Does A Inferior Calcaneal Spur Hurt?

Heel Spur

Overview

When the body is under stress or constent inflammation it will deposit calcium to our bones. This added ‘bone growth’ is designed to relieve the added stress/pressure to our connective tissue. In the case of a heel spur, added calcium to the heel bone (calcaneus). It usually forms at the bottom underside of the heel bone where the plantar fascia attaches. This calcium deposit forms over a period of many months. Heel bones can very in shape and size from person to person. An irregular shape heel (calcaneus) can cause the tissue to twist (plantar ligament and Achilles tendon) or a smaller heel bone will put additional stress on tendons and ligaments.

Causes

Heel Spurs develop when the plantar fascia is excessively and repetitively pulled away from the heel bone. In many cases, a heel spur can develop along with plantar fasciitis, but can also occur by itself. Heel spurs often develop in middle-aged patients, but can also occur in younger people as well. Athletes are especially prone to heel spur due to the regular stress on their heels.

Posterior Calcaneal Spur

Symptoms

Most of the time heel spurs present as pain in the region surrounding the spur, which typically increases in intensity after prolonged periods of rest. Patients may not be able to bear weight on the afflicted heel comfortably. Running, walking, or lifting heavy weight may exacerbate the issue.

Diagnosis

A Diagnosis of Heel Spur Syndrome is a very common reason for having heel pain. Heel pain may be due to other types of conditions such as tendonitis, Haglund’s Deformity, Stress Fracture, Tarsal Tunnel Syndrome, or low back problems. A more common condition in children is Sever’s Disease. The diagnosis is usually made with a combination of x-ray examination and symptoms.

Non Surgical Treatment

In some cases, heel spur pain may not be resolved through conservative treatment options. In those cases, cortisone injections may be used to reduce inflammation associated with the condition, helping to reduce discomfort. However, treatment options such as these must be discussed in detail with your physician, since more serious forms of treatment could yield negative side effects, such as atrophy of the heel’s fat pad, or the rupture of the plantar fascia ligament. Although such side effects are rare, they are potential problems that could deliver added heel pain.

Surgical Treatment

Have surgery if no other treatments work. Before performing surgery, doctors usually give home treatments and improved footwear about a year to work. When nothing else eases the pain, here’s what you need to know about surgical options. Instep plantar fasciotomy. Doctors remove part of the plantar fascia to ease pressure on the nerves in your foot. Endoscopy. This surgery performs the same function as an instep plantar fasciotomy but uses smaller incisions so that you’ll heal faster. However, endoscopy has a higher rate of nerve damage, so consider this before you opt for this option. Be prepared to wear a below-the-knee walking cast to ease the pain of surgery and to speed the healing process. These casts, or “boots,” usually work better than crutches to speed up your recovery time.

Avoiding Posterior Calcaneal Spur

Heel Spur

Overview

Although many people with plantar fasciitis have heel spurs, spurs are not the cause of plantar fasciitis pain. One out of 10 people has heel spurs, but only 1 out of 20 people (5%) with heel spurs has foot pain. Because the spur is not the cause of plantar fasciitis, the pain can be treated without removing the spur.

Causes

There exists a membrane that covers most of the bone along the heel. When this membrane gets torn repeatedly due to straining of the muscles in the foot, the calcium deposits that lead to heel spurs are more likely to occur.

Inferior Calcaneal Spur

Symptoms

The vast majority of people who have heel spurs feel the asscociated pain during their first steps in the morning. The pain is quite intense and felt either the bottom or front of the heel bone. Typically, the sharp pain diminishes after being up for a while but continues as a dull ache. The pain characteristically returns when first standing up after sitting for long periods.

Diagnosis

Your doctor, when diagnosing and treating this condition will need an x-ray and sometimes a gait analysis to ascertain the exact cause of this condition. If you have pain in the bottom of your foot and you do not have diabetes or a vascular problem, some of the over-the-counter anti-inflammatory products such as Advil or Ibuprofin are helpful in eradicating the pain. Pain creams, such as Neuro-eze, BioFreeze & Boswella Cream can help to relieve pain and help increase circulation.

