Tagged: Plantar Fasciitis

What Causes Painful Heel And The Ways To End It

Feet Pain

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

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

Plantar fasciitis has a few possible symptoms. The symptoms can occur suddenly or gradually. Not all of the symptoms must be present at once. The classic symptom of plantar fasciitis is pain around the heel with the first few steps out of bed or after resting for a considerable period of time. This pain fades away a few minutes after the feet warm up. This symptom is so common that it symbols the plantar fasciitis disorder. If you have it then probably you have plantar fasciitis. If you don’t suffer from morning pain then you might want to reconsider your diagnosis. Pain below the heel bone at the connection of the bone to the fascia. As the condition becomes more severe the pain can get more intense during the day without rest. Plantar fasciitis symptoms include pain while touching the inside of the heel or along the arch. Foot pain after you spend long periods of time standing on your feet. Pain when stretching the plantar fascia. Foot pain that worsens when climbing stairs or standing on the toes. Pain that feels as though you are walking on glass. Pain when you start to exercise that gets better as you warm up but returns after you stop.


Diagnosis

Plantar fasciosis is confirmed if firm thumb pressure applied to the calcaneus when the foot is dorsiflexed elicits pain. Fascial pain along the plantar medial border of the fascia may also be present. If findings are equivocal, demonstration of a heel spur on x-ray may support the diagnosis; however, absence does not rule out the diagnosis, and visible spurs are not generally the cause of symptoms. Also, infrequently, calcaneal spurs appear ill defined on x-ray, exhibiting fluffy new bone formation, suggesting spondyloarthropathy (eg, ankylosing spondylitis, reactive arthritis. If an acute fascial tear is suspected, MRI is done.


Non Surgical Treatment

Heel cups are used to decrease the impact on the calcaneus and to theoretically decrease the tension on the plantar fascia by elevating the heel on a soft cushion. Although heel cups have been found to be useful by some physicians and patients, in our experience they are more useful in treating patients with fat pad syndrome and heel bruises than patients with plantar fasciitis. In a survey of 411 patients with plantar fasciitis, heel cups were ranked as the least effective of 11 different treatments.

Foot Pain


Surgical Treatment

More invasive procedures to treat plantar fasciitis are usually sought only after other treatment has failed to produce favorable results. Corticosteroid injections deliver medicine into the injured fascia to reduce pain. However, this treatment may weaken the plantar fascia and result in further damage. In addition, extracorporeal shock wave therapy (ESWT) is a treatment where sound waves are sent through the damaged tissue in order to stimulate the damaged tissue and encourage healing. This method is relatively new in treating plantar fasciitis and your doctor will be able to tell you if it is the right method for you. Lastly, surgery is the last option for those suffering from chronic or severe plantar fasciitis.


Prevention

Being overweight can place excess pressure and strain on your feet, particularly on your heels. Losing weight, and maintaining a healthy weight by combining regular exercise with a healthy, balanced diet, can be beneficial for your feet. Wearing appropriate footwear is also important. Ideally, you should wear shoes with a low to moderate heel that supports and cushions your arches and heels. Avoid wearing shoes with no heels.

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What Exactly Causes Painful Heel

Plantar Fascitis

Overview

The plantar fascia is a thickened fibrous aponeurosis that originates from the medial tubercle of the calcaneus, runs forward to insert into the deep, short transverse ligaments of the metatarsal heads, dividing into 5 digital bands at the metatarsophalangeal joints and continuing forward to form the fibrous flexor sheathes on the plantar aspect of the toes. Small plantar nerves are invested in and around the plantar fascia, acting to register and mediate pain.


Causes

Plantar fasciitis generally occurs over time, rather than being the result of a single event. Micro trauma from repetitive stress to the tissue often combines with a biomechanical deficiency of the foot to produce the condition. In addition, arthritic and metabolic factors may contribute to the development of this injury, (though they are unlikely to affect young athletes). A variety of training errors commonly lead to plantar fasciitis, particularly a rapid increase in either volume or intensity of athletic activity. Volume refers to the distance or time an athlete performs, while intensity refers to the pace of activity and/or the recovery time allowed following performance.


