What Leads To Pain On The Heel

Heel Discomfort

Overview

Plantar fasciitis is that pain in the bottom of your foot usually in the heel. That pain hurts especially with the first few steps in the morning as you get out of bed. This strange name comes from: "Plantar" means something that belongs to the foot, "fascia" means a band or ligament or a connective tissue, and "itis" means inflammation. You can see in the picture the plantar fascia band as it runs along the foot. This band connects your heel bone to the toes.




Causes

Plantar fasciitis symptoms are usually exacerbated via "traction" (or stretching) forces on the plantar fascia. In simple terms, you plantar fascia is repeatedly overstretched. The most common reason for the overstretching are an elongated arch due to either poor foot biomechanics (eg overpronation) or weakness of your foot arch muscles. Compression type plantar fascia injuries have a traumatic history. Landing on a sharp object that bruises your plantar fascia is your most likely truma. The location of plantar fasciitis pain will be further under your arch than under your heel, which is more likely to be a fat pad contusion if a single trauma caused your pain. The compression type plantar fasciitis can confused with a fat pad contusion that is often described as a "stone bruise".




Symptoms

Symptoms of plantar fasciitis can occur suddenly or gradually. When they occur suddenly, there is usually intense heel pain on taking the first morning steps, known as first-step pain. This heel pain will often subside as you begin to walk around, but it may return in the late afternoon or evening. When symptoms occur gradually, a more long-lasting form of heel pain will cause you to shorten your stride while running or walking. You also may shift your weight toward the front of the foot, away from the heel.




Diagnosis

Physical examination is the best way to determine if you have plantar fasciitis. Your doctor examines the affected area to determine if plantar fasciitis is the cause of your pain. The doctor may also examine you while you are sitting, standing, and walking. It is important to discuss your daily routine with your doctor. An occupation in which you stand for long periods of time may cause plantar fasciitis. An X-ray may reveal a heel spur. The actual heel spur is not painful. The presence of a heel spur suggests that the plantar fascia has been pulled and stretched excessively for a long period of time, sometimes months or years. If you have plantar fasciitis, you may or may not have a heel spur. Even if your plantar fasciitis becomes less bothersome, the heel spur will remain.




Non Surgical Treatment

Reducing inflammation in the plantar fascia ligament is an important part of treatment, though this does not address the underlying damage to the ligament. Initial home treatment includes staying off your feet and applying ice for 15 to 20 minutes three or four times a day to reduce swelling. You can also try reducing or changing your exercise activities. Using arch supports in your shoes and doing stretching exercises may also help to relieve pain. Nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen (i.e. Motrin or Advil) and naproxen (i.e. Aleve), are often used to reduce inflammation in the ligament. If home treatments and over-the-counter anti-inflammatory drugs don’t ease the pain, an injection of a corticosteroid directly into the damaged section of the ligament can be given. Your doctor can do this in his or her office. Your doctor may use an ultrasound device to help determine the best place for the injection. Corticosteroids can also be administered on the skin of your heel or the arch of your foot, and then a painless electrical current is applied to let the steroid pass through your skin and into the muscle. Physical therapy is an important part of treatment for planter fasciitis. It can help stretch your plantar fascia and Achilles tendons. A physical therapist can also show you exercises to strengthen your lower leg muscles, helping to stabilize your walk and lessen the workload on your plantar fascia. If pain continues and other methods aren’t working, your doctor may recommend extracorporeal shock wave therapy. Sound waves are bombarded against your heel to stimulate healing within the ligament. This treatment can result in bruises, swelling, pain, and numbness, and has not been proven to be consistently effective in relieving symptoms.

Heel Pain




Surgical Treatment

If you consider surgery, your original diagnosis should be confirmed by the surgeon first. In addition, supporting diagnostic evidence (such as nerve-conduction studies) should be gathered to rule out nerve entrapment, particularly of the first branch of the lateral plantar nerve and the medial plantar nerve. Blood tests should consist of an erythrocyte sedimentation rate (ESR), rheumatoid factor, human leukocyte antigen B27 (HLA-B27), and uric acid. It’s important to understand that surgical treatment of bone spurs rarely improves plantar fasciitis pain. And surgery for plantar fasciitis can cause secondary complications-a troubling condition known as lateral column syndrome.




Prevention

Maintain a healthy weight. This minimizes the stress on your plantar fascia. Choose supportive shoes. Avoid high heels. Buy shoes with a low to moderate heel, good arch support and shock absorbency. Don't go barefoot, especially on hard surfaces. Don't wear worn-out athletic shoes. Replace your old athletic shoes before they stop supporting and cushioning your feet. If you're a runner, buy new shoes after about 500 miles of use. Change your sport. Try a low-impact sport, such as swimming or bicycling, instead of walking or jogging. Apply ice. Hold a cloth-covered ice pack over the area of pain for 15 to 20 minutes three or four times a day or after activity. Or try ice massage. Freeze a water-filled paper cup and roll it over the site of discomfort for about five to seven minutes. Regular ice massage can help reduce pain and inflammation. Stretch your arches. Simple home exercises can stretch your plantar fascia, Achilles tendon and calf muscles.

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