What Is Painful Heel

Painful Heel

Overview

The Plantar Fascia is a strong ligament-like structure under the arch of the foot that runs from the heel bone to the ball of the foot. If we could see it in isolation it has a triangular shape when looked at from underneath but has a curved shape when looked at from the side - much like a sail boat’s sail billowing in the wind. The most functional piece is from the front-bottom-inside area of the heel bone (calcaneous) to the joint of the big toe (hallux) and this is where the majority of stress of walking (and running and jumping) is taken by the fascia. How your plantar fascia reacts to and recovers from this stress is what determines the extent and nature of your plantar fasciitis.




Causes

The most frequent cause is an abnormal motion of the foot called excessive pronation. Normally, while walking or during long distance running, your foot will strike the ground on the heel, then roll forward toward your toes and inward to the arch. Your arch should only dip slightly during this motion. If it lowers too much, you have what is known as excessive pronation. For more details on pronation, please see the section on biomechanics and gait. Clinically not only those with low arches, but those with high arches can sometimes have plantar fasciitis. The mechanical structure of your feet and the manner in which the different segments of your feet are linked together and joined with your legs has a major impact on their function and on the development of mechanically caused problems. Merely having "flat feet" won't take the spring out of your step, but having badly functioning feet with poor bone alignment will adversely affect the muscles, ligaments, and tendons and can create a variety of aches and pains. Excess pronation can cause the arch of your foot to stretch excessively with each step. It can also cause too much motion in segments of the foot that should be stable as you are walking or running. This "hypermobility" may cause other bones to shift and cause other mechanically induced problems.




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

Your doctor will check your feet and watch you stand and walk. He or she will also ask questions about your past health, including what illnesses or injuries you have had. Your symptoms, such as where the pain is and what time of day your foot hurts most. How active you are and what types of physical activity you do. Your doctor may take an X-ray of your foot if he or she suspects a problem with the bones of your foot, such as a stress fracture.




Non Surgical Treatment

Shoe therapy, finding and wearing shoes that allow your feet to be in their natural position, is the most important treatment for plantar fasciosis. Shoes that possess a flat heel, are wide in the toe box, lack toe spring, and have flexible soles are most appropriate for this foot problem. An increasing number of shoe companies are producing shoes with these design characteristics, but shoes that include all these features are still difficult to find. For some suggested footwear models, see our clinic’s shoe list. Most conventional footwear can be modified by stretching the shoe’s upper, stretching out the toe spring, removing the shoe’s liner, and cutting the shoe at certain key points to allow more room for your foot. Visit your podiatrist to help you with these shoe modifications. Correct Toes is another helpful conservative treatment method for plantar fasciosis. Correct Toes addresses the root cause of your plantar fasciosis by properly aligning your big toe and reducing the tension created by your abductor hallucis longus on the blood vessels that feed and "cleanse" the tissues of your plantar fascia. Your plantar fasciosis-related pain will diminish when the dead tissue is washed away. A rehabilitation program, which includes targeted stretches and other exercises, for your foot may be helpful too. Dietary changes and aerobic exercise are particularly important for overweight individuals who have plantar fasciosis. Water aerobics may be most appropriate for those individuals whose pain does not allow them to walk or cycle. Physical therapy may be another helpful treatment modality for this problem, and includes ultrasound, electrical stimulation, contrast baths, and range-of-motion exercises. Massage, acupuncture, reflexology, and magnet therapy are holistic approaches that may be helpful.

Painful Heel




Surgical Treatment

Surgery may be considered in very difficult cases. Surgery is usually only advised if your pain has not eased after 12 months despite other treatments. The operation involves separating your plantar fascia from where it connects to the bone; this is called a plantar fascia release. It may also involve removal of a spur on the calcaneum if one is present. Surgery is not always successful. It can cause complications in some people so it should be considered as a last resort. Complications may include infection, increased pain, injury to nearby nerves, or rupture of the plantar fascia.

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