Tagged: Heel Pain

Everything You Want To Understand About Heel Ache

Overview

Feet Pain

Does it feel like you have a nail in your heel? After walking for a few minutes does the pain slowly disappear? Millions of people each year are faced with this type of Heel Pain. While there may be other causes, the most common is Plantar Fasciitis. Plantar Faciitis is an inflammation of the fibrous tissue, called the plantar fasciia, that runs along the bottom of your foot that connects the heel (calcaneus) to the toes (metatarsals). Treatment for this condition can take many forms including: stretching exercises, drugs, orthotics, injections, and in rare cases surgical procedures. Until now the treatment methods have addressed the active conscious periods only to be undone when a person goes to bed or sits in the easy chair relaxing.

Causes

Plantar Fasciitis is the most common form of heel pain. The tears and inflammation that develop along the plantar fascia ligament result in dull aching pain or a burning sensation along the bottom of the foot. Pain becomes particularly noticeable after periods of rest, such as during the first few steps after getting out of bed in the morning, or after getting up after a prolonged period of sitting. Another common form of heel pain is the development of a heel spur. A heel spur, as mentioned above, is the formation of a bony hook extending from the heel. Typically, these growths develop near the area where the plantar fascia connects to the heel bone. The repetitive pressure on the plantar fascia that results from stretching excessively away from the heel bone causes a response from our body that delivers calcium to the area. The heel pain that ensues develops from the nerves and sensitive tissue that become irritated when the bone fragment digs into the bottom of the heel. Pain may decrease after walking as the tissue in the heel gets used to the fragment and adjusts around it. However, pain will be particularly problematic following periods of rest. Strained muscle tissue may cause heel pain in several areas. A tight plantar fascia causes additional tension, particularly while exercising, placing runners and other athletes at risk if the ligament is not properly warmed up prior to exercise. Additionally, a tight Achilles tendon along the back of the foot can also add tension along the plantar fascia, resulting in possible damage, not to mention the damage and pain that can occur along the Achilles tendon itself (Achilles tendonitis). It is recommended that athletes properly stretch the foot as well as the calf in order to reduce tension on muscle and other tissue in the foot.

Symptoms

See your doctor as soon as possible if you experience severe pain accompanied by swelling near your heel. There is numbness or tingling in the heel, as well as pain and fever. There is pain in your heel as well as fever. You are unable to walk normally. You cannot bend your foot downwards. You cannot stand with the backs of the feet raised (you cannot rise onto your toes). You should arrange to see a doctor if the heel pain has persisted for more than one week. There is still heel pain when you are not standing or walking.

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

Home care, in cases that are not severe, home care is probably enough to get rid of heel pain. Rest, avoid running or standing for long periods, or walking on hard surfaces. Avoid activities that may stress the heels. Ice, place an ice-pack on the affected area for about 15 minutes. Do not place bare ice directly onto skin. Footwear. proper-fitting shoes that provide good support are crucial. Athletes should be particularly fussy about the shoes they use when practicing or competing – sports shoes need to be replaced at specific intervals (ask your trainer). Foot supports, wedges and heel cups can help relieve symptoms.

Surgical Treatment

If treatment hasn’t worked and you still have painful symptoms after a year, your GP may refer you to either an orthopaedic surgeon, a surgeon who specialises in surgery that involves bones, muscles and joints or a podiatric surgeon, a podiatrist who specialises in foot surgery. Surgery is sometimes recommended for professional athletes and other sportspeople whose heel pain is adversely affecting their career. Plantar release surgery is the most widely used type of surgery for heel pain. The surgeon will cut the fascia to release it from your heel bone and reduce the tension in your plantar fascia. This should reduce any inflammation and relieve your painful symptoms. Surgery can be performed either as open surgery, where the section of the plantar fascia is released by making a cut into your heel or endoscopic or minimal incision surgery – where a smaller incision is made and special instruments are inserted through the incision to gain access to the plantar fascia. Endoscopic or minimal incision surgery has a quicker recovery time, so you will be able to walk normally much sooner (almost immediately), compared with two to three weeks for open surgery. A disadvantage of endoscopic surgery is that it requires both a specially trained surgical team and specialised equipment, so you may have to wait longer for treatment than if you were to choose open surgery. Endoscopic surgery also carries a higher risk of damaging nearby nerves, which could result in symptoms such as numbness, tingling or some loss of movement in your foot. As with all surgery, plantar release carries the risk of causing complications such as infection, nerve damage and a worsening of your symptoms after surgery (although this is rare). You should discuss the advantages and disadvantages of both techniques with your surgical team.

