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Satava151

What Causes Painful Heel

Pain Under The Heel

Overview

The Plantar Fascia is a strong ligament-like structure under the arch of the foot that runs from the heel bone to the ball of the foot. If we could see it in isolation it has a triangular shape when looked at from underneath but has a curved shape when looked at from the side - much like a sail boat’s sail billowing in the wind. The most functional piece is from the front-bottom-inside area of the heel bone (calcaneous) to the joint of the big toe (hallux) and this is where the majority of stress of walking (and running and jumping) is taken by the fascia. How your plantar fascia reacts to and recovers from this stress is what determines the extent and nature of your plantar fasciitis.



Causes

Plantar Fasciitis is simply caused by overstretching of the plantar fascia ligament under the foot. So why is the ligament being overstretched? There are different factors, over-use, too much sports, running, walking or standing for long periods (e.g. because of your job) weight gain, our feet are designed to carry a 'normal' weight. Any excess weight places great pressure on the bones, nerves, muscles and ligaments in the feet, which sooner or later will have consequences. Even pregnancy (in the last 10 weeks) can cause foot problems! age, as we get older ligaments become tighter & shorter and msucles become weaker; the ideal circumstances for foot problems, unsupportive footwear, 'floppy' shoes with no support as well as thongs affect our walking pattern, walking barefoot, especially on hard surfaces like concrete or tiles, low arch and flat feet or over-pronation. An important contributing factor to Plantar Fasciitis is 'excess pronation' (or over-pronation). This is a condition whereby the feet roll over, the arches collapse and the foot elongates. This unnatural elongation puts excess strain on the ligaments, muscles and nerves in the foot. When the foot is not properly aligned, the bones unlock and cause the foot to roll inward. With every step taken your foot pronates and elongates, stretching the plantar fascia and causing inflammation and pain at the attachment of the plantar fascia into the heel bone. Re-alignment of the foot should therefore an important part of the treament regime.



Symptoms

Plantar fascia usually causes pain and stiffness on the bottom of your heel although some people have heel spurs and suffer no symptoms at all. Occasionally, heel pain is also associated with other medical disorders such as arthritis (inflammation of the joint), bursitis (inflammation of the tissues around the joint). Those who have symptoms may experience ‘First step’ pain (stone bruise sensation) after getting out of bed or sitting for a period of time. Pain after driving. Pain on the bottom of your heel. Deep aching pain. Pain can be worse when barefoot.



Diagnosis

After you describe your symptoms and discuss your concerns, your doctor will examine your foot. Your doctor will look for these signs. A high arch, an area of maximum tenderness on the bottom of your foot, just in front of your heel bone. Pain that gets worse when you flex your foot and the doctor pushes on the plantar fascia. The pain improves when you point your toes down. Limited "up" motion of your ankle. Your doctor may order imaging tests to help make sure your heel pain is caused by plantar fasciitis and not another problem. X-rays provide clear images of bones. They are useful in ruling out other causes of heel pain, such as fractures or arthritis. Heel spurs can be seen on an x-ray. Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not routinely used to diagnose plantar fasciitis. They are rarely ordered. An MRI scan may be used if the heel pain is not relieved by initial treatment methods.



Non Surgical Treatment

Cut back on walking, running or athletic weight bearing activities. Try the recommended stretches above. Shoes with a good arch support and heel cushioning or over-the-counter orthotics may help. Icing the area of pain or taking a short course of anti-inflammatory medications such as ibuprofen or acetaminophen will help with pain. If treatments do not help, a doctor can suggest other options.

Foot Pain



Surgical Treatment

Surgery is considered only after 12 months of aggressive nonsurgical treatment. Gastrocnemius recession. This is a surgical lengthening of the calf (gastrocnemius) muscles. Because tight calf muscles place increased stress on the plantar fascia, this procedure is useful for patients who still have difficulty flexing their feet, despite a year of calf stretches. In gastrocnemius recession, one of the two muscles that make up the calf is lengthened to increase the motion of the ankle. The procedure can be performed with a traditional, open incision or with a smaller incision and an endoscope, an instrument that contains a small camera. Your doctor will discuss the procedure that best meets your needs. Complication rates for gastrocnemius recession are low, but can include nerve damage. Plantar fascia release. If you have a normal range of ankle motion and continued heel pain, your doctor may recommend a partial release procedure. During surgery, the plantar fascia ligament is partially cut to relieve tension in the tissue. If you have a large bone spur, it will be removed, as well. Although the surgery can be performed endoscopically, it is more difficult than with an open incision. In addition, endoscopy has a higher risk of nerve damage.



Prevention

Do your best to maintain healthy weight. Plantar fasciitis is caused by wear and tear on your feet. Being overweight drastically increases the pounding your feet take every day. Even losing a few pounds can help reduce heel pain. Avoid jobs that require walking or standing for long periods of time. Having your body weight on your feet all day puts a lot of pressure on your plantar fascia tissue. Replace your shoes on a regular basis. Buy new shoes when the old ones are worn-out. Make sure your shoes will fit your foot size comfortably at the end of the day. Pay attention to the width as well as the length. Use good supportive shoes that will help you with your original problem like arch support, motion control, stability, cushioning etc. Stretch regularly as part of your daily routine. There are a few special stretching techniques for the prevention. Choose soft surfaces for your exercise routine to walk, jog or run on. Rest and elevate your feet every chance you have. Strengthen your foot muscles as part of your exercise routine. Strong foot muscles provide a good support to the plantar fascia. Change your shoes during the work week. Don't wear the same pair of shoes every day. Perform Warm up exercises such as a short period of walking, a light jog or other easy movement and then stretch before starting the main exercise. Try to avoid dramatic changes in your exercise routine. Increase your exercise level gradually. Don’t run long distance if you are used to walk. Make the change slowly and gradually. Pay attention to your foot pain, do not ignore it. Visit your doctor if the pain continues. Avoid the activities that cause you pain. Use over-the-counter Orthotics or inserts that your doctor may prescribe. Off-the-shelf or custom-fitted arch supports (orthotics) will help distribute pressure to your feet more evenly. Try to avoid barefoot walking, since it may add stress on the plantar fascia ligament.

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