Non Surgical Treatment

In case of heel spurs rest is most important. Active sports, running, long walks etc should be avoided to start with. If you?re in a job that requires a lot of standing, take a few days off work. Rest (or reduced activity) is essential to allow the inflammation from becoming aggrevated. Furthermore, you can use ice packs (placed on the heel for 5-10 minutes) to ?cool down? the inflamed area. You may take anti-inflammatory medication or apply a topical inflammatory (i.e. a cream) to help reduce inflammation. In addition, there are some simple exercises that should be done daily to help relieve heel spur pain.

Surgical Treatment

More than 90 percent of people get better with nonsurgical treatments. If conservative treatment fails to treat symptoms of heel spurs after a period of 9 to 12 months, surgery may be necessary to relieve pain and restore mobility. Surgical techniques include release of the plantar fascia, removal of a spur. Pre-surgical tests or exams are required to identify optimal candidates, and it’s important to observe post-surgical recommendations concerning rest, ice, compression, elevation of the foot, and when to place weight on the operated foot. In some cases, it may be necessary for patients to use bandages, splints, casts, surgical shoes, crutches, or canes after surgery. Possible complications of heel surgery include nerve pain, recurrent heel pain, permanent numbness of the area, infection, and scarring. In addition, with plantar fascia release, there is risk of instability, foot cramps, stress fracture, and tendinitis.

Prevention

You can prevent heel spurs by wearing well-fitting shoes with shock-absorbent soles, rigid shanks, and supportive heel counters; choosing appropriate shoes for each physical activity; warming up and doing stretching exercises before each activity; and pacing yourself during the activities. Avoid wearing shoes with excessive wear on the heels and soles. If you are overweight, losing weight may also help prevent heel spurs.

Bursitis Of The Foot Bursa Removal Complications

Overview

The foot only contains one naturally occurring bursal sac between the Achilles tendon and the heel bone, which protects the Achilles from the pressure against the heel bone during ambulation. However, shoes may put pressure on this bursa. The bursa might also incur trauma from walking on hard ground. And, though they are not naturally occurring, bursa sacs can also form, and become inflamed, in other parts of the foot, including the bottom of the heel, and the metatarsal plate, the outside of the foot below the fifth toe, and so on.

Causes

The calcaneal bursa can become inflamed in patients with heel spurs or in patients with poor-fitting shoes (eg, high heels). Inflammation can occur secondarily from Achilles tendinitis, especially in young athletes. Patients exhibit tenderness to palpation of the bursa anterior to the Achilles tendon on both the medial and lateral aspects. They have pain with movement, which is worsened with dorsiflexion.

Symptoms

Where the tendon joins the calcaneal bone, friction can cause the spaces between the tendon, bone and skin to swell and inflame with bursitis. This constitutes a calcaneal bursa. Apart from swelling over the back of the heel, you?ll feel acute tenderness and pain when you move it or even apply light pressure. Your swollen heel may look more red than the other one, and the swelling is often so hard it can feel like bone, partly because it sometimes is, as a bony overgrowth can occur in chronic cases.

Diagnosis

The doctor will discuss your symptoms and visually assess the bones and soft tissue in your foot. If a soft tissue injury is suspected, an MRI will likely be done to view where and how much the damage is in your ankle. An x-ray may be recommended to rule out a bone spur or other foreign body as the cause of your ankle pain. As the subcutaneous bursa is close to the surface of the skin, it is more susceptible to septic, or infectious, bursitis caused by a cut or scrape at the back of the heel. Septic bursitis required antibiotics to get rid of the infection. Your doctor will be able to determine whether there is an infection or not by drawing a small sample of the bursa fluid with a needle.

Non Surgical Treatment

The initial treatment for retrocalcaneal bursitis is to avoid activities that cause pain and take non-steroidal anti-inflammatory medications (for example, ibruprofen). Your doctor may recommend icing the heel several times a day and may prescribe physical therapy to improve flexibility and strength around the ankle. Physical therapy serves two functions, it can help the bursitis improve and it can help prevent future recurrences.

Surgical Treatment

Only if non-surgical attempts at treatment fail, will it make sense to consider surgery. Surgery for retrocalcanel bursitis can include many different procedures. Some of these include removal of the bursa, removing any excess bone at the back of the heel (calcaneal exostectomy), and occasionally detachment and re-attachment of the Achilles tendon. If the foot structure and shape of the heel bone is a primary cause of the bursitis, surgery to re-align the heel bone (calcaneal osteotomy) may be considered. Regardless of which exact surgery is planned, the goal is always to decrease pain and correct the deformity. The idea is to get you back to the activities that you really enjoy. Your foot and ankle surgeon will determine the exact surgical procedure that is most likely to correct the problem in your case. But if you have to have surgery, you can work together to develop a plan that will help assure success.