Prevention

Pain Of The Heel

A variety of steps can be taken to avoid heel pain and accompanying afflictions. Wear shoes that fit well-front, back, and sides-and have shock-absorbent soles, rigid shanks, and supportive heel counters. Wear the proper shoes for each activity. Do not wear shoes with excessive wear on heels or soles. Prepare properly before exercising. Warm up and do stretching exercises before and after running. Pace yourself when you participate in athletic activities. Don?t underestimate your body’s need for rest and good nutrition. If obese, lose weight.

What Is Plantar Fasciitis And Techniques To Heal It

Heel Discomfort

Overview

The plantar fascia is a thick band of connective tissue that runs along the underneath of the foot from the heel bone to the toes. At the heel it can also have fascial connections to the achilles tendon. Its job is to maintain the arch of the foot, it acts as a bowstring pulled between the heel and the toes. “Itis” as a suffix indicates inflammation, but with the plantar fascia there is still some controversy over what exactly happens to the tissue when it becomes painful.


Causes

Plantar fasciitis is caused by drastic or sudden increases in mileage, poor foot structure, and inappropriate running shoes, which can overload the plantar fascia, the connective tissue that runs from the heel to the base of the toes. The plantar fascia may look like a series of fat rubber bands, but it’s made of collagen, a rigid protein that’s not very stretchy. The stress of overuse, overpronation, or overused shoes can rip tiny tears in it, causing pain and inflammation, a.k.a. plantar fasciitis.


Symptoms

The main symptom of plantar fasciitis is heel pain when you walk. You may also feel pain when you stand and possibly even when you are resting. This pain typically occurs first thing in the morning after you get out of bed, when your foot is placed flat on the floor. The pain occurs because you are stretching the plantar fascia. The pain usually lessens with more walking, but you may have it again after periods of rest. You may feel no pain when you are sleeping because the position of your feet during rest allows the fascia to shorten and relax.


Diagnosis

The health care provider will perform a physical exam. This may show tenderness on the bottom of your foot, flat feet or high arches, mild foot swelling or redness, stiffness or tightness of the arch in the bottom of your foot. X-rays may be taken to rule out other problems.


Non Surgical Treatment

The initial treatment of plantar fasciitis focuses on reducing pain and inflammation. Resting the affected foot is the most important aspect of this treatment. Other initial treatment may include, aplying ice to the sole of the foot, Anti-inflammatory medications. Gentle stretching of the plantar fascia and Achilles tendon. Physiotherapy. Taping the foot and ankle to provide adequate support and alignment, Wearing supportive footwear with shock-absorbing soles or inserts. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Brufen) and diclofenac (Voltaren) are often used to treat plantar fasciitis. It is unclear whether NSAIDs assist in the healing process but they are useful for controlling pain during treatment. If the condition does not respond to initial treatment, a corticosteroid therapy may be recommended. This involves the injection of corticosteroid medication such as hydrocortisone (Solu-Cortef) directly into the affected area in order to treat the inflammation and thus relieve the pain. Night splints to prevent the plantar fascia tightening during sleep may also be recommended at this stage.

Heel Discomfort


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.


Prevention

While there are no sure ways to prevent plantar fasciitis, these prevention tips may be helpful. Keep your weight under reasonable control. Wear comfortable, supportive shoes. Use care when starting or intensifying exercise programmes.

What Triggers Heel Discomfort To Flare Up

Plantar Fascitis

Overview

Heel pain is the most common musculoskeletal complaint of patients presenting to podiatric practitioners throughout the country. It is well-recognized that subcalcaneal pain syndrome, commonly attributed to plantar fascitis, is a disease entity that is increasing in its incidence, owing partly to the fact that it has a predilection for people between the age of 40 and 60, the largest age segment in our population.


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

Plantar fasciitis typically causes a stabbing pain in the bottom of your foot near the heel. The pain is usually worst with the first few steps after awakening, although it can also be triggered by long periods of standing or getting up from a seated position.


Diagnosis

X-rays are a commonly used diagnostic imaging technique to rule out the possibility of a bone spur as a cause of your heel pain. A bone spur, if it is present in this location, is probably not the cause of your pain, but it is evidence that your plantar fascia has been exerting excessive force on your heel bone. X-ray images can also help determine if you have arthritis or whether other, more rare problems, stress fractures, bone tumors-are contributing to your heel pain.


