What Is Painful Heel And How To Prevent It

Painful Heel

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

This is a problem of either extreme, so people with high arches or those that have very flat feet are at risk of developing pain in this region. This is because of the relative stress the plantar fascia is put under. In people with excessive pronation, the plantar fascia is put under too much stretch, as their range flattens and strains it. People with a stiff, supinated (high-arched) foot lack the flexibility to appropriately shock absorb, so this too puts extra strain on the plantar fascia. Clinically, we see more people presenting with plantar fascia pain who have excessive pronation than those with stiff, supinated feet. But while the foot type is the biggest risk factor for plantar fasciitis, the whole leg from the pelvis down can affect how the foot hits the ground. A thorough biomechanical assessment will determine where in the kinetic chain things have gone wrong to cause the overload.




Symptoms

Plantar fasciitis sufferers feel a sharp stab or deep ache in the middle of the heel or along the arch. Another sign is the morning hobble from the foot trying to heal itself in a contracted position overnight. Taking that first step causes sudden strain on the bottom of the foot. The pain can recur after long spells of sitting, but it tends to fade during a run, once the area is warmed up.




Diagnosis

Most cases of plantar fasciitis are diagnosed by a health care provider who listens carefully to your description of symptoms. During an examination of your feet, your health care provider will have to press on the bottom of your feet, the area most likely to be painful in plantar fasciitis. Because the pain of plantar fasciitis has unique characteristics, pain upon rising, improvement after walking for several minutes, pain produced by pressure applied in a specific location on your foot but not with pressure in other areas, your health care provider will probably feel comfortable making the diagnosis based on your symptoms and a physical examination. Your health care provider may suggest that you have an X-ray of your foot to verify that there is no stress fracture causing your pain.




Non Surgical Treatment

At the first sign of soreness, massage (roll a golf ball under your foot) and apply ice (roll a frozen bottle of water under your foot). What you wear on your feet when you're not running makes a difference. Arch support is key, and walking around barefoot or in flimsy shoes can delay recovery. If pain is present for more than three weeks, see a sports podiatrist. Treatments such as orthotics, foot taping, cortisone injections, night splints, and anti-inflammatories decrease symptoms significantly in about 95 percent of sufferers within six weeks. For more stubborn cases, physical therapy may be prescribed; six months of chronic pain may benefit from shock-wave therapy, an FDA-approved plantar-fasciitis treatment.

Plantar Fascia




Surgical Treatment

Surgery should be reserved for patients who have made every effort to fully participate in conservative treatments, but continue to have pain from plantar fasciitis. Patients should fit the following criteria. Symptoms for at least 9 months of treatment. Participation in daily treatments (exercises, stretches, etc.). If you fit these criteria, then surgery may be an option in the treatment of your plantar fasciitis. Unfortunately, surgery for treatment of plantar fasciitis is not as predictable as a surgeon might like. For example, surgeons can reliably predict that patients with severe knee arthritis will do well after knee replacement surgery about 95% of the time. Those are very good results. Unfortunately, the same is not true of patients with plantar fasciitis.

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