Symptoms

When plantar fasciitis occurs, the pain is typically sharp and usually unilateral (70% of cases).Heel pain worsens by bearing weight on the heel after long periods of rest. Individuals with plantar fasciitis often report their symptoms are most intense during their first steps after getting out of bed or after prolonged periods of sitting. Improvement of symptoms is usually seen with continued walking. Numbness, tingling, swelling, or radiating pain are rare but reported symptoms. If the plantar fascia continues to be overused in the setting of plantar fasciitis, the plantar fascia can rupture. Typical signs and symptoms of plantar fascia rupture include a clicking or snapping sound, significant local swelling, and acute pain in the sole of the foot.


Diagnosis

Your GP or podiatrist (a healthcare professional who specialises in foot care) may be able to diagnose the cause of your heel pain by asking about your symptoms and examining your heel and foot. You will usually only need further tests if you have additional symptoms that suggest the cause of your heel pain is not inflammation, such as numbness or a tingling sensation in your foot, this could be a sign of nerve damage in your feet and legs (peripheral neuropathy) your foot feels hot and you have a high temperature (fever) of 38C (100.4F) or above – these could be signs of a bone infection, you have stiffness and swelling in your heel, this could be a sign of arthritis. Possible further tests may include blood tests, X-rays – where small doses of radiation are used to detect problems with your bones and tissues, a magnetic resonance imaging (MRI) scan or ultrasound scan, which are more detailed scans.


Non Surgical Treatment

You may experience concern in reading about treatment options for this condition that involve taking medications, having injections or undergoing surgery. While these remedies may be necessary in some cases, there are natural, non-invasive, affordable methods for treating and healing Plantar Fasciitis. A simple, three-step approach may be all you need to experience immediate or rapid symptom relief. Step 1) Give Your Feet A Rest. When a ligament is stressed and inflamed, it is absolutely essential to take pressure off it and let it rest. Adjust your daily habits to spend some time each day off your feet. Step 2) Ice Brings Cooling Relief. Apply an ice bag or cold pack to your heel for twenty minutes, twice a day. This will numb soreness and help control inflammation. Step 3) Gain Support From Orthotics. Orthotics are devices designed to modify body motions or lessen pressure on areas of the body. In the case of foot orthotics, these products may include splints, wraps and shoe inserts.

Plantar Fascia


Surgical Treatment

Surgery is considered only after 12 months of aggressive nonsurgical treatment. Gastrocnemius recession. This is a surgical lengthening of the calf (gastrocnemius) muscles. Because tight calf muscles place increased stress on the plantar fascia, this procedure is useful for patients who still have difficulty flexing their feet, despite a year of calf stretches. In gastrocnemius recession, one of the two muscles that make up the calf is lengthened to increase the motion of the ankle. The procedure can be performed with a traditional, open incision or with a smaller incision and an endoscope, an instrument that contains a small camera. Your doctor will discuss the procedure that best meets your needs. Complication rates for gastrocnemius recession are low, but can include nerve damage. Plantar fascia release. If you have a normal range of ankle motion and continued heel pain, your doctor may recommend a partial release procedure. During surgery, the plantar fascia ligament is partially cut to relieve tension in the tissue. If you have a large bone spur, it will be removed, as well. Although the surgery can be performed endoscopically, it is more difficult than with an open incision. In addition, endoscopy has a higher risk of nerve damage.


Stretching Exercises

Stretching your plantar fasciitis is something you can do at home to relieve pain and speed healing. Ice massage performed three to four times per day in 15 to 20 minute intervals is also something you can do to reduce inflammation and pain. Placing arch supports in your shoes absorbs shock and takes pressure off the plantar fascia.

What Triggers Painful Heel To Surface

Heel Discomfort

Overview

Plantar fasciosis is a foot condition characterized by heel pain and pain in your plantar fascia-a strong and dense connective tissue structure on the sole of your foot that supports your foot arch. This condition has historically been called plantar fasciitis because it was believed that plantar fascia inflammation was the principle underlying cause. Plantar fasciosis is a more accurate name for this condition because it involves degeneration-microtears, cell death-of your plantar fascia, not inflammation. Active men between the ages of 40 and 70 are most commonly affected by this health problem.


