What Brings About Heel Discomfort To Appear

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 most commonly occurs due to repetitive or prolonged activities placing strain on the plantar fascia. It is often seen in runners, or dancers and gymnasts who perform regular activities involving end of range foot and ankle movements. It may also occur in patients who walk excessively, especially up hills or on uneven surfaces. Older patients who spend a lot of time on their feet may also develop the condition. Plantar fasciitis frequently occurs in association with calf muscle tightness, inappropriate footwear, or biomechanical abnormalities, such as excessive pronation (flat feet) or supination (high arches). Occasionally the condition may occur suddenly due to a high force going through the plantar fascia beyond what it can withstand. This may be due to activities such as a sudden acceleration or a forceful jump.




Symptoms

Symptoms of plantar fasciitis include pain in the heel of the foot. Some people complain of a sharp stabbing pain especially with walking. Others describe the pain as a dull ache after prolonged standing. The pain of plantar fasciitis is often worst in the morning or following activity.




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

No single treatment works best for everyone with plantar fasciitis. But there are many things you can try to help your foot get better. Give your feet a rest. Cut back on activities that make your foot hurt. Try not to walk or run on hard surfaces. To reduce pain and swelling, try putting ice on your heel. Or take an over-the-counter pain reliever like ibuprofen (such as Advil or Motrin) or naproxen (such as Aleve). Do toe stretches , calf stretches and towel stretches several times a day, especially when you first get up in the morning. (For towel stretches, you pull on both ends of a rolled towel that you place under the ball of your foot.) Get a new pair of shoes. Pick shoes with good arch support and a cushioned sole. Or try heel cups or shoe inserts ( orthotics ). Use them in both shoes, even if only one foot hurts. If these treatments do not help, your doctor may recommend splints that you wear at night, shots of medicine (such as a steroid ) in your heel, or other treatments. You probably will not need surgery. Doctors only suggest it for people who still have pain after trying other treatments for 6 to 12 months.






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.