Painful Heel

Overview

There are many diagnoses within the differential of heel pain; however, plantar fasciitis is the most common cause of heel pain for which professional care is sought. Approximately 10% of the United States population experiences bouts of heel pain, which results in 1 million visits per year to medical professionals for treatment of plantar fasciitis. The annual cost of treatments for plantar fasciitis is estimated to be between $192 and $376 million dollars. The etiology of this condition is multifactorial, and the condition can occur traumatically; however, most cases are from overuse stresses.


Causes

You’re more likely to develop the condition if you’re female, overweight or have a job that requires a lot of walking or standing on hard surfaces. You’re also at risk if you walk or run for exercise, especially if you have tight calf muscles that limit how far you can flex your ankles. People with very flat feet or very high arches also are more prone to plantar fasciitis.


Symptoms

Plantar fasciitis is the inflammation of the plantar fascia – a band of tough fibrous tissue running along the sole of the foot. It occurs when small tears develop in the plantar fascia, leading to inflammation and heel pain. The plantar fascia tissue branches out from the heel like a fan, connecting the heel bone to the base of the toes. When the foot moves, the plantar fascia stretches and contracts. The plantar fascia helps to maintain the arch of the foot in much the same way that the string of a bow maintains the bow’s arch. The most notable symptom of plantar fasciitis is heel pain. This is typically most severe in the middle of the heel though it may radiate along the sole of the foot. The pain is most often felt when walking first thing in the morning or after a period of rest. As walking continues the pain may decrease; however some degree of pain remains present on movement. The pain may disappear when resting, as the plantar fascia is relaxed. Redness, swelling and warmth over the affected area may also be noticed. The onset of plantar fasciitis is gradual and only mild pain may be experienced initially. However, as the condition progresses the pain experienced tends to become more severe. Chronic plantar fasciitis may cause a person to change their walking or running action, leading to symptoms of discomfort in the knee, hip and back.


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

In many instances, plantar fasciitis can be treated with home care. Changing your physical activities, resting the foot, and applying ice to the area are common remedies. Taking over the counter medications such as ibuprofen or acetaminophen can help reduce pain and inflammation that may have developed. An orthotic device placed in your shoes can also significantly help to reduce pain. In addition, orthotics can also help promote healing to reverse plantar fasciitis. If pain from plantar fasciitis continues despite conservative treatments, you may need to visit a doctor or podiatrist. It’s important to seek medical advice before heel pain and damage becomes worse. If the condition is allowed to worsen, more serious or invasive forms of treatment may be required to stop pain. A visit to a doctor may reveal other conditions affecting the foot as well, such as Achilles tendonitis, heel spurs, or other heel pain conditions. An x-ray may also be taken, which can reveal the presence of a heel spur. In rare cases surgery may be required to release tension on the plantar fascia, or to remove a portion of a heel spur. But again, most heel pain conditions can be resolved using conservative treatment.

Plantar Fasciitis


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.


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.

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