What Is Pain Under The Heel And Simple Methods To Alleviate It

Heel Discomfort

Overview

Plantar fasciitis is a common cause of heel pain in adults. The disorder classically presents with pain that is particularly severe with the first few steps taken in the morning. In general, plantar fasciitis is a self-limited condition. However, symptoms usually resolve more quickly when the interval between the onset of symptoms and the onset of treatment is shorter. Many treatment options exist, including rest, stretching, strengthening, change of shoes, arch supports, orthotics, night splints, anti-inflammatory agents and surgery. Usually, plantar fasciitis can be treated successfully by tailoring treatment to an individual’s risk factors and preferences.


Causes

Plantar fasciitis generally occurs over time, rather than being the result of a single event. Micro trauma from repetitive stress to the tissue often combines with a biomechanical deficiency of the foot to produce the condition. In addition, arthritic and metabolic factors may contribute to the development of this injury, (though they are unlikely to affect young athletes). A variety of training errors commonly lead to plantar fasciitis, particularly a rapid increase in either volume or intensity of athletic activity. Volume refers to the distance or time an athlete performs, while intensity refers to the pace of activity and/or the recovery time allowed following performance.


Symptoms

When a patient has plantar fasciitis, the connective tissue that forms the arch of the foot becomes inflamed (tendonitis) and degenerative (tendinosis)–these abnormalities cause plantar fasciitis and can make normal activities quite painful. Symptoms of plantar fasciitis are typically worsened early in the morning after sleep. At that time, the arch tissue is tight and simple movements stretch the contracted tissue. As you begin to loosen the foot, the pain usually subsides, but often returns with prolonged standing or walking.


Diagnosis

A physical exam performed in the office along with the diagnostic studies as an x-ray. An MRI may also be required to rule out a stress fracture, or a tear of the plantar fascia. These are conditions that do not normally respond to common plantar fasciitis treatment.


Non Surgical Treatment

Treatment initially involves offloading the plantar fascia by aoiding aggravating factors, such as running. Taping, this can work very well to alleviate pain, and can be almost immediate. It isn’t a long-term solution, but can relieve symptoms in the beginning. Using a night splint to stretch the calf, so that less load is placed on the plantar fascia (if tightness in the calf is a factor). Using a gel heel cup, this can act to increase shock absorption, and by raising the heel there is also less stretch on the calf. So, temporarily, this may relieve pain in someone who has a tight calf. Massage, but this depends if the plantarfascia is actually tight or just painful. If it is tight, then massage can temporarily relieve the pain, but if it is irritated then taping and corrective footwear is preferable.

Plantar Fascia


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.

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