Great Well Being

HEEL PAIN INTRODUCTION

The most common cause of heel pain is plantar fasciitis which is commonly referred to as a heel spur. Plantar fascia is a broad band of fibrous tissue which runs along the bottom surface of the foot, from the heel to the toes. Plantar fasciitis is a condition in which this plantar fascia is inflamed. This condition can be very painful and cause considerable amount of suffering. Long standing inflammation causes the deposition of calcium at the point where the plantar fascia inserts into the heel. This results in the appearance of a sharp thorn like heel spur on x-ray. The heel spur is Asymptomatic (not painful) the pain arises from the inflammation of the plantar fascia.

APPEARANCE OF A HEEL SPUR

• There will no visible signs of plantar fasciitis, swelling and redness is minimal.

• However, careful observation will reveal flattening of the arch when the patient is standing.

SYMPTOMS OF HEEL PAIN

• A dull ache is felt most of the time with episodes of a sharp pain in the center of the heel or on the inside margin of the heel.

• Often the pain is worse on first rising in the morning and after rest.

• It may severely limit activities.

• Aggravated by prolonged weight bearing & thin soled shoes.

• The patient may also complain of shootings pains.

CAUSES OF HEEL PAIN

• Excessive load on the foot from obesity is a major cause of plantar fasciitis. That is why this condition is most common in middle aged and over weight adults. The plantar fascia is not able to withstand excessive pressure.

• A sudden increase in weight, such as pregnancy can also lead to heel pain.

• A sudden increase in walking or a sporting activity can also be a contributing factor. A classical example is a post man who returned to work after a period away from the job can develop this condition.

• A tight plantar fascia (this is often caused by tight calf muscles).

• Excessive flattening of the arch on weight bearing.

• Biomechanical problems (walking abnormalities) are a major cause of plantar fasciitis.

• Different type of arthritis can also lead to this condition such as osteoarthritis and rheumatoid arthritis.

WHAT YOU CAN DO FOR HEEL PAIN

• Rest the affected area as much as possible. This will allow the inflammation to subside.

• Wear a supportive shoe with a stiff heel counter, a shock absorbing sole and a good arch. A well made running shoe is ideal for a patient who suffers from plantar fasciitis.

• Application of ice to the heel area after prolonged activity will help to minimize the inflammation.

• A silicone heel cup and other silicone devices can help cure heel pain.

• A shoe with a moderately high heel may relieve pressure from the painful symptoms.

• Over the counter medications such ibuprofen may be of benefit.

• Calf stretching exercises can help to alleviate the pain associated with plantar fascitus.

Below are three exercises that can help to take stress away from the plantar fascia and help to relieve heel pain. Choose the appropriate exercise depending on your health, age and maneuverability. If you have any queries please consult your family doctor before attempting any exercise.

To stretch the calf muscle, this is the muscle that runs along the back of the leg from the knee to the ankle:

1. CALF STRETCH

Get in a push up position, but put one knee on the ground.
Put your weight on the toes of your other foot and then push the heel down until you feel a slight pull.
Hold that position for a count of 10.
Relax and repeat three times with each leg.

2. CALF RAISE

This stretch is used to strengthen the lower leg and ankle. Stand with your hands on your hips, or on the back of a chair for balance.
Spread your feet 6 to 12 inches apart and slowly raise your body up on the toes, lifting the heels.
Return to the starting position, and repeat 10 to 15 times.

3. THE LUNGE

This exercise is suitable for stretching both calf muscles. The gastrocnemius (the main muscle in the calf region) is stretched by keeping the heel of the back leg on the ground. The front leg goes well forward, keep your balance; stay tall and in this upright position, lean forward until the stretch is felt on the straight back leg. “Placing the front foot flat on a chair, the soleus (the smaller muscle in the calf) can be given an extra stretch. Push the bent knee forward with the hands until the muscle starts to feel a little tight.

WHAT YOU SHOULD NOT DO FOR HEEL PAIN

• Do not attempt any stretching of the plantar fascia when the heel is sore as it can lead to a increase in pain from the condition

WHAT THE CHIROPODIST WILL DO FOR HEEL PAIN

• Once a positive diagnosis has been established (x-rays may be required). The chiropodist will endeavor to treat the underlying condition. The correction of a Biomechanical complaint may be necessary.

