Overview
Heel pain is common and has many causes. Typically, these problems are easily solved by rest or simple exercises. Pain may occur in two places - beneath or under the heel. Inflammation of tissues on the foot?s bottom produces pain beneath the heel. Common causes include bruises, injury to tissue connecting toes and heel bone (referred to as plantar fasciitis), or calcium deposits resulting from extended plantar fasciitis. Under-the-heel pain comes from inflammation where the Achilles tendon meets the heel bone.
Causes
Near the inflamed plantar fascia attachment, but not in it, some extra bone may form, producing a small "spur". In fact, it is a shelf of bone, not a sharp spur. These "heel spurs" are commoner in people with plantar fascitis, but they can be found in people with no heel pain. The heel spur is caused by the same process as the heel pain, but the spur is not itself the cause of the pain.
Symptoms
Pain typically comes on gradually, with no injury to the affected area. It is frequently triggered by wearing a flat shoe, such as flip-flop sandals. Flat footwear may stretch the plantar fascia to such an extent that the area becomes swollen (inflamed). In most cases, the pain is under the foot, toward the front of the heel. Post-static dyskinesia (pain after rest) symptoms tend to be worse just after getting out of bed in the morning, and after a period of rest during the day. After a bit of activity symptoms often improve a bit. However, they may worsen again toward the end of the day.
Diagnosis
A biomechanical exam by your podiatrist will help reveal these abnormalities and in turn resolve the cause of plantar fasciitis. By addressing this cause, the patient can be offered a podiatric long-term solution to his problem.
Non Surgical Treatment
Treating plantar fasciitis in the early stages usually allows for a quicker recovery. Left untreated, this condition can progress to the point where there is pain with each and every step. This typically means a return to a pain free day will take much longer. Initial treatments are aimed at reducing stress on the fascia so it can begin to heal. Also, treatment to reduce the associated inflammation is started. These treatments often include: ice therapy, anti-inflammatory medications, stretching exercises, wearing shoes with appropriate support, taping of the foot and the use of a night splint. If these interventions do not lead to a full resolution, custom shoe inserts, cortisone injections and additional treatment by a physical therapist are often utilized. For patients that fail to respond to all of these efforts, surgical release of the plantar fascia can be a very effective course of action. The good news is this: 95% of the time plantar fasciitis can be fully resolved without the need for surgery. High energy shock wave therapy, sometimes referred to as orthotripsy, is a relatively new treatment that has been shown to be effective 70% of the time in patients that continue to have pain despite extensive non-surgical treatment.
Surgical Treatment
Extracorporeal shockwave therapy (EST) is a fairly new type of non-invasive treatment. Non-invasive means it does not involve making cuts into your body. EST involves using a device to deliver high-energy soundwaves into your heel. The soundwaves can sometimes cause pain, so a local anaesthetic may be used to numb your heel. It is claimed that EST works in two ways. It is thought to have a "numbing" effect on the nerves that transmit pain signals to your brain, help stimulate and speed up the healing process. However, these claims have not yet been definitively proven. The National Institute for Health and Care Excellence (NICE) has issued guidance about the use of EST for treating plantar fasciitis. NICE states there are no concerns over the safety of EST, but there are uncertainties about how effective the procedure is for treating heel pain. Some studies have reported that EST is more effective than surgery and other non-surgical treatments, while other studies found the procedure to be no better than a placebo (sham treatment).
heel pads shoes too big
Prevention
Preventing heel pain is crucial to avoid pain that can easily interrupt a busy or active lifestyle. Athletes can prevent damage by stretching the foot and calf both before and after an exercise routine. The plantar fascia ligament can be stretched by using a tennis ball or water bottle and rolling it across the bottom of the foot. With regular stretching, the stretching and flexibility of tissue through the foot can be significantly improved, helping to prevent damage and injury. Athletes should also ease into new or more difficult routines, allowing the plantar fascia and other tissue to become accustomed to the added stress and difficulty. Running up hills is also common among athletes in their routines. However, this activity should be reduced since it places an increased amount of stress on the plantar fascia and increases the risk of plantar fasciitis. Maintaining a healthy weight is also an essential heel pain prevention technique. Obesity brings additional weight and stress on the heel of the foot, causing damage and pain in the heel as well as in other areas of the foot.