Hammertoe Treatment

Hammer ToeOverview

A Hammer toe is a deformity of the second, third or fourth toes. In this condition, the toe is bent at the middle joint, so that it resembles a hammer. Initially, hammer toes are flexible and can be corrected with simple measures but, if left untreated, they can become fixed and require surgery. People with hammer toe may have corns or calluses on the top of the middle joint of the toe or on the tip of the toe. They may also feel pain in their toes or feet and have difficulty finding comfortable shoes.

Causes

Hammertoe has three main culprits: tight shoes, trauma, and nerve injuries or disorders. When toes are crowded in shoes that are too tight and narrow, they are unable to rest flat, and this curled toe position may become permanent even when you aren’t wearing shoes due to the tendons of the toe permanently tightening. When the tendons are held in one position for too long, the muscles tighten and eventually become unable to stretch back out. A similar situation may result when tendons are injured due to trauma, such as a stubbed, jammed, or broken toe.

Hammer ToeSymptoms

Symptoms may include pain in the affected toe or toes when you wear shoes, making it hard or painful to walk. A corn or callus on the top of the joint caused by rubbing against the shoe. Swelling and redness of the skin over the joint. Trouble finding comfortable shoes.

Diagnosis

A hammertoe is usually diagnosed with a physical inspection of your toe. Imaging tests, such as X-rays, may be ordered if you have had a bone, muscle, or ligament injury in your toe.

Non Surgical Treatment

If the affected toe is still flexible, you may be able to treat it by taping or splinting the toe to hold it straight. Your family doctor can show you how to do this. You may also try corrective footwear, corn pads and other devices to reduce pain. You may need to do certain exercises to keep your toe joints flexible. For example, you may need to move and stretch your toe gently with your hands. You can also exercise by picking things up with your toes. Small or soft objects, such as marbles or towels, work best. If your hammer toe becomes painful, you may need to apply an ice pack several times a day. This can help relieve the soreness and swelling. Nonsteroidal anti-inflammatory medicines (also called NSAIDs), such as ibuprofen (two brand names: Advil, Motrin) or naproxen (one brand name: Aleve), may be helpful. If your pain and swelling are severe, your doctor may need to give you a steroid injection in the toe joint.

Surgical Treatment

Surgery to correct for a hammertoe may be performed as a day procedure. There are several different types of procedures that can be used depending on the foot structure and if the deformity is flexible or rigid.

Hammer ToePrevention

The best ways to prevent a hammertoe are. Wear shoes that fit well. Shoes should be one-half inch longer than your longest toe. Shoes should be wide enough and the toe box should be high enough to give the foot room to move. Don?t wear shoes with heels over 2 inches high. If a toe starts to look like a hammertoe, buy shoes that have an extra high toe box. Wear corn pad hammertoe removers or cushion pads on top of the affected toe. See your healthcare provider any time you have foot pain that does not go away quickly or is more than mild pain. Foot pain is not normal.

Over-Pronation Treatments And Causes

Overview

Over-pronation is very common and affects millions of people. To better understand this condition, we’ll take a closer look at the 3 most common foot types. An estimated 70% of the population has fallen arches (or a low arch). Only 20% has a normal arch. And 10% have abnormal feet, in other words they either have flat feet or the opposite a high arched foot.Over Pronation

Causes

There are many biomechanical issues that can contribute to excessive pronation, including weak foot intrinsic muscles, limited ankle dorsiflexion mobility and calf flexibility, weak ankle invertor muscles (e.g. posterior tibialis), weak forefoot evertor muscles (peroneus longus), poor hip strength and control, Anterior pelvic tilting, heel InversionIn a person who overpronates, the heel bone goes into an everted position meaning that it turns out away from the midline of the body. The opposite motion of eversion is inversion. Inversion is a motion that needs to be controlled to prevent the foot from excessively pronating.

Symptoms

Common conditions that develop with prolonged overpronation typically include plantar fasciitis, achilles tendonitis, shin splints, posterior tibial stress syndrome and even IT band syndrome. With long term neglect you may see the development of bunyons, foot deformities and early onset of hip and knee arthritis.

