What Can Cause Painful Heel And Ways To Successfully Treat It

Pain At The Heel

Overview

Plantar fasciitis is one of the most common explanations of heel pain. It is caused by inflammation to the thick band that connects the toes to the heel bone, called the plantar fascia, which runs across the bottom of your foot. The condition is most commonly seen in runners, pregnant women, overweight people, and individuals who wear inadequately supporting shoes. Plantar fasciitis typically affects people between the ages of 40 and 70.




Causes

Training on improper, hard and/or irregular surfaces as well as excessive track work in spiked shoes, or steep hill running, can stress the plantar fascia past its limits of elasticity, leading to injury. Finally, failure in the early season to warm up gradually gives the athlete insufficient time for the structures of the foot to re-acclimate and return to a proper fitness level for intensive exercise. Such unprepared and repeated trauma causes microscopic tearing, which may only be detected once full-blown plantar fasciitis and accompanying pain and debilitation have resulted. If the level of damage to the plantar fascia is significant, an inflammatory reaction of the heel bone can produce spike-like projections of new bone, known as heel spurs. Indeed, plantar fasciitis has occasionally been refereed to as heel spur syndrome, though such spurs are not the cause of the initial pain but are instead a further symptom of the problem. While such spurs are sometimes painless, in other cases they cause pain or disability in the athlete, and surgical intervention to remove them may be required. A dull, intermittent pain in the heel is typical, sometimes progressing to a sharp, sustained discomfort. Commonly, pain is worse in the morning or after sitting, later decreasing as the patient begins walking, though standing or walking for long periods usually brings renewal of the pain.




Symptoms

The classic sign of plantar fasciitis is that the worst pain occurs with the first few steps in the morning, but not every patient will have this symptom. Patients often notice pain at the beginning of activity that lessens or resolves as they warm up. The pain may also occur with prolonged standing and is sometimes accompanied by stiffness. In more severe cases, the pain will also worsen toward the end of the day.




Diagnosis

Plantar fasciitis is usually diagnosed by a health care provider after consideration of a person’s presenting history, risk factors, and clinical examination. Tenderness to palpation along the inner aspect of the heel bone on the sole of the foot may be elicited during the physical examination. The foot may have limited dorsiflexion due to tightness of the calf muscles or the Achilles tendon. Dorsiflexion of the foot may elicit the pain due to stretching of the plantar fascia with this motion. Diagnostic imaging studies are not usually needed to diagnose plantar fasciitis. However, in certain cases a physician may decide imaging studies (such as X-rays, diagnostic ultrasound or MRI) are warranted to rule out other serious causes of foot pain. Bilateral heel pain or heel pain in the context of a systemic illness may indicate a need for a more in-depth diagnostic investigation. Lateral view x-rays of the ankle are the recommended first-line imaging modality to assess for other causes of heel pain such as stress fractures or bone spur development. Plantar fascia aponeurosis thickening at the heel greater than 5 millimeters as demonstrated by ultrasound is consistent with a diagnosis of plantar fasciitis. An incidental finding associated with this condition is a heel spur, a small bony calcification on the calcaneus (heel bone), which can be found in up to 50% of those with plantar fasciitis. In such cases, it is the underlying plantar fasciitis that produces the heel pain, and not the spur itself. The condition is responsible for the creation of the spur though the clinical significance of heel spurs in plantar fasciitis remains unclear.




Non Surgical Treatment

A number of conservative measures can help take stress off the plantar fascia and encourage healing, including Icing, Taping the arch and bottom of the foot, Stretching, especially the calf, Avoiding walking with bare feet, especially on hard surfaces, Wearing orthotics or arch supports, Taking over-the-counter anti-inflammatories. If these methods fail, we generally try one of two things, A cortisone injection can help reduce swelling. Often a single injection will do the trick, but occasionally a second injection may be needed. Alternatively, we can try extracorporeal pulse activation therapy, or EPAT. This method uses sound waves to penetrate to the plantar fascia and stimulate the body’s healing response. We typically do one treatment a week for three weeks, with complete healing taking between nine to 12 weeks.

Heel Pain




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.




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.

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