Heel pain is common and has many causes. Typically, these problems are easily solved by rest or simple exercises. Pain may occur in two places - beneath or under the heel. Inflammation of tissues on the foot?s bottom produces pain beneath the heel. Common causes include bruises, injury to tissue connecting toes and heel bone (referred to as plantar fasciitis), or calcium deposits resulting from extended plantar fasciitis. Under-the-heel pain comes from inflammation where the Achilles tendon meets the heel bone.
Causes
Near the inflamed plantar fascia attachment, but not in it, some extra bone may form, producing a small "spur". In fact, it is a shelf of bone, not a sharp spur. These "heel spurs" are commoner in people with plantar fascitis, but they can be found in people with no heel pain. The heel spur is caused by the same process as the heel pain, but the spur is not itself the cause of the pain.
Symptoms
Pain typically comes on gradually, with no injury to the affected area. It is frequently triggered by wearing a flat shoe, such as flip-flop sandals. Flat footwear may stretch the plantar fascia to such an extent that the area becomes swollen (inflamed). In most cases, the pain is under the foot, toward the front of the heel. Post-static dyskinesia (pain after rest) symptoms tend to be worse just after getting out of bed in the morning, and after a period of rest during the day. After a bit of activity symptoms often improve a bit. However, they may worsen again toward the end of the day.
Diagnosis
A biomechanical exam by your podiatrist will help reveal these abnormalities and in turn resolve the cause of plantar fasciitis. By addressing this cause, the patient can be offered a podiatric long-term solution to his problem.
Non Surgical Treatment
Treating plantar fasciitis in the early stages usually allows for a quicker recovery. Left untreated, this condition can progress to the point where there is pain with each and every step. This typically means a return to a pain free day will take much longer. Initial treatments are aimed at reducing stress on the fascia so it can begin to heal. Also, treatment to reduce the associated inflammation is started. These treatments often include: ice therapy, anti-inflammatory medications, stretching exercises, wearing shoes with appropriate support, taping of the foot and the use of a night splint. If these interventions do not lead to a full resolution, custom shoe inserts, cortisone injections and additional treatment by a physical therapist are often utilized. For patients that fail to respond to all of these efforts, surgical release of the plantar fascia can be a very effective course of action. The good news is this: 95% of the time plantar fasciitis can be fully resolved without the need for surgery. High energy shock wave therapy, sometimes referred to as orthotripsy, is a relatively new treatment that has been shown to be effective 70% of the time in patients that continue to have pain despite extensive non-surgical treatment.
Surgical Treatment
Extracorporeal shockwave therapy (EST) is a fairly new type of non-invasive treatment. Non-invasive means it does not involve making cuts into your body. EST involves using a device to deliver high-energy soundwaves into your heel. The soundwaves can sometimes cause pain, so a local anaesthetic may be used to numb your heel. It is claimed that EST works in two ways. It is thought to have a "numbing" effect on the nerves that transmit pain signals to your brain, help stimulate and speed up the healing process. However, these claims have not yet been definitively proven. The National Institute for Health and Care Excellence (NICE) has issued guidance about the use of EST for treating plantar fasciitis. NICE states there are no concerns over the safety of EST, but there are uncertainties about how effective the procedure is for treating heel pain. Some studies have reported that EST is more effective than surgery and other non-surgical treatments, while other studies found the procedure to be no better than a placebo (sham treatment).
heel pads shoes too big
Prevention
Preventing heel pain is crucial to avoid pain that can easily interrupt a busy or active lifestyle. Athletes can prevent damage by stretching the foot and calf both before and after an exercise routine. The plantar fascia ligament can be stretched by using a tennis ball or water bottle and rolling it across the bottom of the foot. With regular stretching, the stretching and flexibility of tissue through the foot can be significantly improved, helping to prevent damage and injury. Athletes should also ease into new or more difficult routines, allowing the plantar fascia and other tissue to become accustomed to the added stress and difficulty. Running up hills is also common among athletes in their routines. However, this activity should be reduced since it places an increased amount of stress on the plantar fascia and increases the risk of plantar fasciitis. Maintaining a healthy weight is also an essential heel pain prevention technique. Obesity brings additional weight and stress on the heel of the foot, causing damage and pain in the heel as well as in other areas of the foot.