Diagnosis

Look at the wear on your shoes and especially running trainers; if you overpronate it’s likely the inside of your shoe will be worn down (or seem crushed if they’re soft shoes) from the extra strain.Foot Pronation

Non Surgical Treatment

No matter what the cause in your case, over pronation can be remedied in several ways. Those who are overweight should consider permanently losing weight to naturally alleviate pressure on the ligaments and heel of the foot. Also, you should consult a podiatrist to examine your posture and movement habits. You may be reinjuring yourself due to poor alignment without even knowing it. If you also have lower back problems, this could be a sign of over pronation as a result of misalignment.

Prevention

Massage and stretch the calves to increase dorsiflexion at the foot/ankle. Dorsiflexion is the bending at the ankle. By improving the dorsiflexion, one will have more flexibility at the ankle, which will allow the foot to over-pronate less. Massage the IT Band with a foam roller or tennis ball to quiet down the tightness throughout this part of the leg. The IT Band attaches from the glute maximus and runs down the side of the leg into the knee area. When the IT Band is tight it will accelerate the force of the leg moving inward, which will cause the foot to move inward as well. It is often that tightness through the IT Band that promotes over-pronation. Decreasing over-pronation, which is very prominent in runners, will help add endurance, speed and efficiency to your run and ultimately place less stress on your body.

What Are The Chief Causes Of Severs Disease?

Overview

Sever?s disease, also known as calcaneal apophysitis, is a common heel problem affecting children. This heel bone disorder is often painful, though it?s usually temporary and causes no long-term health effects. With Sever?s disease, the Achilles tendon repeatedly pulls on the heel?s growth plate, causing microtrauma (i.e. microfractures), inflammation, and swelling in the affected area. Sever?s disease is similar to Osgood-Schlatter disease, which affects the knee. Inappropriate footwear may be a contributing factor in the onset of this condition.

Causes

The more active a child is then the greater the chance of suffering from Sever?s disease. Poor foot function such as flat feet causes the calf and Achilles to work harder and pull on the growth plate leading to Sever?s disease. Tight calves or Achilles is common in growing children and can increase tension on the growth plate.

Symptoms

Sever’s disease usually develops gradually. The pain from Sever’s disease is often intermittent and localized to the area where the Achilles tendon attaches to the calcaneus. Swelling may be noted in this area. There can be tenderness on squeezing the calcaneus or pain when trying to stretch the calf muscles. Occasionally there is night pain. As Sever’s disease progresses there can be continuous pain.

Diagnosis

Sever’s disease is diagnosed based on a doctor?s physical examination of the lower leg, ankle, and foot. If the diagnosis is in question, the doctor may order X-rays or an MRI to determine if there are other injuries that may be causing the heel pain.

Non Surgical Treatment

Resting the foot and applying ice to the affected area are some of the most effective methods when it comes to treating Sever?s Disease. Make sure the ice is always wrapped in a cloth of some sort. Applying ice directly to the skin can cause frostbite. A monitored stretching program of the lower limbs (particularly of the calf muscles) as well as a small heel lift may also be suggested.

Prevention

It is important to undertake correct warm ups and warm downs before and after exercise. This should include a stretching routine. It may be necessary to undertake additional stretching outside of sport, especially during stages of growth. Only playing one sport should be avoided. You should not allow your child to play through pain.

Heel Discomfort

Overview

Foot Pain

Many types of Heel Pain are simply the result of overuse injuries and can easily be avoided. Follow these tips to reduce your chances of heel pain. Wear properly fitting shoes with good arch support. Replace them regularly. Stretch your feet, ankles, and legs before and after you exercise. Avoid walking barefoot on hard surfaces. If your feet hurt, stop what you?re doing. No pain is normal. Keep your weight under control, being overweight or obese can be a significant contributor to heel pain.

Causes

The most common cause of heel pain is plantar fasciitis. Plantar fasciitis is a stretching of the plantar fascia, a ligament that runs from the ball of foot through the arch and is attached to the heel. It is that attachment which becomes aggravated and typically causes pain after being on your feet for lengths of time. Abnormal motion of the foot (pronation) is one cause of plantar fasciitis. Heel spurs, which are abnormal bone growths coming off the heel, can also cause heel pain. Other causes include repetitive stress or shock to the heel, standing for prolonged periods or osteoarthritis.

