What Triggers Heel Discomfort And Ways To Alleviate It

Plantar Fasciitis


Overview


The plantar fascia is a band of connective tissue that runs along the sole from the heel to the ball of the foot. One of its main roles is to keep the bones and joints in position. Bruising or overstretching this ligament can cause inflammation and heel pain. A common cause is flat feet, because the ligament is forced to overstretch as the foot spreads out and the arch flattens. The pain may be worse first thing in the morning or after rest. In many cases, plantar fasciitis is associated with heel spur. The plantar fascia tears and bleeds at the heel and, over time, these injuries calcify and form a bony growth.






Causes


It usually starts following an increase in activity levels. Increase in weight. Standing for long periods. Poor footwear. Tight muscle groups. Abnormal pressure on the plantar Fascia can be caused by any of the above. The plantar fascia becomes inflamed and tiny rips can occur where it attaches into the inside of the heel bone. The area becomes inflamed and swollen, and it is the increase in fluid to the area that accumulates when weight is taken off the area that then causes the pain on standing.






Symptoms


Plantar fasciitis is the inflammation of the plantar fascia - a band of tough fibrous tissue running along the sole of the foot. It occurs when small tears develop in the plantar fascia, leading to inflammation and heel pain. The plantar fascia tissue branches out from the heel like a fan, connecting the heel bone to the base of the toes. When the foot moves, the plantar fascia stretches and contracts. The plantar fascia helps to maintain the arch of the foot in much the same way that the string of a bow maintains the bow's arch. The most notable symptom of plantar fasciitis is heel pain. This is typically most severe in the middle of the heel though it may radiate along the sole of the foot. The pain is most often felt when walking first thing in the morning or after a period of rest. As walking continues the pain may decrease; however some degree of pain remains present on movement. The pain may disappear when resting, as the plantar fascia is relaxed. Redness, swelling and warmth over the affected area may also be noticed. The onset of plantar fasciitis is gradual and only mild pain may be experienced initially. However, as the condition progresses the pain experienced tends to become more severe. Chronic plantar fasciitis may cause a person to change their walking or running action, leading to symptoms of discomfort in the knee, hip and back.






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


The initial treatment of plantar fasciitis focuses on reducing pain and inflammation. Resting the affected foot is the most important aspect of this treatment. Other initial treatment may include, aplying ice to the sole of the foot, Anti-inflammatory medications. Gentle stretching of the plantar fascia and Achilles tendon. Physiotherapy. Taping the foot and ankle to provide adequate support and alignment, Wearing supportive footwear with shock-absorbing soles or inserts. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Brufen) and diclofenac (Voltaren) are often used to treat plantar fasciitis. It is unclear whether NSAIDs assist in the healing process but they are useful for controlling pain during treatment. If the condition does not respond to initial treatment, a corticosteroid therapy may be recommended. This involves the injection of corticosteroid medication such as hydrocortisone (Solu-Cortef) directly into the affected area in order to treat the inflammation and thus relieve the pain. Night splints to prevent the plantar fascia tightening during sleep may also be recommended at this stage.


Painful Heel






Surgical Treatment


Surgery may be considered in very difficult cases. Surgery is usually only advised if your pain has not eased after 12 months despite other treatments. The operation involves separating your plantar fascia from where it connects to the bone; this is called a plantar fascia release. It may also involve removal of a spur on the calcaneum if one is present. Surgery is not always successful. It can cause complications in some people so it should be considered as a last resort. Complications may include infection, increased pain, injury to nearby nerves, or rupture of the plantar fascia.






Stretching Exercises


Stretching exercises for your foot are important. Do the stretches shown here at least twice a day. Don't bounce when you stretch. Plantar fascia stretch. To do the plantar fascia stretch, stand straight with your hands against a wall and your injured leg slightly behind your other leg. Keeping your heels flat on the floor, slowly bend both knees. You should feel the stretch in the lower part of your leg. Hold the stretch for 10 to 15 seconds. Repeat the stretch 6 to 8 times. Calf stretch. Stand with your hands against a wall and your injured leg behind your other leg. With your injured leg straight, your heel flat on the floor and your foot pointed straight ahead, lean slowly forward, bending the other leg. You should feel the stretch in the middle of your calf. Hold the stretch for 10 to 15 seconds. Repeat the stretch 6 to 8 times. Other exercises. You can also strengthen your leg muscles by standing on the ball of your foot at the edge of a step and raising up as high as possible on your toes. Relax between toe raises and let your heel fall a little lower than the edge of the step. It's also helpful to strengthen the foot by grabbing a towel with your toes as if you are going to pick up the towel with your foot. Repeat this exercise several times a day.

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