Non Surgical Treatment

Treatment for plantar fasciitis should begin with rest, icing, and over the counter medications. As mentioned above, an orthotic is a device that can be slipped into any pair of shoes and can often relieve pain and help to reverse the damage and occurrence of plantar fasciitis. They do this by adding support to the heel and helping to distribute weight during movement. In addition to orthotics, many people consider night splints for treating this condition. These devices are worn during the night while you sleep, helping to keep the plantar fascia stretched to promote healing. Physical therapy has also become a common option. With this conservative treatment alternative, a physical therapist designs a set of exercises that are intended to address your specific needs in order to promote healing.

Plantar Fasciitis


Surgical Treatment

If treatment hasn’t worked and you still have painful symptoms after a year, your GP may refer you to either an orthopaedic surgeon, a surgeon who specialises in surgery that involves bones, muscles and joints, a podiatric surgeon, a podiatrist who specialises in foot surgery. Surgery is sometimes recommended for professional athletes and other sportspeople whose heel pain is adversely affecting their career. Plantar release surgery. Plantar release surgery is the most widely used type of surgery for heel pain. The surgeon will cut the fascia to release it from your heel bone and reduce the tension in your plantar fascia. This should reduce any inflammation and relieve your painful symptoms. Surgery can be performed either as, open surgery, where the section of the plantar fascia is released by making a cut into your heel, endoscopic or minimal incision surgery – where a smaller incision is made and special instruments are inserted through the incision to gain access to the plantar fascia. Endoscopic or minimal incision surgery has a quicker recovery time, so you will be able to walk normally much sooner (almost immediately), compared with two to three weeks for open surgery. A disadvantage of endoscopic surgery is that it requires both a specially trained surgical team and specialised equipment, so you may have to wait longer for treatment than if you were to choose open surgery. Endoscopic surgery also carries a higher risk of damaging nearby nerves, which could result in symptoms such as numbness, tingling or some loss of movement in your foot. As with all surgery, plantar release carries the risk of causing complications such as infection, nerve damage and a worsening of your symptoms after surgery (although this is rare). You should discuss the advantages and disadvantages of both techniques with your surgical team. Extracorporeal shockwave therapy (EST) is a fairly new type of non-invasive treatment. Non-invasive means it does not involve making cuts into your body. EST involves using a device to deliver high-energy soundwaves into your heel. The soundwaves can sometimes cause pain, so a local anaesthetic may be used to numb your heel. It is claimed that EST works in two ways. It is thought to, have a “numbing” effect on the nerves that transmit pain signals to your brain, help stimulate and speed up the healing process. However, these claims have not yet been definitively proven. The National Institute for Health and Care Excellence (NICE) has issued guidance about the use of EST for treating plantar fasciitis. NICE states there are no concerns over the safety of EST, but there are uncertainties about how effective the procedure is for treating heel pain. Some studies have reported that EST is more effective than surgery and other non-surgical treatments, while other studies found the procedure to be no better than a placebo (sham treatment).


Stretching Exercises

Exercises designed to stretch both your calf muscles and your plantar fascia (the band of tissue that runs under the sole of your foot) should help relieve pain and improve flexibility in the affected foot. A number of stretching exercises are described below. It’s usually recommended that you do the exercises on both legs, even if only one of your heels is affected by pain. This will improve your balance and stability, and help relieve heel pain. Towel stretches. Keep a long towel beside your bed. Before you get out of bed in the morning, loop the towel around your foot and use it to pull your toes towards your body, while keeping your knee straight. Repeat three times on each foot. Wall stretches. Place both hands on a wall at shoulder height, with one of your feet in front of the other. The front foot should be about 30cm (12 inches) away from the wall. With your front knee bent and your back leg straight, lean towards the wall until you feel a tightening in the calf muscles of your back leg. Then relax. Repeat this exercise 10 times before switching legs and repeating the cycle. You should practise wall stretches twice a day. Stair stretches. Stand on a step of your stairs facing upstairs, using your banister for support. Your feet should be slightly apart, with your heels hanging off the back of the step. Lower your heels until you feel a tightening in your calves. Hold this position for about 40 seconds, before raising your heels back to the starting position. Repeat this procedure six times, at least twice a day. Chair stretches. Sit on a chair, with your knees bent at right angles. Turn your feet sideways so your heels are touching and your toes are pointing in opposite directions. Lift the toes of the affected foot upwards, while keeping the heel firmly on the floor. You should feel your calf muscles and Achilles tendon (the band of tissue that connects your heel bone to your calf muscle) tighten. Hold this position for several seconds and then relax. Repeat this procedure 10 times, five to six times a day. Dynamic stretches. While seated, roll the arch of your foot (the curved bottom part of the foot between your toes and heel) over a round object, such as a rolling pin, tennis ball or drinks can. Some people find that using a chilled can from their fridge has the added benefit of helping to relieve pain. Move your foot and ankle in all directions over the object for several minutes. Repeat the exercise twice a day.