Symptoms

The symptoms of plantar fasciitis include pain along the inside edge of the heel near the arch of the foot. The pain is worse when weight is placed on the foot especially after a long period of rest or inactivity. This is usually most pronounced in the morning when the foot is first placed on the floor. This symptom called first-step pain is typical of plantar fasciitis. Prolonged standing can also increase the painful symptoms. It may feel better after activity but most patients report increased pain by the end of the day. Pressing on this part of the heel causes tenderness. Pulling the toes back toward the face can be very painful.

Diagnosis

Your GP or podiatrist (a healthcare professional who specialises in foot care) may be able to diagnose the cause of your heel pain by asking about your symptoms and examining your heel and foot. You will usually only need further tests if you have additional symptoms that suggest the cause of your heel pain is not inflammation, such as numbness or a tingling sensation in your foot – this could be a sign of nerve damage in your feet and legs (peripheral neuropathy), your foot feels hot and you have a high temperature (fever) of 38C (100.4F) or above – these could be signs of a bone infection, you have stiffness and swelling in your heel – this could be a sign of arthritis. Possible further tests may include, blood tests, X-rays – where small doses of radiation are used to detect problems with your bones and tissues, a magnetic resonance imaging (MRI) scan or ultrasound scan, which are more detailed scans.

Non Surgical Treatment

The following steps may help relieve your heel pain. Use crutches to take weight off your feet. Rest as much as possible for at least a week. Apply ice to the painful area. Do this at least twice a day for 10 to 15 minutes, more often in the first couple of days. Take acetaminophen or ibuprofen for pain. Wear proper-fitting shoes. Use a heel cup, felt pads in the heel area, or shoe insert. Wear night splints. Your doctor may recommend other treatments, depending on the cause of your heel pain. Call your doctor if your heel pain does not get better after 2 – 3 weeks of home treatment. Also call if your pain is getting worse despite home treatment. Your pain is sudden and severe. You have redness or swelling of your heel. You cannot put weight on your foot.

Surgical Treatment

When a diagnosis of plantar fasciitis is made early, most patients respond to conservative treatment and don?t require surgical intervention. Often, when there is a secondary diagnosis contributing to your pain, such as an entrapped nerve, and you are non-responsive to conservative care, surgery may be considered. Dr. Talarico will discuss all options and which approach would be the most beneficial for your condition.

Prevention

Painful Heel

Maintaining flexible and strong muscles in your calves, ankles, and feet can help prevent some types of heel pain. Always stretch and warm-up before exercising. Wear comfortable, properly fitting shoes with good arch support and cushioning. Make sure there is enough room for your toes.

Just What Could Cause Tendonitis Ache In The Achilles ?

Overview

Achilles TendinitisAchilles tendonitis is inflammation and tendonosis is degeneration and irregular healing of the achilles tendon. The achilles tendon is the large tendon located in the back of the leg that inserts into the heel. The pain caused by achilles tendonitis/osis can develop gradually without a history of trauma. The pain can be a shooting pain, burning pain, or even an extremely piercing pain. Achilles tendonitis/osis should not be left untreated due to the danger that the tendon can become weak and rupture requiring surgery.

Causes

Achilles tendonitis is aggravated by activities that repeatedly stress the tendon, causing inflammation. In some cases even prolonged periods of standing can cause symptoms. In many people who have developed achilles tendonitis, chronic shortening of the gastroc-soleus muscle complex is the reason that home remedies and anti-inflammatory medications fail. In these instances the muscle itself becomes shortened and creates a constant stress at the tendon?s attachment. Like a green branch that is slowly bent, eventually it begins to breakdown. Over a prolonged period the tendon becomes inflamed, and in the worst cases, appears swollen and thickened. In certain circumstances attempts to heal have failed and the body?s inability to heal the tissue results in degenerative changes known as achilles tendonosis. Anti-inflammatory medication, stretching and ice may only provide temporary relief, because they address the inflammation but not the root cause.

Symptoms

Symptoms of Achilles Tendinitis include the following. Pain and stiffness along the Achilles tendon in the morning. Pain along the tendon or back of the heel that worsens with activity. Severe pain the day after exercising. Thickening of the tendon. Bone spur (insertional tendinitis). Swelling that is present all the time and gets worse throughout the day with activity. If you have an Achilles tendon rupture, you might feel a pop or snap, accompanied by a sharp pain behind your ankle. You are likely to have difficulty walking properly. If you have ruptured your Achilles tendon then surgery is likely to be the best treatment option.

