heel


Surgical Treatment

Surgery is considered only after 12 months of aggressive nonsurgical treatment. Gastrocnemius recession. This is a surgical lengthening of the calf (gastrocnemius) muscles. Because tight calf muscles place increased stress on the plantar fascia, this procedure is useful for patients who still have difficulty flexing their feet, despite a year of calf stretches. In gastrocnemius recession, one of the two muscles that make up the calf is lengthened to increase the motion of the ankle. The procedure can be performed with a traditional, open incision or with a smaller incision and an endoscope, an instrument that contains a small camera. Your doctor will discuss the procedure that best meets your needs. Complication rates for gastrocnemius recession are low, but can include nerve damage. Plantar fascia release. If you have a normal range of ankle motion and continued heel pain, your doctor may recommend a partial release procedure. During surgery, the plantar fascia ligament is partially cut to relieve tension in the tissue. If you have a large bone spur, it will be removed, as well. Although the surgery can be performed endoscopically, it is more difficult than with an open incision. In addition, endoscopy has a higher risk of nerve damage.


Prevention

It is not always possible to prevent heel pain, but there are measures you can take to help avoid further episodes. Healthy weight. Being overweight can place excess pressure and strain on your feet, particularly on your heels. This increases the risk of damaging your feet and heels. If you are overweight, losing weight and maintaining a healthy weight by combining regular exercise with a healthy, balanced diet can be beneficial for your feet. You can calculate your body mass index (BMI) to find out whether you are a healthy weight for your height and build. To work out your BMI, divide your weight in kilograms by your height in metres squared. A BMI of less than 18.5 means that you are underweight, 18.5-24.9 means that your weight is healthy, 25-29 means that you are overweight, 30-40 means that you are obese, over 40 means that you are morbidly obese. You can also use the BMI healthy weight calculator to work out your BMI. Healthy feet. You should always wear footwear that is appropriate for your environment and day-to-day activities. Wearing high heels when you go out in the evening is unlikely to be harmful. However, wearing them all week at work may damage your feet, particularly if your job involves a lot of walking or standing. Ideally, you should wear shoes with laces and a low to moderate heel that supports and cushions your arches and heels. Avoid wearing shoes with no heels.

What Is Heel Pain

Painful Heel

Overview

Plantar fasciitis is the pain caused by degenerative irritation at the insertion of the plantar fascia on the medial process of the calcaneal tuberosity. The pain may be substantial, resulting in the alteration of daily activities. Various terms have been used to describe plantar fasciitis, including jogger’s heel, tennis heel, policeman’s heel, and even gonorrheal heel. Although a misnomer, this condition is sometimes referred to as heel spurs by the general public.


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

People with this condition sometimes describe the feeling as a hot, sharp sensation in the heel. You usually notice the pain first thing in the morning when you stand. After walking for a period of time, the pain usually lessens or even disappears. However, sharp pain in the center of the heel may return after resting for a period of time and then resuming activity.


Diagnosis

Your doctor can usually diagnose plantar fasciitis just by talking to you and examining your feet. Rarely, tests are needed if the diagnosis is uncertain or to rule out other possible causes of heel pain. These can include X-rays of the heel or an ultrasound scan of the fascia. An ultrasound scan usually shows thickening and swelling of the fascia in plantar fasciitis.


Non Surgical Treatment

A doctor may prescribe anti-inflammatory medication such as ibuprofen to help reduce pain and inflammation. Electrotherapy such as ultrasound or laser may also help with symptoms. An X-ray may be taken to see if there is any bone growth or calcification, known as a heel spur but this is not necessarily a cause of pain. Deep tissue sports massage techniques can reduce the tension in and stretch the plantar fascia and the calf muscles. Extracorporeal shock wave therapy has been known to be successful and a corticosteroid injection is also an option.


Surgical Treatment

If treatment hasn’t worked and you still have painful symptoms after a year, your GP may refer you to either an orthopaedic surgeon, a surgeon who specialises in surgery that involves bones, muscles and joints, a podiatric surgeon, a podiatrist who specialises in foot surgery. Surgery is sometimes recommended for professional athletes and other sportspeople whose heel pain is adversely affecting their career. Plantar release surgery. Plantar release surgery is the most widely used type of surgery for heel pain. The surgeon will cut the fascia to release it from your heel bone and reduce the tension in your plantar fascia. This should reduce any inflammation and relieve your painful symptoms. Surgery can be performed either as, open surgery, where the section of the plantar fascia is released by making a cut into your heel, endoscopic or minimal incision surgery – where a smaller incision is made and special instruments are inserted through the incision to gain access to the plantar fascia. Endoscopic or minimal incision surgery has a quicker recovery time, so you will be able to walk normally much sooner (almost immediately), compared with two to three weeks for open surgery. A disadvantage of endoscopic surgery is that it requires both a specially trained surgical team and specialised equipment, so you may have to wait longer for treatment than if you were to choose open surgery. Endoscopic surgery also carries a higher risk of damaging nearby nerves, which could result in symptoms such as numbness, tingling or some loss of movement in your foot. As with all surgery, plantar release carries the risk of causing complications such as infection, nerve damage and a worsening of your symptoms after surgery (although this is rare). You should discuss the advantages and disadvantages of both techniques with your surgical team. Extracorporeal shockwave therapy (EST) is a fairly new type of non-invasive treatment. Non-invasive means it does not involve making cuts into your body. EST involves using a device to deliver high-energy soundwaves into your heel. The soundwaves can sometimes cause pain, so a local anaesthetic may be used to numb your heel. It is claimed that EST works in two ways. It is thought to, have a “numbing” effect on the nerves that transmit pain signals to your brain, help stimulate and speed up the healing process. However, these claims have not yet been definitively proven. The National Institute for Health and Care Excellence (NICE) has issued guidance about the use of EST for treating plantar fasciitis. NICE states there are no concerns over the safety of EST, but there are uncertainties about how effective the procedure is for treating heel pain. Some studies have reported that EST is more effective than surgery and other non-surgical treatments, while other studies found the procedure to be no better than a placebo (sham treatment).


Stretching Exercises

While it’s typical to experience pain in just one foot, massage and stretch both feet. Do it first thing in the morning, and three times during the day. Achilles Tendon Stretch. Stand with your affected foot behind your healthy one. Point the toes of the back foot toward the heel of the front foot, and lean into a wall. Bend the front knee and keep the back knee straight, heel firmly planted on the floor. Hold for a count of 10. Plantar Fascia Stretch. Sit down, and place the affected foot across your knee. Using the hand on your affected side, pull your toes back toward your shin until you feel a stretch in your arch. Run your thumb along your foot–you should feel tension. Hold for a count of 10.