• The chiropodist may apply tapping and padding to relieve the strain on the plantar fascia.

• Ultra sound and laser therapy is proven to be highly successful in combating plantar fasciitis.

• It may necessary to prescribe anti-inflammatory medication or inject anti-inflammatory medication such as hydrocortisone to calm the inflammation around the heel.

• The chiropodist will encourage the patient to stretch the tissue at the bottom of the foot. Three times a day, the patients sits with his/hers legs extended and loops a belt, scarf or towel around the forefoot. Then the patient pulls the forefoot towards the upper leg for about 30 seconds in a hold position. This should be repeated 3 times, quite easy to remember, 30 seconds for 3 repetitions! However, this exercise may only benefit certain individuals, therefore, it is essential to seek advice from a chiropodist before starting such an exercise routine.

• He or she may advise heel pain products such as a silicone heel cup to stop the heel pain.

• If conservative methods are not successful then the surgical release of the plantar fascia may be necessary.

REVIEW OF TREATMENT OPTIONS

Orthotics- One of the most effective treatment options.

Silicone Heel Cups- Treats morning heel pain and provides excellent support and pain relief.
Reusable Hot and Cold Gel Packs- Proven therapy for plantar fasciitis by alternating application of heat and cold coupled with massage works wonders to relieve pain, reduce swelling and promote healing. Use ice pack in morning and heat pack in the evening.

Plantar Fascia Night splints- Immobilize and stretch fascia, can be effective if used for several weeks.

Stretching exercises for plantar fascia and Achilles tendon - Can provide effective results if combined with other treatment options.

Ultrasound and Lasers- Found to have little or no benefit.

Extracorporeal shock wave therapy (ESWT)- Their are differing views about the safety and effectiveness of this treatment.

NSAIDs (Non Steroidal Anti-Inflammatory Drugs)- These treat the symptoms and provide temporary relief but do not treat the underlying cause. Observe usual cautions and contraindications as these can have long term implications on your health.
Steroid/local anesthetic injection- Not one of our preferred treatment options.

Surgery- ‘Open’ or endoscopic plantar fascia release. No good evidence of effectiveness, and complications include increased pain, nerve injury, fascial rupture and infection. May need to consider in resistant cases after trying night splints and a walking brace.

OTHER CONDITIONS THAT CAUSE HEEL PAIN

• Various types of arthritis

• Inflammation of the tendons around the heel

• Trauma to the heel.

The treatment for heel pain due to plantar fasciitis is a two fold process. You have to heal the inflamed tissue where the plantar fascia attaches to the heel. As the inflamed tissue is healing it is important to also correct the problem that initially caused the plantar fasciitis and the heel pain.
The healing of the inflamed plantar fascia is accomplished by healing the inflamed tissue and correcting the cause. First of all you should start some type of anti-inflammatory medication such as Motrin® or Aleve®. Tylenol® may reduce pain but does not have anti-inflammatory properties. Applying ice to the heel will also reduce some of the inflammation. In addition some doctors prescribe what is called a dorsal night splint to heal the plantar fascia. The dorsal night splint is worn on the lower leg at night. The idea is to use the splint to hold the foot slightly flexed up toward your head as you sleep. This allows the plantar fascia to heal in a stretched out position so that the first steps in the morning do not break away the newly healed tissue.

As the plantar fascia begins healing it is essential that the problem which caused the heel pain is corrected. Most heel pain is the result of a biomechanical problem that causes excessive pronation (excessive flattening of the arch) and thus excessive stretching of the plantar fascia. The excessive pronation can be corrected with an arch support. The over the counter cushioning devices are helpful to reduce the pain, help calm things down a bit and allow the healing to start but in order to prevent the heel pain from returning you have to correct the faulty biomechanics. This usually requires a custom arch support. Custom arch supports will be made to match the exact contour of your foot. The custom arch support will limit the pronation, reduce stretch on the plantar fascia, reduce the heel pain and allow the heel to heal.