Diagnosis

The diagnosis is made via discussion with your doctor and physical examination. Typically, imaging studies are not needed to make the diagnosis. However, in some cases, an ultrasound is useful in looking for evidence of degenerative changes in the tendon and to rule out tendon rupture. An MRI can be used for similar purposes, as well. Your physician will determine whether or not further studies are necessary.

Nonsurgical Treatment

Nonsurgical methods include rest and stop doing activities that cause stress to the tendon. Ice the area by applying ice to the tendon for 15 minutes after exercising. Compress the tendon by using an athletic wrap or surgical tape. Elevate your injury. You can reduce swelling by lying down and raising your foot at a level that is above your heart. Stretch your ankles and calf muscles. Take anti-inflammatory medication (e.g.: ibuprofen to reduce swelling). Wear orthotics and running shoes. Take part in physical therapy.

Achilles Tendinitis

Surgical Treatment

Surgery is considered the last resort and is often performed by an orthopedic surgeon. It is only recommended if all other treatment options have failed after at least six months. In this situation, badly damaged portions of the tendon may be removed. If the tendon has ruptured, surgery is necessary to re-attach the tendon. Rehabilitation, including stretching and strength exercises, is started soon after the surgery. In most cases, normal activities can be resumed after about 10 weeks. Return to competitive sport for some people may be delayed for about three to six months.

Prevention

Suggestions to reduce your risk of Achilles tendonitis include, icorporate stretching into your warm-up and cool-down routines. Maintaining an adequate level of fitness for your sport. Avoid dramatic increases in sports training. If you experience pain in your Achilles tendon, rest the area. Trying to ?work through? the pain will only make your injury worse. Wear good quality supportive shoes appropriate to your sport. If there is foot deformity or flattening, obtain orthoses. Avoid wearing high heels on a regular basis. Maintaining your foot in a ?tiptoe? position shortens your calf muscles and reduces the flexibility of your Achilles tendon. An inflexible Achilles tendon is more susceptible to injury. Maintain a normal healthy weight.

What Is Pain At The Heel

Foot Pain

Overview

Plantar fasciitis is the most common cause of heel pain. It can be caused by inadequate or inappropriate footwear, weight gain, or a particular exercise or activity. It is common for plantar fasciitis symptoms to affect only one foot at a time. Treatment focuses on reducing pain and inflammation. Chronic (long-term) plantar fasciitis can lead to a build-up of bone (a “spur”) at the point where the plantar fascia connects to the heel bone. For this reason plantar fasciitis is sometimes referred to as “heel spur syndrome”.


Causes

You are more likely to develop plantar fasciitis if you are Active, sports that place excessive stress on the heel bone and attached tissue, especially if you have tight calf muscles or a stiff ankle from a previous ankle sprain, which limits ankle movement eg. Running, ballet dancing and aerobics. Overweight. Carrying around extra weight increases the strain and stress on your plantar fascia. Pregnant. The weight gain and swelling associated with pregnancy can cause ligaments to become more relaxed, which can lead to mechanical problems and inflammation. On your feet. Having a job that requires a lot of walking or standing on hard surfaces ie factory workers, teachers and waitresses. Flat Feet or High Foot Arches. Changes in the arch of your foot changes the shock absorption ability and can stretch and strain the plantar fascia, which then has to absorb the additional force. Middle-Aged or Older. With ageing the arch of your foot may begin to sag – putting extra stress on the plantar fascia. Wearing shoes with poor support. Weak Foot Arch Muscles. Muscle fatigue allows your plantar fascia to overstress and cause injury. Arthritis. Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis. Diabetes. Although doctors don’t know why, plantar fasciitis occurs more often in people with diabetes.


Symptoms

Symptoms of plantar fasciitis can occur suddenly or gradually. When they occur suddenly, there is usually intense heel pain on taking the first morning steps, known as first-step pain. This heel pain will often subside as you begin to walk around, but it may return in the late afternoon or evening. When symptoms occur gradually, a more long-lasting form of heel pain will cause you to shorten your stride while running or walking. You also may shift your weight toward the front of the foot, away from the heel.


