What Is Painful Heel

Feet Pain


Overview


The plantar fascia is a band of connective tissue on the bottom of the foot that helps form the arch of the foot. Acute injury or cumulative trauma to the plantar fascia can be a cause of inflammation and heel pain. This is called plantar fasciitis.






Causes


Plantar fasciitis is caused by drastic or sudden increases in mileage, poor foot structure, and inappropriate running shoes, which can overload the plantar fascia, the connective tissue that runs from the heel to the base of the toes. The plantar fascia may look like a series of fat rubber bands, but it's made of collagen, a rigid protein that's not very stretchy. The stress of overuse, overpronation, or overused shoes can rip tiny tears in it, causing pain and inflammation, a.k.a. plantar fasciitis.






Symptoms


Plantar fasciitis commonly causes a stabbing pain in the heel of the foot, which is worse during the first few steps of the day after awakening. As you continue to walk on the affected foot, the pain gradually lessens. Usually, only one foot is affected, but it can occur in both feet simultaneously.






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


Give your painful heel lots of rest. You may need to stay completely off your foot for several days when the pain is severe. Your healthcare provider may recommend or prescribe anti-inflammatory medicines, such as aspirin or ibuprofen. These drugs decrease pain and inflammation. Adults aged 65 years and older should not take non-steroidal anti-inflammatory medicine for more than 7 days without their healthcare provider’s approval. Resting your heel on an ice pack for a few minutes several times a day can also help. Try to cushion your foot. You can do this by wearing athletic shoes, even at work, for awhile. Heel cushions can also be used. The cushions should be worn in both shoes. They are most helpful if you are overweight or an older adult. Your provider may recommend special arch supports or inserts for your shoes called orthotics, either custom-made or off the shelf. These supports can be particularly helpful if you have flat feet or high arches. Your provider may recommend an injection of a cortisone-like medicine. Lose weight if needed. A night splint may be recommended. This will keep the plantar fascia stretched while you are sleeping. Physical therapy for additional treatments may be recommended. Surgery is rarely needed.


Foot Pain






Surgical Treatment


Like every surgical procedure, plantar fasciitis surgery carries some risks. Because of these risks your doctor will probably advise you to continue with the conventional treatments at least 6 months before giving you approval for surgery. Some health experts recommend home treatment as long as 12 months. If you can’t work because of your heel pain, can’t perform your everyday activities or your athletic career is in danger, you may consider a plantar fasciitis surgery earlier. But keep in mind that there is no guarantee that the pain will go away completely after surgery. Surgery is effective in many cases, however, 20 to 25 percent of patients continue to experience heel pain after having a plantar fasciitis surgery.


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