What Will Cause Heel Pain

Painful Heel

Overview

The plantar fascia (a connective tissue structure) stretches from the toes and ball of the foot, through the arch, and connects to the heel bone in three places: outside, center and inside. Normally it helps the foot spring as it rolls forward. It also provides support for the arch of the foot. The plantar fascia helps keep the foot on track, cutting down on oscillation. When the foot over-pronates (rolls to the inside) the plantar fascia tries to stabilize it and prevent excessive roll. In time, the inside and sometimes center connections are overstressed and pull away from their attachments. The first sign is usually heel pain as you rise in the morning. When you walk around, the pain may subside, only to return the next morning. Inflammation and increased soreness are the results of long-term neglect and continued abuse. A heel bone spur may develop after a long period of injury when there is no support for the heel. The plantar fascia attaches to the heel bone with small fibers. When these become irritated they become inflamed with blood containing white blood cells. Within the white blood cells are osteoblasts which calcify to form bone spurs and calcium deposits. The body is trying to reduce stress on that area by building a bone in the direction of stress. Unfortunately, these foreign substances cause pain and further irritation in the surrounding soft tissue.




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

The most obvious symptom of plantar fasciitis is a sharp pain on the bottom of the foot, near the heel. Here are some signals that this pain may be plantar fasciitis. The pain is strongest first thing in the morning but gets better after a few minutes of walking around. The pain is worse after standing for a long time or after getting up from sitting. The pain develops gradually and becomes worse over time. The pain is worse after exercise or activity than it is during activity. It hurts when stretching the foot. It hurts when pressing on the sides of the heel or arch of the foot.




Diagnosis

A physical exam performed in the office along with the diagnostic studies as an x-ray. An MRI may also be required to rule out a stress fracture, or a tear of the plantar fascia. These are conditions that do not normally respond to common plantar fasciitis treatment.




Non Surgical Treatment

Biomechanical plantar fasciitis can be easily reduced by correcting misalignment of the feet. Wearing orthopedic shoes for plantar fasciitis and orthotic inserts is an easy, effective method of naturally realigning the foot. Worn consistently from first thing in the morning to last thing at night, orthotic support can reduce and sometimes eliminate plantar fasciitis. Biomechanical plantar fasciitis can be easily reduced by correcting misalignment of the feet. Wearing orthopedic shoes for plantar fasciitis and orthotic inserts is an easy, effective method of naturally realigning the foot. Worn consistently from first thing in the morning to last thing at night, orthotic support can reduce and sometimes eliminate plantar fasciitis. Preserve Your Arch with Strengthening Exercises. While seated and barefoot, squeeze your foot as if you have a small marble under the ball of your foot. If you just happen to have a few marbles handy, you can actually practice picking them up between your toes and ball of your foot - and then set them down again. This stretches and helps strengthen the muscles that run under metatarsals (the longest bones in the foot which create its arched shape). Slowly Increase Physical Activity. If you're a runner, a tried and true method of preventing over-use injuries is to only increase your mileage by 10% weekly, max. If you’re new to a walking program, the same caution should be exercised. Ice and Rest. After mild stretching, use a frozen water bottle to roll under the arch of your foot for 10-20 minutes. It may be possible to make an active recovery by wearing Orthaheel Technology to keep your feet naturally aligned, therefore reducing strain on the plantar fascia, while moving throughout your day.

Painful Heel




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).




Prevention

The best way to prevent plantar fasciitis is to wear shoes that are well made and fit your feet. This is especially important when you exercise or walk a lot or stand for a long time on hard surfaces. Get new athletic shoes before your old shoes stop supporting and cushioning your feet. You should also avoid repeated jarring to the heel. Keep a healthy weight. Do your leg and foot stretching exercises regularly.

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