Diagnosis

Plantar fasciitis is one of many conditions causing “heel pain”. Some other possible causes include nerve compression either in the foot or in the back, stress fracture of the calcaneus, and loss of the fatty tissue pad under the heel. Plantar fasciitis can be distinguished from these and other conditions based on a history and examination done by a physician. It should be noted that heel spurs are often inappropriately thought to be the sole cause of heel pain. In fact, heel spurs are common and are nothing more than the bone’s response to traction or pulling-type forces from the plantar fascia and other muscles in the foot where they attach to the heel bone. They are commonly present in patients without pain, and frequently absent from those who have pain. It is the rare patient who has a truly enlarged and problematic spur requiring surgery.


Non Surgical Treatment

Treatment of plantar fasciitis is sometimes a drawn out and frustrating process. A program of rehabilitation should be undertaken with the help of someone qualified and knowledgeable about the affliction. Typically, plantar fasciitis will require at least six weeks and up to six months of conservative care to be fully remedied. Should such efforts not provide relief to the athlete, more aggressive measures including surgery may be considered. The initial goals of physical therapy should be to increase the passive flexion of the foot and improve flexibility in the foot and ankle, eventually leading to a full return to normal function. Prolonged inactivity in vigorous sports is often the price to be paid for thorough recovery. Half measures can lead to a chronic condition, in some cases severely limiting athletic ability. As a large amount of time is spent in bed during sleeping hours, it is important to ensure that the sheets at the foot of the bed do not constrict the foot, leading to plantar flexion in which the foot is bent straight out with the toes pointing. This constricts and thereby shortens the gastroc complex, worsening the condition. A heating pad placed under the muscles of the calf for a few minutes prior to rising may help loosen tension, increase circulation in the lower leg and reduce pain. Also during sleep, a night splint may be used in order to hold the ankle joint in a neutral position. This will aid in the healing of the plantar fascia and ensure that the foot will not become flexed during the night.

Foot Pain


Surgical Treatment

In cases that do not respond to any conservative treatment, surgical release of the plantar fascia may be considered. Plantar fasciotomy may be performed using open, endoscopic or radiofrequency lesioning techniques. Overall, the success rate of surgical release is 70 to 90 percent in patients with plantar fasciitis. Potential risk factors include flattening of the longitudinal arch and heel hypoesthesia as well as the potential complications associated with rupture of the plantar fascia and complications related to anesthesia.


Stretching Exercises

While it’s typical to experience pain in just one foot, massage and stretch both feet. Do it first thing in the morning, and three times during the day. Achilles Tendon Stretch. Stand with your affected foot behind your healthy one. Point the toes of the back foot toward the heel of the front foot, and lean into a wall. Bend the front knee and keep the back knee straight, heel firmly planted on the floor. Hold for a count of 10. Plantar Fascia Stretch. Sit down, and place the affected foot across your knee. Using the hand on your affected side, pull your toes back toward your shin until you feel a stretch in your arch. Run your thumb along your foot–you should feel tension. Hold for a count of 10.

What Is Plantar Fasciitis

Heel Discomfort

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

The plantar fascia is designed to absorb the high stresses and strains we place on our feet. But, sometimes, too much pressure damages or tears the tissues. The body’s natural response to injury is inflammation, which results in the heel pain and stiffness of plantar fasciitis.


Symptoms

Plantar fasciitis typically causes a stabbing pain in the bottom of your foot near the heel. The pain is usually worst with the first few steps after awakening, although it can also be triggered by long periods of standing or getting up from a seated position.


Diagnosis

Physical examination is the best way to determine if you have plantar fasciitis. Your doctor examines the affected area to determine if plantar fasciitis is the cause of your pain. The doctor may also examine you while you are sitting, standing, and walking. It is important to discuss your daily routine with your doctor. An occupation in which you stand for long periods of time may cause plantar fasciitis. An X-ray may reveal a heel spur. The actual heel spur is not painful. The presence of a heel spur suggests that the plantar fascia has been pulled and stretched excessively for a long period of time, sometimes months or years. If you have plantar fasciitis, you may or may not have a heel spur. Even if your plantar fasciitis becomes less bothersome, the heel spur will remain.


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.

Foot Pain


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

There are certain things that you can do to try to prevent plantar fasciitis, especially if you have had it before. These include regularly changing training shoes used for running or walking. Wearing shoes with good cushioning in the heels and good arch support. Losing weight if you are overweight. Regularly stretching the plantar fascia and Achilles tendon, especially before exercise. Avoiding exercising on hard surfaces.