What Is Heel DiscomfortPosted: January 13, 2015
To find out where this condition gets its name, we need to look at a specific area of the foot. Your foot is made up of bones, muscles, tendons, and ligaments. The plantar fascia is a relatively inflexible, strong, fibrous band on the bottom of the foot that supports the arch of your foot. Beginning at the heel bone, the plantar fascia extends the length of your foot to connect with your toes at the ball of the foot. When you walk, your weight is distributed across your feet. Any imbalances in the mechanics of your foot and distribution of weight can potentially cause pain. Diseases involving inflammation end with “itis.” This explains the name of the condition as being an inflammation of the plantar fascia, thus plantar fasciitis. Repetitive movements such as walking or running stretch the plantar fascia. Because it is not very flexible, this can cause small tears in the fascia, which leads to inflammation and pain. Other factors such as high arches, fallen arches, or a change in the walking surface contribute to the stress placed on the plantar fascia and heel.
Plantar fasciitis is caused by small, repetitive trauma to the plantar fascia. This trauma can be due to activity that puts extra stress on the foot. Plantar fasciitis is most common in people who are 40-60 years old. Other risk factors that increase your chance of getting plantar fasciitis include physical exertion, especially in sports such as running, Volleyball, tennis, a sudden increase in exercise intensity or duration, physical activity that stresses the plantar fascia. People who spend a lot of time standing, a sudden increase in activities that affect the feet, obesity or weight gain, pre-existing foot problems, including an abnormally tight Achilles tendon, flat feet, or an ankle that rolls inward too much. Poor footwear. Heel spurs.
The main symptom of plantar fasciitis is heel pain when you walk. You may also feel pain when you stand and possibly even when you are resting. This pain typically occurs first thing in the morning after you get out of bed, when your foot is placed flat on the floor. The pain occurs because you are stretching the plantar fascia. The pain usually lessens with more walking, but you may have it again after periods of rest. You may feel no pain when you are sleeping because the position of your feet during rest allows the fascia to shorten and relax.
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
There are several things you can do to self-treat your heel or arch pain. The first thing is to wear better shoes and consider adding arch supports or custom foot orthotics to your shoes. Stretching the calf muscles can also often be helpful. Try to stretch when you first get up in the morning and before you go to bed at night. Another good exercise is to “roll” your arch and heel. This is done by placing a tennis ball, golf ball, or lacrosse ball on the floor and rolling your foot on top of it. Some people get extra benefit by “rolling” on a frozen water bottle. You should also carefully evaluate your fitness program as you may be overdoing it. You may want consider backing of new or recently added exercises or increases in training until your heel pain improves. If you work at a standing job try to take more time to walk around during the day and avoid standing in one place for too long.
In cases that do not respond to any conservative treatment, surgical release of the plantar fascia may be considered. Plantar fasciotomy may be performed using open, endoscopic or radiofrequency lesioning techniques. Overall, the success rate of surgical release is 70 to 90 percent in patients with plantar fasciitis. Potential risk factors include flattening of the longitudinal arch and heel hypoesthesia as well as the potential complications associated with rupture of the plantar fascia and complications related to anesthesia.