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What Is Painful Heel

Plantar Fascitis

Overview

A common condition that affects people of all ages. Symptoms include heel pain that is worse upon arising in the morning or standing after prolonged sitting. The pain is caused by inflammation of the plantar fascia, the ligament that connects the heel bone to the toes.




Causes

Causes can be by one or a combination of foot activity overloads. Jogging, climbing, or walking for extended periods puts too much stress on the plantar fascia. But even routine, non-athletic activities such as moving heavy furniture can set off pain. Some kinds of arthritis are also attributed to plantar fasciitis. Certain arthritic conditions cause the tendons of the heel to swell. Diabetes is also a culprit- there is still no explanation why, but studies have repeatedly shown that diabetics are more prone to developing plantar fasciitis. In some cases, plantar fasciitis is triggered by shoes of poor quality or shoes that do not fit. Those with thin soles, no arch support, and no shock-absorbing properties, for example, do not five feet enough protection. Shoes that are too tight and those with very high heels can also cause the Achilles tendon to tighten, straining the tissue surrounding the heels.




Symptoms

Symptoms of plantar fasciitis include pain in the heel of the foot. Some people complain of a sharp stabbing pain especially with walking. Others describe the pain as a dull ache after prolonged standing. The pain of plantar fasciitis is often worst in the morning or following activity.




Diagnosis

A health care professional will ask you whether you have the classic symptoms of first-step pain and about your activities, including whether you recently have intensified your training or changed your exercise pattern. Your doctor often can diagnose plantar fasciitis based on your history and symptoms, together with a physical examination. If the diagnosis is in doubt, your doctor may order a foot X-ray, bone scan or nerve conduction studies to rule out another condition, such as a stress fracture or nerve problem.




Non Surgical Treatment

Most doctors recommend an initial six- to eight-week program of conservative treatment, including Rest, balanced with stretching exercises to lengthen the heel cord and plantar fascia. Ice massage to the bottom of the foot after activities that trigger heel pain. Avoidance of walking barefoot or wearing slippers or sandals that provide little arch support. A temporary switch to swimming and/or bicycling instead of sports that involve running and jumping. Shoes with soft heels and insoles. Taping the bottom of the injured foot. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin and other brand names), or acetaminophen (Tylenol) for pain. Physical therapy using ultrasound, electrical stimulation with corticosteroids or massage techniques. If this conservative treatment does not help, your doctor may recommend that you wear a night splint for six to eight weeks. While you sleep, the night splint will keep your foot in a neutral or slightly flexed (bent) position to help maintain the normal stretch of the plantar fascia and heel cord. If the night splint doesn't work, your doctor may inject corticosteroid medication into the painful area or place your foot in a short leg cast for one to three months. Shock wave therapy, in which focused sound energy is applied to the sore heel, may be recommended for plantar fasciitis. The shock waves are intended to irritate or injure the plantar fascia to promote healing. The overall benefit of this approach is uncertain. Other therapies that have been tried include radiation therapy and botulinum toxin injections. But their effectiveness is unclear. If all else fails, your doctor may suggest surgery. But this is rare, and surgery is not always successful.

Plantar Fascitis




Surgical Treatment

More invasive procedures to treat plantar fasciitis are usually sought only after other treatment has failed to produce favorable results. Corticosteroid injections deliver medicine into the injured fascia to reduce pain. However, this treatment may weaken the plantar fascia and result in further damage. In addition, extracorporeal shock wave therapy (ESWT) is a treatment where sound waves are sent through the damaged tissue in order to stimulate the damaged tissue and encourage healing. This method is relatively new in treating plantar fasciitis and your doctor will be able to tell you if it is the right method for you. Lastly, surgery is the last option for those suffering from chronic or severe plantar fasciitis.




Stretching Exercises

Calf stretch. Lean forward against a wall with one knee straight and the heel on the ground. Place the other leg in front, with the knee bent. To stretch the calf muscles and the heel cord, push your hips toward the wall in a controlled fashion. Hold the position for 10 seconds and relax. Repeat this exercise 20 times for each foot. A strong pull in the calf should be felt during the stretch. Plantar fascia stretch. This stretch is performed in the seated position. Cross your affected foot over the knee of your other leg. Grasp the toes of your painful foot and slowly pull them toward you in a controlled fashion. If it is difficult to reach your foot, wrap a towel around your big toe to help pull your toes toward you. Place your other hand along the plantar fascia. The fascia should feel like a tight band along the bottom of your foot when stretched. Hold the stretch for 10 seconds. Repeat it 20 times for each foot. This exercise is best done in the morning before standing or walking.
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