Heel Discomfort

Overview

Foot Pain

Heel Pain is one of the most common conditions treated by podiatrists. It is often a message that something is in need of medical attention. Pain that occurs right after an injury or early in an illness may play a protective role, often warning us about the damage we have suffered. Heel pain is a problem which affects people of all ages and vocations, whether they are active or not and it comes in many different forms. Heel pain can also occur in children usually between the ages of 8 and 13, as they become increasingly active in sporting activities and during the growing phase.

Causes

To understand the cause of the pain one must understand the anatomy of the foot and some basic mechanics in the function of the foot. A thick ligament, called the plantar fascia, is attached into the bottom of the heel and fans out into the ball of the foot, attaching into the base of the toes. The plantar fascia is made of dense, fibrous connective tissue that will stretch very little. It acts something like a shock absorber. As the foot impacts the ground with each step, it flattens out lengthening the foot. This action pulls on the plantar fascia, which stretches slightly. When the heel comes off the ground the tension on the ligament is released. Anything that causes the foot to flatten excessively will cause the plantar fascia to stretch greater that it is accustom to doing. One consequence of this is the development of small tears where the ligament attaches into the heel bone. When these small tears occur, a very small amount of bleeding occurs and the tension of the plantar fascia on the heel bone produces a spur on the bottom of the heel to form. Pain experienced in the bottom of the heel is not produced by the presence of the spur. The pain is due to excessive tension of the plantar fascia as it tears from its attachment into the heel bone. Heel spur formation is secondary to the excessive pull of the plantar fascia where it attaches to the heel bone. Many people have heel spurs at the attachment of the plantar fascia with out having any symptoms or pain. There are some less common causes of heel pain but they are relatively uncommon. There are several factors that cause the foot to flatten and excessively stretching the plantar fascia. The primary factor is the structure of a joint complex below the ankle joint, called the subtalar joint. The movement of this joint complex causes the arch of the foot to flatten and to heighten. Flattening of the arch of the foot is termed pronation and heightening of the arch is called supination. If there is excessive pronation of the foot during walking and standing, the plantar fascia is strained. Over time, this will cause a weakening of the ligament where it attaches into the heel bone, causing pain. When a person is at rest and off of their feet, the plantar fascia attempts to mend itself. Then, with the first few steps the fascia re-tears causing pain. Generally, after the first few steps the pain diminishes. This is why the heel pain tends to be worse the first few steps in the morning or after rest. Another factor that contributes to the flattening of the arch of the foot is tightness of the calf muscles. The calf muscle attaches into the foot by the achilles tendon into the back of the heel. When the calf muscle is tight it limits the movement of the ankle joint. When ankle joint motion is limited by the tightness of the calf muscle it forces the subtalar joint to pronate excessively. Excessive subtalar joint pronation can cause several different problems to occur in the foot. In this instance, it results in excessive tension of the plantar fascia. Tightness of the calf muscles can be a result of several different factors. Exercise, such as walking or jogging will cause the calf muscle to tighten. Inactivity or prolonged rest will also cause the calf muscle to tighten. Women who wear high heels and men who wear western style cowboy boots will, over time, develop tightness in the calf muscles.

Symptoms

Pain typically comes on gradually, with no injury to the affected area. It is frequently triggered by wearing a flat shoe, such as flip-flop sandals. Flat footwear may stretch the plantar fascia to such an extent that the area becomes swollen (inflamed). In most cases, the pain is under the foot, toward the front of the heel. Post-static dyskinesia (pain after rest) symptoms tend to be worse just after getting out of bed in the morning, and after a period of rest during the day. After a bit of activity symptoms often improve a bit. However, they may worsen again toward the end of the day.

Diagnosis

Your doctor will perform a physical exam and ask questions about your medical history and symptoms, such as have you had this type of heel pain before? When did your pain begin? Do you have pain upon your first steps in the morning or after your first steps after rest? Is the pain dull and aching or sharp and stabbing? Is it worse after exercise? Is it worse when standing? Did you fall or twist your ankle recently? Are you a runner? If so, how far and how often do you run? Do you walk or stand for long periods of time? What kind of shoes do you wear? Do you have any other symptoms? Your doctor may order a foot x-ray. You may need to see a physical therapist to learn exercises to stretch and strengthen your foot. Your doctor may recommend a night splint to help stretch your foot. Surgery may be recommended in some cases.

Non Surgical Treatment

Treatment for plantar fasciitis - the vast majority of patients recover with conservative treatments (designed to avoid radical medical therapeutic measures or operative procedures) within months. Heel with ice-pack. Home care such as rest, ice-pack use, proper-fitting footwear and foot supports are often enough to ease heel pain. Non-steroidal anti-inflammatory drugs (NSAIDs) - medications with analgesic (pain reducing), antipyretic (fever reducing) effects. In higher doses they also have anti-inflammatory effects, they reduce inflammation (swelling). Non-steroidal distinguishes NSAIDs from other drugs which contain steroids, which are also anti-inflammatory. NSAIDs are non-narcotic (they do not induce stupor). For patients with plantar fasciitis they may help with pain and inflammation. Corticosteroids, a corticosteroid solution is applied over the affected area on the skin; an electric current is used to help absorption. Alternatively, the doctor may decide to inject the medication. However, multiple injections may result in a weakened plantar fascia, significantly increasing the risk of rupture and shrinkage of the fat pad covering the heel bone. Some doctors may use ultrasound to help them make sure they have injected in the right place Corticosteroids are usually recommended when NSAIDs have not helped. Physical therapy, a qualified/specialized physical therapist (UK: physiotherapist) can teach the patient exercises which stretch the plantar fascia and Achilles tendon, as well as strengthening the lower leg muscles, resulting in better stabilization of the ankle and heel. The patient may also be taught how to apply athletic taping, which gives the bottom of the foot better support. Night splints, the splint is fitted to the calf and foot; the patient keeps it on during sleep. Overnight the plantar fascia and Achilles tendon are held in a lengthened position; this stretches them. Orthotics, insoles and orthotics (assistive devices) can be useful to correct foot faults, as well as cushioning and cradling the arch during the healing process. Extracorporeal shock wave therapy, sound waves are aimed at the affected area to encourage and stimulate healing. This type of therapy is only recommended for chronic (long-term) cases, which have not responded to conservative therapy.

Surgical Treatment

With the advancements in technology and treatments, if you do need to have surgery for the heel, it is very minimal incision that?s done. And the nice thing is your recovery period is short and you should be able to bear weight right after the surgery. This means you can get back to your weekly routine in just a few weeks. Recovery is a lot different than it used to be and a lot of it is because of doing a minimal incision and decreasing trauma to soft tissues, as well as even the bone. So if you need surgery, then your recovery period is pretty quick.

Prevention

Heel Discomfort

You should always wear footwear that is appropriate for your environment and day-to-day activities. Wearing high heels when you go out in the evening is unlikely to be harmful. However, wearing them all week at work may damage your feet, particularly if your job involves a lot of walking or standing. Ideally, you should wear shoes with laces and a low to moderate heel that supports and cushions your arches and heels. Avoid wearing shoes with no heels. Do not walk barefoot on hard ground, particularly while on holiday. Many cases of heel pain occur when a person protects their feet for 50 weeks of the year and then suddenly walks barefoot while on holiday. Their feet are not accustomed to the extra pressure, which causes heel pain. If you do a physical activity, such as running or another form of exercise that places additional strain on your feet, you should replace your sports shoes regularly. Most experts recommend that sports shoes should be replaced after you have done about 500 miles in them. It is also a good idea to always stretch after exercising, and to make strength and flexibility training a part of your regular exercise routine.

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