What Is Painful Heel

Heel Pain

Overview

Plantar fasciitis is a poorly understood condition. There is little consensus among medical professionals about what causes the problem, and no treatments have been reliably proven to treat it. A number of theories exists for why plantar fasciitis develops, but the ineffectiveness of conventional treatments suggests something is missing. The plantar fascia is a band of connective tissue that runs along the underside of the foot from the heel to the toes. The fascia helps maintain the integrity of the arch, provides shock absorption, and plays an important role in the normal mechanical function of the foot.




Causes

Plantar fasciitis is one of those injuries that magically seems to appear for no apparent reason. However, plantar fasciitis is caused by one of two methods. They are either traction or compression injuries. Plantar fasciitis is most often associated with impact and running sports, especially those that involve toe running rather than heel running styles. It is also commonly diagnosed in individuals with poor foot biomechanics that stress the plantar fascia. Flat feet or weak foot arch control muscles are two common causes of plantar fasciitis.




Symptoms

The typical presentation is sharp pain localized at the anterior aspect of the calcaneus. Plantar fasciitis has a partial association with a heel spur (exostosis); however, many asymptomatic individuals have bony heel spurs, whereas many patients with plantar fasciitis do not have a spur.




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

Rest until the pain resolves and you are feeling better. For most people with plantar fasciitis it is very difficult to rest as daily routine demands using their feet during the day for work or other activities. By using the painful foot you keep on hurting the plantar fascia, harming the foot and increasing inflammation. Rest as much as you can, reduce unnecessary activities and additional stress on the fascia. Cold therapy like applying ice to the bottom of your foot helps reduce pain and inflammation. Cold therapy can be used all the time until symptoms have resolved. Some patients prefer to roll their foot over an iced cold drink can or bottle taken out of the freezer. Physical therapy Exercises are good plantar fasciitis treatment. Stretching and other physical therapy measures may be used to provide relief. Stretching the plantar fascia is reported in scientific studies to be a very effective treatment technique. Gait analysis will determine if you overpronate or oversupinate. An expert may perform a test of the way you stand and walk to see if you step in a way that puts more stress on the plantar fascia. You can try to change the way you walk and stand according to the experts recommendation as part of your treatment. Exercise the foot muscles to make the muscles stronger. One good exercise is grabbing and lifting up a towel or marbles using your toes. You can do the same exercise without a towel as though you are grasping something with the toes of each foot. Another good exercise is walking as tall as you can on your toes and on the balls of your feet. Stretching the plantar fascia and the calf muscles several times a day is an important part of the treatment and prevention. There are many stretching exercises for the plantar fascia and the calf muscles that you can find. Long term treatment should not focus in reduction of pain and inflammation alone. This is a passive short term relief treatment. Stretching exercises results are longer and more flexible foot movement which can prevent another fascia injury. Plantar fasciitis taping technique can assist the foot getting rest and help it from getting injured again. Athletic tape is applied in strips on the skin on the bottom of the foot supporting the plantar fascia. The tape restricts the movement of the foot so the fascia can not be injured again. Taping supports the foot by putting the tired foot muscles and tendons in a physiologically more relaxed position. A night splint is worn during sleep. It holds the calf muscles and plantar fascia in a stretched position. Night splint treatment lets the fascia heal in a stretched position so it will not get bruised again when waking up and stretching it again while walking. Orthotics or inserts that your doctor may prescribe or custom made arch supports (orthotics) plantar fascia orthotic. help to distribute the pressure on your feet more evenly. Arch Support gives a little raise to the arch assisting the plantar fascia. There are also over-the-counter inserts that are used for arch support and heel cushioning. Heel cups and cradles provide extra comfort and cushion the heel. They reduce shock placed on the foot during everyday activities like Shock absorbers. Anti-inflammatory or Pain medication that a clinician may recommend can be a plantar fasciitis treatment. Non-steroidal anti-inflammatory drugs such as ibuprofen can reduce swelling and relieve pain. However, these medications may have many side effects and it is important to consider the potential risks and benefits. These medications may relieve the pain and inflammation but will not cure the fascia. Lose weight as much as you can. Extra weight puts more stress on your plantar fascia. Platelet Rich Plasma or PRP therapy, is a procedure which involves an injection of special plasma, made out of the patients own blood, to the injured area. Platelets are special blood components that have a major role in the body ability to heal itself. Blood is taken from the patient and separated into its components. The platelet rich part of the blood is than taken and injected into the injured area - in our case to the bottom of the foot. The special plasma helps the foot recovery process. The procedure is actually maximizing the body's natural healing response of the treated area. Extracorporeal shock wave therapy is a procedure which sound waves are targeted at the area of heel pain to encourage healing. It is mostly used for chronic plantar fasciitis which does not respond to conservative treatments. This procedure has many possible side effects like bruising, swelling, pain or numbness and has not proved to be consistently effective. Corticosteroid injection (or cortisone shots) into the painful area may provide relief in severe cases. This kind of medication is very efficient in inflammation reduction. Corticosteroid injections usually provide short-term relief from plantar fasciitis pain. Symptom relief from the corticosteroid injection lasts for 3 to 6 weeks, but the effect often deteriorates and symptoms return. Botox Injections (botulinum toxin) are used to relieve the pain of plantar fasciitis, assist foot function recovery and the ability to walk better. Although the use of Botox injections as heel pain treatment is relatively new, there are a number of medical studies that show significant good results.

Plantar Fascia




Surgical Treatment

In cases that do not respond to any conservative treatment, surgical release of the plantar fascia may be considered. Plantar fasciotomy may be performed using open, endoscopic or radiofrequency lesioning techniques. Overall, the success rate of surgical release is 70 to 90 percent in patients with plantar fasciitis. Potential risk factors include flattening of the longitudinal arch and heel hypoesthesia as well as the potential complications associated with rupture of the plantar fascia and complications related to anesthesia.




Prevention

An important part of prevention is to perform a gait analysis to determine any biomechanical problems with the foot which may be causing the injury. This can be corrected with orthotic inserts into the shoes. If symptoms do not resolve then surgery is an option, however this is more common for patients with a rigid high arch where the plantar fascia has shortened.

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