What Can Cause Pain At The Heel

Overview

Plantar fasciitis is an inflammation of the structures (of the plantar fascia) on the sole of the foot. The inflammation is caused by excess pressure on the structures on the sole of the foot. The plantar fascia becomes inflamed and tiny rips can occur where it attaches into the inside of the heel bone. It tends to be most painful first thing in the morning, or when standing up after sitting for a while. The area becomes inflamed and swollen, and it is the increase in fluid to the area that accumulates when weight is taken off the area, that then causes the pain on standing. Plantar Fasciitis usually starts gradually with pain on standing after rest. Pain is usually located under the heel or to the inside of the heel. Pain is usually at its worst on standing first thing in the morning. The pain will begin to ease once you get moving. Pain in the early stages tends to occur after activity rather than during activity. As plantar fasciitis continues the pain can become more constant and can then start to affect the way you walk.




Causes

Plantar fasciitis is a painful disorder in the lower part of your foot usually around the heel. That pain usually hurts as you get up in the morning when you try to stand on your feet, or after any periods of inactivity. It is a disorder of a tough and strong band that connects the heel bone to the toes. Plantar Fasciitis is caused by injuring that tough band on the bottom of the foot. The following may be the causes of plantar fasciitis. Tight calf muscles or tight Achilles tendon produces repetitive over-stretching of the plantar fascia. Gait and balance Problem may be a dominant cause of this disorder. Many people have a special style of walking, with something unique that causes some kind of imbalance in their body. It might be something like locked knees, feet that turn-out, a weak abdomen etc. This imbalance may place some pressure on the fascia, which eventually causes plantar fasciitis. Weak foot muscles don’t give enough support to the plantar fascia. The small muscles in the foot give the foot its shape by keeping the bones in place and by expanding and contracting to make a movement. Weak foot muscles will allow greater stress on the fascia. Foot anatomical problems such as flat feet or high arches can make the fascia ligament work or stretch abnormally. Flattening of the fat pad at the sole of the feet under the heels is a Degeneration process that is caused by poor footwear or by age. Shoes that have no proper heel cup can flatten that fat pad quite quickly and cause this disorder. Walking in shoes which do not have good arch support is considered to be a cause of plantar fasciitis. Wearing inadequate or worn out shoes may place more stress on the fascia ligament. If you wear shoes that don't fit you by size or width, you may put your feet under excessive stress. Overweight Men and women are more vulnerable to developing the condition because of the excess weight on the foot. Pregnant women are at risk due to gaining weight through pregnancy and due to the pregnancy hormones that make ligaments loosen and relax. Sudden increase of activity like starting to run long distance or complete change of daily activity can cause heel pain and this disorder. Practice of repetitive athletic activities, like long distance running, playing a ball game, dancing or jumping, is a common cause for the disorder. Actually it is considered as one of the most common running injuries. Spending long periods of time on your feet everyday can cause plantar fasciitis. Working on your feet a few hours a day evey day may be the reason for your heel pain.




Symptoms

Patients with plantar fasciitis typically experience pain underneath the heel and along the inner sole of the foot. In less severe cases, patients may only experience an ache or stiffness in the plantar fascia or heel that increases with rest (typically at night or first thing in the morning) following activities which place stress on the plantar fascia. These activities typically include standing, walking or running excessively (especially up hills, on uneven surfaces or in poor footwear such as thongs), jumping, hopping and general weight bearing activity. The pain associated with this condition may also warm up with activity in the initial stages of injury. As the condition progresses, patients may experience symptoms that increase during sport or activity, affecting performance. In severe cases, patients may walk with a limp or be unable to weight bear on the affected leg. Patients with this condition may also experience swelling, tenderness on firmly touching the plantar fascia (often on a specific spot on the inner aspect of the heel) and sometimes pain on performing a plantar fascia stretch.




Diagnosis

Plantar fasciitis is usually diagnosed by a health care provider after consideration of a person’s presenting history, risk factors, and clinical examination. Tenderness to palpation along the inner aspect of the heel bone on the sole of the foot may be elicited during the physical examination. The foot may have limited dorsiflexion due to tightness of the calf muscles or the Achilles tendon. Dorsiflexion of the foot may elicit the pain due to stretching of the plantar fascia with this motion. Diagnostic imaging studies are not usually needed to diagnose plantar fasciitis. However, in certain cases a physician may decide imaging studies (such as X-rays, diagnostic ultrasound or MRI) are warranted to rule out other serious causes of foot pain. Bilateral heel pain or heel pain in the context of a systemic illness may indicate a need for a more in-depth diagnostic investigation. Lateral view x-rays of the ankle are the recommended first-line imaging modality to assess for other causes of heel pain such as stress fractures or bone spur development. Plantar fascia aponeurosis thickening at the heel greater than 5 millimeters as demonstrated by ultrasound is consistent with a diagnosis of plantar fasciitis. An incidental finding associated with this condition is a heel spur, a small bony calcification on the calcaneus (heel bone), which can be found in up to 50% of those with plantar fasciitis. In such cases, it is the underlying plantar fasciitis that produces the heel pain, and not the spur itself. The condition is responsible for the creation of the spur though the clinical significance of heel spurs in plantar fasciitis remains unclear.




Non Surgical Treatment

About 90% of plantar fasciitis cases are self-limited and will improve within six months with conservative treatment and within a year regardless of treatment. Many treatments have been proposed for the treatment of plantar fasciitis. First-line conservative approaches include rest, heat, ice, calf-strengthening exercises, techniques to stretch the calf muscles, achilles tendon, and plantar fascia, weight reduction in the overweight or obese, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. NSAIDs are commonly used to treat plantar fasciitis, but fail to resolve the pain in 20% of people. Extracorporeal shockwave therapy (ESWT) is an effective treatment modality for plantar fasciitis pain unresponsive to conservative nonsurgical measures for at least three months. Corticosteroid injections are sometimes used for cases of plantar fasciitis refractory to more conservative measures. The injections may be an effective modality for short-term pain relief up to one month, but studies failed to show effective pain relief after three months. Notable risks of corticosteroid injections for plantar fasciitis include plantar fascia rupture, skin infection, nerve or muscle injury, or atrophy of the plantar fat pad. Custom orthotic devices have been demonstrated as an effective method to reduce plantar fasciitis pain for up to 12 weeks. Night splints for 1-3 months are used to relieve plantar fasciitis pain that has persisted for six months. The night splints are designed to position and maintain the ankle in a neutral position thereby passively stretching the calf and plantar fascia overnight during sleep. Other treatment approaches may include supportive footwear, arch taping, and physical therapy.






Surgical Treatment

Most studies indicate that 95% of those afflicted with plantar fasciitis are able to relieve their heel pain with nonsurgical treatments. If you are one of the few people whose symptoms don't improve with other treatments, your doctor may recommend plantar fascia release surgery. Plantar fascia release involves cutting part of the plantar fascia ligament in order to release the tension and relieve the inflammation of the ligament. Overall, the success rate of surgical release is 70 to 90 percent in patients with plantar fasciitis. While the success rate is very high following surgery, one should be aware that there is often a prolonged postoperative period of discomfort similar to the discomfort experienced prior to surgery. This pain usually will abate within 2-3 months. One should always be sure to understand all the risks associated with any surgery they are considering.