Causes

Plantar fasciitis can be confused with a condition called tarsal tunnel syndrome. In tarsal tunnel syndrome, an important nerve in the foot, the tibial nerve, is trapped and pinched as it passes through the tarsal tunnel, a condition analogous to carpal tunnel syndrome in the wrist. This may cause symptoms similar to the pain of a plantar fasciitis. There are also other less common problems such as nerve entrapments, stress fractures, and fat pad necrosis, all of which can cause foot pain. Finally, several rheumatologic conditions can cause heel pain. These syndromes such as Reiter’s syndrome and ankylosing spondylitis can cause heel pain similar to plantar fasciitis. If your symptoms are not typical for plantar fasciitis, or if your symptoms do not resolve with treatment, your doctor will consider these possible diagnoses.


Symptoms

Plantar fasciosis is characterized by pain at the bottom of the heel with weight bearing, particularly when first arising in the morning; pain usually abates within 5 to 10 min, only to return later in the day. It is often worse when pushing off of the heel (the propulsive phase of gait) and after periods of rest. Acute, severe heel pain, especially with mild local puffiness, may indicate an acute fascial tear. Some patients describe burning or sticking pain along the plantar medial border of the foot when walking.


Diagnosis

A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose plantar fasciitis. Occasionally, further investigations such as an X-ray, ultrasound or MRI may be required to assist with diagnosis and assess the severity of the condition.


Non Surgical Treatment

Most doctors recommend an initial six- to eight-week program of conservative treatment, including Rest, balanced with stretching exercises to lengthen the heel cord and plantar fascia. Ice massage to the bottom of the foot after activities that trigger heel pain. Avoidance of walking barefoot or wearing slippers or sandals that provide little arch support. A temporary switch to swimming and/or bicycling instead of sports that involve running and jumping. Shoes with soft heels and insoles. Taping the bottom of the injured foot. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin and other brand names), or acetaminophen (Tylenol) for pain. Physical therapy using ultrasound, electrical stimulation with corticosteroids or massage techniques. If this conservative treatment does not help, your doctor may recommend that you wear a night splint for six to eight weeks. While you sleep, the night splint will keep your foot in a neutral or slightly flexed (bent) position to help maintain the normal stretch of the plantar fascia and heel cord. If the night splint doesn’t work, your doctor may inject corticosteroid medication into the painful area or place your foot in a short leg cast for one to three months. Shock wave therapy, in which focused sound energy is applied to the sore heel, may be recommended for plantar fasciitis. The shock waves are intended to irritate or injure the plantar fascia to promote healing. The overall benefit of this approach is uncertain. Other therapies that have been tried include radiation therapy and botulinum toxin injections. But their effectiveness is unclear. If all else fails, your doctor may suggest surgery. But this is rare, and surgery is not always successful.

Feet Pain


Surgical Treatment

Surgery is considered only after 12 months of aggressive nonsurgical treatment. Gastrocnemius recession. This is a surgical lengthening of the calf (gastrocnemius) muscles. Because tight calf muscles place increased stress on the plantar fascia, this procedure is useful for patients who still have difficulty flexing their feet, despite a year of calf stretches. In gastrocnemius recession, one of the two muscles that make up the calf is lengthened to increase the motion of the ankle. The procedure can be performed with a traditional, open incision or with a smaller incision and an endoscope, an instrument that contains a small camera. Your doctor will discuss the procedure that best meets your needs. Complication rates for gastrocnemius recession are low, but can include nerve damage. Plantar fascia release. If you have a normal range of ankle motion and continued heel pain, your doctor may recommend a partial release procedure. During surgery, the plantar fascia ligament is partially cut to relieve tension in the tissue. If you have a large bone spur, it will be removed, as well. Although the surgery can be performed endoscopically, it is more difficult than with an open incision. In addition, endoscopy has a higher risk of nerve damage.


Stretching Exercises

While it’s typical to experience pain in just one foot, massage and stretch both feet. Do it first thing in the morning, and three times during the day. Achilles Tendon Stretch. Stand with your affected foot behind your healthy one. Point the toes of the back foot toward the heel of the front foot, and lean into a wall. Bend the front knee and keep the back knee straight, heel firmly planted on the floor. Hold for a count of 10. Plantar Fascia Stretch. Sit down, and place the affected foot across your knee. Using the hand on your affected side, pull your toes back toward your shin until you feel a stretch in your arch. Run your thumb along your foot–you should feel tension. Hold for a count of 10.