What Exactly Triggers Pain In The Heel

Plantar Fasciitis

Overview

The plantar fascia acts like a bowstring and supports the arch and several muscles inside the foot. When there is increased stress on the arch, microscopic tears can occur within the plantar fascia, usually at its attachment on the heel. This results in inflammation and pain with standing and walking and sometimes at rest.




Causes

Inappropriate footwear is the No. 1 cause of plantar fasciosis. Footwear that possesses toe spring and a tapered toe box holds your big toe in an adducted and extended position. In this position, your abductor hallucis muscle-the muscle responsible for moving your big toe away from your foot’s midline-pulls on a foot structure called the flexor retinaculum and may restrict blood flow through your posterior tibial artery, the vessel that carries blood to the bottom of your foot. Tissues in the sole of your feet begin to degenerate as blood supply to this area is decreased. Other recognized causes of or contributors to this health problem include the following, calf muscle shortening, plantar fascia contracture, Obesity, rheumatoid arthritis, reactive arthritis, Psoriatic arthritis, Corticosteroid injections.




Symptoms

Plantar fasciitis and heel spur pain usually begins in the bottom of the heel, and frequently radiates into the arch. At times, however, the pain may be felt only in the arch. The pain is most intense when first standing, after any period of rest. Most people with this problem experience their greatest pain in the morning, with the first few steps after sleeping. After several minutes of walking, the pain usually becomes less intense and may disappear completely, only to return later with prolonged walking or standing. If a nerve is irritated due to the swollen plantar fascia, this pain may radiate into the ankle. In the early stages of Plantar Fasciitis and Heel Spurs, the pain will usually subside quickly with getting off of the foot and resting. As the disease progresses, it may take longer periods of time for the pain to subside.




Diagnosis

Diagnosis of plantar fasciitis is based on a medical history, the nature of symptoms, and the presence of localised tenderness in the heel. X-rays may be recommended to rule out other causes for the symptoms, such as bone fracture and to check for evidence of heel spurs. Blood tests may also be recommended.




Non Surgical Treatment

As with most soft tissue injuries the initial treatment is Rest, Ice, and Protection. In the early phase you’ll most likely be unable to walk pain-free. Our first aim is to provide you with some active rest from pain-provoking foot postures. This means that you should stop doing any movement or activity that provoked your foot pain in the first place. Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot. A frozen water bottle can provide you with a ice foot roller that can simultaneously provide you with some gentle plantar fascia massage. Anti-inflammatory medication (if tolerated) and natural substances eg arnica may help reduce your pain and swelling. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as a pain reducing medication. To support and protect your plantar fascia, you may need to be wear a plantar fascia brace, heel cups or have your foot taped to provide pain relief. As mentioned earlier, the cause of your plantar fasciitis will determine what works best for you. Your physiotherapist will guide you. Your physiotherapist will guide you and utilise a range of pain relieving techniques including joint mobilisations for stiff joints, massage, electrotherapy, acupuncture or dry needling to assist you during this pain-full phase.

Plantar Fascia




Surgical Treatment

Most practitioners agree that treatment for plantar fasciitis is a slow process. Most cases resolve within a year. If these more conservative measures don't provide relief after this time, your doctor may suggest other treatment. In such cases, or if your heel pain is truly debilitating and interfering with normal activity, your doctor may discuss surgical options with you. The most common surgery for plantar fasciitis is called a plantar fascia release and involves releasing a portion of the plantar fascia from the heel bone. A plantar fascia release can be performed through a regular incision or as endoscopic surgery, where a tiny incision allows a miniature scope to be inserted and surgery to be performed. About one in 20 patients with plantar fasciitis will need surgery. As with any surgery, there is still some chance that you will continue to have pain afterwards.




Prevention

Maintain a healthy weight. This minimizes the stress on your plantar fascia. Choose supportive shoes. Avoid high heels. Buy shoes with a low to moderate heel, good arch support and shock absorbency. Don't go barefoot, especially on hard surfaces. Don't wear worn-out athletic shoes. Replace your old athletic shoes before they stop supporting and cushioning your feet. If you're a runner, buy new shoes after about 500 miles of use. Change your sport. Try a low-impact sport, such as swimming or bicycling, instead of walking or jogging. Apply ice. Hold a cloth-covered ice pack over the area of pain for 15 to 20 minutes three or four times a day or after activity. Or try ice massage. Freeze a water-filled paper cup and roll it over the site of discomfort for about five to seven minutes. Regular ice massage can help reduce pain and inflammation. Stretch your arches. Simple home exercises can stretch your plantar fascia, Achilles tendon and calf muscles.

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