What Is Painful Heel

Plantar Fasciitis

Overview

Plantar fasciitis often occurs in middle-age. It also occurs in people who spend long hours standing on their feet at work, like athletes or soldiers. It can happen in one foot or both feet. It is common in sports like long distance running, dancing etc. Athletes who overpronate (rolling in or flattening feet) are especially at risk as the biomechanics of their feet place more stress to the band. Plantar fasciitis can take a long time to heal. Six months is the average time reported in medical research. There are some who will get cured after a few weeks and for others it will take more than a year. It can also become a chronic condition in which case some sort of treatment will always be needed to prevent the pain from coming back. As sooner as the condition is treated chances are it will not get chronic or in other words if you treat plantar fasciitis sooner you will get cured faster.


Causes

Excessive stretching of the plantar fascia can result in microtrauma of this structure either along its course or where it inserts onto the medial calcaneal tuberosity. This microtrauma, if repetitive, can result in chronic degeneration of the plantar fascia fibers. The loading of the degenerative and healing tissue at the plantar fascia may cause significant plantar pain, particularly with the first few steps after sleep or other periods of inactivity. The term fasciitis may, in fact, be something of a misnomer, because the disease is actually a degenerative process that occurs with or without inflammatory changes, which may include fibroblastic proliferation. This has been proven from biopsies of fascia from people undergoing surgery for plantar fascia release.


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

To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis. In addition, diagnostic imaging studies such as x-rays or other imaging modalities may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.


Non Surgical Treatment

Stabilize the foot by using uniquely placed wedges, deep heel cups, and “posts” (stabilizers). When the foot is stabilized, it is brought back to a neutral or normal alignment. When the foot is in its normal alignment, pronation and supination are reduced or completely corrected, and the abnormal pull on the Plantar Fascia is alleviated. This will allow the Plantar Fascia to begin to heal. When healing occurs, the pain and inflammation gradually subside. Provide the specific amount of arch support that your foot requires. Our custom-made orthotics support not only the arch as a whole, but each individual bone and joint that forms the arch. Whether your arch is flat or abnormally high, our custom-made orthotics will provide the support that you need. When the arch is properly supported, the Plantar Fascia is protected and healing can begin. Aid in shock absorption. The primary shock absorbers of our feet, and therefore our body, are the Plantar Fascia and the arch. To aid these structures, we construct our custom-made orthotics so that they provide semi-flexible support to the arch by “giving” to absorb the shock of each step, rather than our foot absorbing the shock (our orthotics act in the same way a shock absorber does on an automobile). When your weight is removed from the orthotic, the arch returns to its original height since the material we use has a built-in “memory.” This action will help to keep the Plantar Fascia and arch healthy and pain free. Cushion the heel. Our custom-made orthotics use thin, cushiony, durable, materials to cushion and protect the heel. This helps to alleviate painful heels.

Feet Pain


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.


Stretching Exercises

Stretching exercises for your foot are important. Do the stretches shown here at least twice a day. Don’t bounce when you stretch. Plantar fascia stretch. To do the plantar fascia stretch, stand straight with your hands against a wall and your injured leg slightly behind your other leg. Keeping your heels flat on the floor, slowly bend both knees. You should feel the stretch in the lower part of your leg. Hold the stretch for 10 to 15 seconds. Repeat the stretch 6 to 8 times. Calf stretch. Stand with your hands against a wall and your injured leg behind your other leg. With your injured leg straight, your heel flat on the floor and your foot pointed straight ahead, lean slowly forward, bending the other leg. You should feel the stretch in the middle of your calf. Hold the stretch for 10 to 15 seconds. Repeat the stretch 6 to 8 times. Other exercises. You can also strengthen your leg muscles by standing on the ball of your foot at the edge of a step and raising up as high as possible on your toes. Relax between toe raises and let your heel fall a little lower than the edge of the step. It’s also helpful to strengthen the foot by grabbing a towel with your toes as if you are going to pick up the towel with your foot. Repeat this exercise several times a day.

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