What Exactly Brings About Pain On The Heel

Plantar Fascia

Overview

Plantar fasciitis is a common painful disorder affecting the heel and underside of the foot. It is a disorder of the insertion site of plantar fascia on the bone and is characterized by scarring, inflammation, or structural breakdown of the foot’s plantar fascia. It is often caused by overuse injury of the plantar fascia, increases in exercise, weight or age. Although plantar fasciitis was originally thought to be an inflammatory process, newer studies have demonstrated structural changes more consistent with a degenerative process. As a result of this new observation, many in the academic community have stated the condition should be renamed plantar fasciosis.




Causes

Plantar fasciitis is the most common cause of heel pain, accounting for around four out of five cases. Plantar fasciitis is when the thick band of tissue that connects the heel bone with the rest of the foot (the plantar fascia) becomes damaged and thickened. Damage to the plantar fascia is thought to occur following sudden damage, for example, damaging your heel while jogging, running or dancing; this type of damage usually affects younger people who are physically active, gradual wear and tear of the tissues that make up the plantar fascia - this usually affects adults who are 40 years of age or over. You are at an increased risk of gradual wear and tear damaging your plantar fasciitis if you are overweight or obese, if you have a body mass index (BMI) of 30 or over, you are considered to be obese, have a job that involves spending long periods of time standing, wear flat-soled shoes, such as sandals or flip flops. Less common causes of heel pain are a stress fracture. A stress fracture can occur if your heel bone is damaged during an injury. Fat pad atrophy. Fat pad atrophy is where the layer of fat that lies under the heel bone, known as the fat pad, starts to waste away due to too much strain being placed on the pad. Women who wear high-heeled shoes for many years have an increased risk of developing fat pad atrophy. Bursitis. Bursitis is inflammation of one or more bursa (small fluid-filled sacs under the skin, usually found over the joints and between tendons and bones). It's possible to develop bursitis anywhere inside the body, not just in the foot. Tarsal tunnel syndrome. The nerves in the sole of your foot pass through a small tunnel on the inside of the ankle joint, known as the tarsal tunnel. If a cyst forms or the tunnel is damaged, the nerves can become compressed (squashed). This can cause pain anywhere along the nerve, including beneath your heel. Sever's disease. Sever's disease is a common cause of heel pain in children. It's caused by the muscles and tendons of the hamstrings and calves stretching and tightening in response to growth spurts. The stretching of the calf muscle pulls on the Achilles tendon. This pulls on the growing area of bone at the back of the heel (growth plate), causing pain in the heel. The pain is further aggravated by activities such as football and gymnastics. The pain often develops at the side of the heel, but can also be felt under the heel. Calf and hamstring stretches and, if necessary, heel pads are usually effective treatments for Sever's disease. Bone spurs. Bone spurs are an excess growth of bone that forms on a normal bone. Bone spurs can develop on the heel (a heel spur) and are more common in people with heel pain. However, they can also occur in people without heel pain. A heel spur does not cause heel pain.




Symptoms

The major complaint of those with plantar fasciitis is pain and stiffness in the bottom of the heel. This develops gradually over time. It usually affects just one foot, but can affect both feet. Some people describe the pain as dull, while others experience a sharp pain, and some feel a burning or ache on the bottom of the foot extending outward from the heel. The pain is usually worse in the morning when you take your first steps out of bed, or if you’ve been sitting or lying down for a while. Climbing stairs can be very difficult due to the heel stiffness. After prolonged activity, the pain can flare-up due to increased inflammation. Pain is not usually felt during the activity, but rather just after stopping.




Diagnosis

To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis. In addition, diagnostic imaging studies such as x-rays or other imaging modalities may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.




Non Surgical Treatment

Night splints are treatment that can help stretch your calf and the arch of your foot. Night splints are a type of brace that holds your foot in a flexed position and lengthens the plantar fascia and Achilles tendon overnight. This can prevent morning pain and stiffness. Special orthotics, or arch supports, for your shoes may help alleviate some of the pain by distributing pressure, and can prevent further damage to the plantar fascia. A boot cast may be used to immobilize your foot and reduce strain while the plantar fascia heals. A boot cast looks like a ski boot and can be removed for bathing.

Painful Heel




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

Making sure your ankle, Achilles tendon, and calf muscles are flexible can help prevent plantar fasciitis. Stretch your plantar fascia in the morning before you get out of bed. Doing activities in moderation can also help.

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