Overview
Heel pain accounts for one of the most common types of pain felt in the foot. Pain in the heel of the foot can be caused as a result of exercise, daily work routines or recreational activities. Some type of repetitive stress on the foot is often at the root of heel pain. The largest bone in the foot is the calcaneus, or heel bone. When we walk, the heel bone is usually the first part of the foot that hits the ground and is responsible for supporting much of the body's weight. This makes the heel of the foot prone to injury. Causes Heel pain can have many causes but the vast majority is caused by plantar fasciitis. Plantar means, ?bottom of the foot.? Fascia is a ligament or ?bundle? of ligaments. The plantar fascia is the thick ligament that helps to hold up the foot and provide spring in our step. Plantar fasciitis is an inflammation of the plantar fascia and causes more than 90% of heel pain among adults in the US. Plantar fasciitis can be acute, that is, as simple strain of the ligament but often is chronic, hanging on for months if not years. Why does that happen? The answer is poor foot mechanics, the foot sinking down too far allowing the plantar fascia to overstretch with each step taken. Symptoms Pain in the heel can be caused by many things. The commonest cause is plantar fascitis. Other causes include, being overweight, constantly being on your feet, especially on a hard surface like concrete and wearing hard-soled footwear, thinning or weakness of the fat pads of the heel, injury to the bones or padding of the heel, arthritis in the ankle or heel (subtalar) joint, irritation of the nerves on the inner or outer sides of the heel, fracture of the heel bone (calcaneum). Diagnosis A podiatrist (doctor who specializes in the evaluation and treatment of foot diseases) will carry out a physical examination, and ask pertinent questions about the pain. The doctor will also ask the patient how much walking and standing the patient does, what type of footwear is worn, and details of the his/her medical history. Often this is enough to make a diagnosis. Sometimes further diagnostic tests are needed, such as blood tests and imaging scans. Non Surgical Treatment There are many treatments for fasciitis. The most common initial treatment provided by the family doctor are anti-inflammatory medications. They may take the edge off the pain, but they don't often resolve the condition fully. Steroid injections, which deliver the medication directly to the most painful area, are usually more effective. Rest, ice, weight loss, taping, strapping, immobilization, physiotherapy, massage, stretching, heel cushions, acupuncture, night splints and extra-corporeal shock wave therapy all help some patients. Many patients, however, have a biomechanical cause such as excessively pronated feet to their complaint, and this may mean many of the treatments listed above will only provide temporary relief of fasciitis symptoms. When you stop the treatment, the pain often returns. This is why many cases of fasciitis respond well to orthoses, custom-made inserts that control the mechanical cause of the complaint. If you're considering orthoses, it's very important to have a podiatrist specializing in the field to examine you. There are many biomechanical factors to consider when assessing the need for literally dozens of types of devices available, so you need to have an expert to properly assess you. (Unfortunately, as is the case in many jurisdictions, there is no minimum standard of training required in British Columbia to make orthoses, and there are many fly-by-night operations around that employ salesmen with little, if any, training in understanding anatomy or foot function. The emphasis with these groups is on selling you some sort of device, rather than providing proper assessment, treatment and follow-up. Surgical Treatment It is rare to need an operation for heel pain. It would only be offered if all simpler treatments have failed and, in particular, you are a reasonable weight for your height and the stresses on your heel cannot be improved by modifying your activities or footwear. The aim of an operation is to release part of the plantar fascia from the heel bone and reduce the tension in it. Many surgeons would also explore and free the small nerves on the inner side of your heel as these are sometimes trapped by bands of tight tissue. This sort of surgery can be done through a cut about 3cm long on the inner side of your heel. Recently there has been a lot of interest in doing the operation by keyhole surgery, but this has not yet been proven to be effective and safe. Most people who have an operation are better afterwards, but it can take months to get the benefit of the operation and the wound can take a while to heal fully. Tingling or numbness on the side of the heel may occur after operation. how to get rid of heel spurs Prevention Wear shoes that fit well, front, back and sides and have shock-absorbent soles, rigid uppers and supportive heel counters. Do not wear shoes with excessive wear on heels or soles. Prepare properly before exercising. Warm-up before running or walking, and do some stretching exercises afterward. Pace yourself when you participate in athletic activities. If overweight, try non weight-bearing activities such as swimming or cycling. Your podiatrist may also use taping or strapping to provide extra support for your foot. Orthoses (shoe inserts) specifically made to suit your needs may be also be prescribed.
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