What Is Pain Of The Heel

Plantar Fasciitis

Painful Heel

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

When the foot moves, the plantar fascia stretches and contracts. Plantar fasciitis is caused by the repetitive overstretching of the plantar fascia. If the tension on the plantar fascia is too great, this overstretching causes small tears in the plantar fascia. This in turn causes the plantar fascia to become inflamed and painful. Factors that contribute to the development of plantar fasciitis include having very high arches or flat feet, gender, while anyone can develop plantar fasciitis, it tends to occur more commonly in women, exercises such as running, walking and dancing, particularly if the calf muscles are tight. Activities or occupations that involve walking or standing for long periods of time, particularly on hard surfaces, wearing high heeled shoes or shoes that do not offer adequate arch support and cushioning, being overweight, additional weight increases the tension on the plantar fascia, poor biomechanics, extra tension is placed on the plantar fascia if weight is not spread evenly when standing, walking or running. Some cases of plantar fasciitis may be linked to underlying diseases that cause arthritis, such as ankylosing spondylitis.


Symptoms

Among the symptoms for Plantar Fasciitis is pain usually felt on the underside of the heel, often most intense with the first steps after getting out of bed in the morning. It is commonly associated with long periods of weight bearing or sudden changes in weight bearing or activity. Plantar Fasciitis also called “policeman’s heel” is presented by a sharp stabbing pain at the bottom or front of the heel bone. In most cases, heel pain is more severe following periods of inactivity when getting up and then subsides, turning into a dull ache.


Diagnosis

Your doctor can usually diagnose plantar fasciitis just by talking to you and examining your feet. Rarely, tests are needed if the diagnosis is uncertain or to rule out other possible causes of heel pain. These can include X-rays of the heel or an ultrasound scan of the fascia. An ultrasound scan usually shows thickening and swelling of the fascia in plantar fasciitis.


Non Surgical Treatment

Over-the-counter arch supports may be useful in patients with acute plantar fasciitis and mild pes planus. The support provided by over-the-counter arch supports is highly variable and depends on the material used to make the support. In general, patients should try to find the most dense material that is soft enough to be comfortable to walk on. Over-the-counter arch supports are especially useful in the treatment of adolescents whose rapid foot growth may require a new pair of arch supports once or more per season. Custom orthotics are usually made by taking a plaster cast or an impression of the individual’s foot and then constructing an insert specifically designed to control biomechanical risk factors such as pes planus, valgus heel alignment and discrepancies in leg length. For patients with plantar fasciitis, the most common prescription is for semi-rigid, three-quarters to full-length orthotics with longitudinal arch support. Two important characteristics for successful treatment of plantar fasciitis with orthotics are the need to control over-pronation and metatarsal head motion, especially of the first metatarsal head. In one study, orthotics were cited by 27 percent of patients as the best treatment. The main disadvantage of orthotics is the cost, which may range from $75 to $300 or more and which is frequently not covered by health insurance.

Plantar Fascia


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.

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