What Triggers Pain Under The Heel

Plantar Fascia

Overview

Plantar Fasciitis is actually, in most cases, plantar fasciosis but it’s a bit like pen/biro or hoover/vacuum. The term ‘-itis‘ means ‘inflammation’. This is a term we use for this problem in the early stages of damage because it usually is quite literally an inflammation of part of the plantar fascia. So, what is commonly known as ‘plantar fasciitis’ is really ‘plantar fasciosis’ – a degradation or degeneration of the collagen fibres because of prolonged (most of your adult life) unsustainable stress being applied to the fascia. So, we call it plantar fasciitis but it usually hasn’t been an ‘-itis‘ for years and that is why in many cases anti-inflammatory drugs do not help ease the pain of walking. This is also why most sufferers experience pain first thing in the morning. If inflammation was the source of discomfort then why would it hurt after a nights rest and the good old drugs pumping through your system.


Causes

There are a number of plantar fasciitis causes. The plantar fascia ligament is like a rubber band and loosens and contracts with movement. It also absorbs significant weight and pressure. Because of this function, plantar fasciitis can easily occur from a number of reasons. Among the most common is an overload of physical activity or exercise. Athletes are particularly prone to plantar fasciitis and commonly suffer from it. Excessive running, jumping, or other activities can easily place repetitive or excessive stress on the tissue and lead to tears and inflammation, resulting in moderate to severe pain. Athletes who change or increase the difficulty of their exercise routines are also prone to overdoing it and causing damage. Another common cause of plantar fasciitis is arthritis. Certain types of arthritis can cause inflammation to develop in tendons, resulting in plantar fasciitis. This cause is particularly common among elderly patients. Diabetes is also a factor that can contribute to further heel pain and damage, particularly among the elderly. Among the most popular factors that contribute to plantar fasciitis is wearing incorrect shoes. In many cases, shoes either do not fit properly, or provide inadequate support or cushioning. While walking or exercising in improper shoes, weight distribution becomes impaired, and significantly stress can be added to the plantar fascia ligament.


Symptoms

Among the symptoms for Plantar Fasciitis is pain usually felt on the underside of the heel, often most intense with the first steps after getting out of bed in the morning. It is commonly associated with long periods of weight bearing or sudden changes in weight bearing or activity. Plantar Fasciitis also called “policeman’s heel” is presented by a sharp stabbing pain at the bottom or front of the heel bone. In most cases, heel pain is more severe following periods of inactivity when getting up and then subsides, turning into a dull ache.


Diagnosis

Plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination. After confirming your plantar fasciitis they will investigate WHY you are likely to be predisposed to plantar fasciitis and develop a treatment plan to decrease your chance of future bouts. X-rays may show calcification within the plantar fascia or at its insertion into the calcaneus, which is known as a calcaneal or heel spur. Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification. Pathology tests (including screening for HLA B27 antigen) may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.


Non Surgical Treatment

No single treatment works best for everyone with plantar fasciitis. But there are many things you can try to help your foot get better. Give your feet a rest. Cut back on activities that make your foot hurt. Try not to walk or run on hard surfaces. To reduce pain and swelling, try putting ice on your heel. Or take an over-the-counter pain reliever like ibuprofen (such as Advil or Motrin) or naproxen (such as Aleve). Do toe stretches camera.gif, calf stretches camera.gif and towel stretches camera.gif several times a day, especially when you first get up in the morning. (For towel stretches, you pull on both ends of a rolled towel that you place under the ball of your foot.) Get a new pair of shoes. Pick shoes with good arch support and a cushioned sole. Or try heel cups or shoe inserts. Use them in both shoes, even if only one foot hurts. If these treatments do not help, your doctor may recommend splints that you wear at night, shots of medicine (such as a steroid) in your heel, or other treatments. You probably will not need surgery. Doctors only suggest it for people who still have pain after trying other treatments for 6 to 12 months. Plantar fasciitis most often occurs because of injuries that have happened over time. With treatment, you will have less pain within a few weeks. But it may take time for the pain to go away completely. It may take a few months to a year. Stay with your treatment. If you don’t, you may have constant pain when you stand or walk. The sooner you start treatment, the sooner your feet will stop hurting.

Pain At The Heel


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.