What Brings About Heel Pain To Appear

Plantar Fascia

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.


Causes

Plantar Fasciitis is simply caused by overstretching of the plantar fascia ligament under the foot. So why is the ligament being overstretched? There are different factors, over-use, too much sports, running, walking or standing for long periods (e.g. because of your job) weight gain, our feet are designed to carry a ‘normal’ weight. Any excess weight places great pressure on the bones, nerves, muscles and ligaments in the feet, which sooner or later will have consequences. Even pregnancy (in the last 10 weeks) can cause foot problems! age, as we get older ligaments become tighter & shorter and msucles become weaker; the ideal circumstances for foot problems, unsupportive footwear, ‘floppy’ shoes with no support as well as thongs affect our walking pattern, walking barefoot, especially on hard surfaces like concrete or tiles, low arch and flat feet or over-pronation. An important contributing factor to Plantar Fasciitis is ‘excess pronation’ (or over-pronation). This is a condition whereby the feet roll over, the arches collapse and the foot elongates. This unnatural elongation puts excess strain on the ligaments, muscles and nerves in the foot. When the foot is not properly aligned, the bones unlock and cause the foot to roll inward. With every step taken your foot pronates and elongates, stretching the plantar fascia and causing inflammation and pain at the attachment of the plantar fascia into the heel bone. Re-alignment of the foot should therefore an important part of the treament regime.


Symptoms

The most common symptom is pain and stiffness in the bottom of the heel. The heel pain may be dull or sharp. The bottom of the foot may also ache or burn. The pain is often worse in the morning when you take your first steps, after standing or sitting for awhile, when climbing stairs, after intense activity. The pain may develop slowly over time, or come on suddenly after intense activity.


Diagnosis

Your doctor will perform a physical exam to check for tenderness in your foot and the exact location of the pain to make sure that it’s not caused by a different foot problem. The doctor may ask you to flex your foot while he or she pushes on the plantar fascia to see if the pain gets worse as you flex and better as you point your toe. Mild redness or swelling will also be noted. Your doctor will evaluate the strength of your muscles and the health of your nerves by checking your reflexes, your muscle tone, your sense of touch and sight, your coordination, and your balance. X-rays or a magnetic resonance imaging (MRI) scan may be ordered to check that nothing else is causing your heel pain, such as a bone 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

When more-conservative measures aren’t working, your doctor might recommend steroid shots. Injecting a type of steroid medication into the tender area can provide temporary pain relief. Multiple injections aren’t recommended because they can weaken your plantar fascia and possibly cause it to rupture, as well as shrink the fat pad covering your heel bone. Extracorporeal shock wave therapy. In this procedure, sound waves are directed at the area of heel pain to stimulate healing. It’s usually used for chronic plantar fasciitis that hasn’t responded to more-conservative treatments. This procedure may cause bruises, swelling, pain, numbness or tingling and has not been shown to be consistently effective. Surgery. Few people need surgery to detach the plantar fascia from the heel bone. It’s generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot.


Prevention

Making sure your ankle, Achilles tendon, and calf muscles are flexible can help prevent plantar fasciitis. Stretch your plantar fascia in the morning before you get out of bed. Doing activities in moderation can also help.

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