Archive for the ‘Plantar Fasciitis’ Category

What Can Cause Heel Discomfort

Pain Of The Heel

Overview

Plantar fasciitis is sometimes mixed up with a heel spur although they are not the same. A heel spur is a calcium deposit that occurs where the plantar fascia is attached to the heel bone (calcaneus). In many cases a heel spur is found on a foot with no pain or other symptoms at all. And in many painful heels there is no sign for a heel spur. Heel spur and painful heal does not necessarily go together. For many years plantar fasciitis was believed to be an inflammatory condition. It is thought now to be inaccurate because there were many cases of the disorder with no inflammatory signs observed within the fascia. The heel pain cause is now believed to be damage to the collagen fibers of the fascia. This damage, caused by stress injury, sometimes may include inflammatory cells.


Causes

Plantar fasciitis occurs because of irritation to the thick ligamentous connective tissue that runs from the heel bone to the ball of the foot. This strong and tight tissue contributes to maintaining the arch of the foot. It is also one of the major transmitters of weight across the foot as you walk or run. Therefore, the stress placed on the this tissue is tremendous.


Symptoms

Among the symptoms for Plantar Fasciitis is pain usually felt on the underside of the heel, often most intense with the first steps after getting out of bed in the morning. It is commonly associated with long periods of weight bearing or sudden changes in weight bearing or activity. Plantar Fasciitis also called “policeman’s heel” is presented by a sharp stabbing pain at the bottom or front of the heel bone. In most cases, heel pain is more severe following periods of inactivity when getting up and then subsides, turning into a dull ache.


Diagnosis

Plantar fasciosis is confirmed if firm thumb pressure applied to the calcaneus when the foot is dorsiflexed elicits pain. Fascial pain along the plantar medial border of the fascia may also be present. If findings are equivocal, demonstration of a heel spur on x-ray may support the diagnosis; however, absence does not rule out the diagnosis, and visible spurs are not generally the cause of symptoms. Also, infrequently, calcaneal spurs appear ill defined on x-ray, exhibiting fluffy new bone formation, suggesting spondyloarthropathy (eg, ankylosing spondylitis, reactive arthritis. If an acute fascial tear is suspected, MRI is done.


Non Surgical Treatment

Rest until the pain resolves and you are feeling better. For most people with plantar fasciitis it is very difficult to rest as daily routine demands using their feet during the day for work or other activities. By using the painful foot you keep on hurting the plantar fascia, harming the foot and increasing inflammation. Rest as much as you can, reduce unnecessary activities and additional stress on the fascia. Cold therapy like applying ice to the bottom of your foot helps reduce pain and inflammation. Cold therapy can be used all the time until symptoms have resolved. Some patients prefer to roll their foot over an iced cold drink can or bottle taken out of the freezer. Physical therapy Exercises are good plantar fasciitis treatment. Stretching and other physical therapy measures may be used to provide relief. Stretching the plantar fascia is reported in scientific studies to be a very effective treatment technique. Gait analysis will determine if you overpronate or oversupinate. An expert may perform a test of the way you stand and walk to see if you step in a way that puts more stress on the plantar fascia. You can try to change the way you walk and stand according to the experts recommendation as part of your treatment. Exercise the foot muscles to make the muscles stronger. One good exercise is grabbing and lifting up a towel or marbles using your toes. You can do the same exercise without a towel as though you are grasping something with the toes of each foot. Another good exercise is walking as tall as you can on your toes and on the balls of your feet. Stretching the plantar fascia and the calf muscles several times a day is an important part of the treatment and prevention. There are many stretching exercises for the plantar fascia and the calf muscles that you can find. Long term treatment should not focus in reduction of pain and inflammation alone. This is a passive short term relief treatment. Stretching exercises results are longer and more flexible foot movement which can prevent another fascia injury. Plantar fasciitis taping technique can assist the foot getting rest and help it from getting injured again. Athletic tape is applied in strips on the skin on the bottom of the foot supporting the plantar fascia. The tape restricts the movement of the foot so the fascia can not be injured again. Taping supports the foot by putting the tired foot muscles and tendons in a physiologically more relaxed position. A night splint is worn during sleep. It holds the calf muscles and plantar fascia in a stretched position. Night splint treatment lets the fascia heal in a stretched position so it will not get bruised again when waking up and stretching it again while walking. Orthotics or inserts that your doctor may prescribe or custom made arch supports (orthotics) plantar fascia orthotic. help to distribute the pressure on your feet more evenly. Arch Support gives a little raise to the arch assisting the plantar fascia. There are also over-the-counter inserts that are used for arch support and heel cushioning. Heel cups and cradles provide extra comfort and cushion the heel. They reduce shock placed on the foot during everyday activities like Shock absorbers. Anti-inflammatory or Pain medication that a clinician may recommend can be a plantar fasciitis treatment. Non-steroidal anti-inflammatory drugs such as ibuprofen can reduce swelling and relieve pain. However, these medications may have many side effects and it is important to consider the potential risks and benefits. These medications may relieve the pain and inflammation but will not cure the fascia. Lose weight as much as you can. Extra weight puts more stress on your plantar fascia. Platelet Rich Plasma or PRP therapy, is a procedure which involves an injection of special plasma, made out of the patients own blood, to the injured area. Platelets are special blood components that have a major role in the body ability to heal itself. Blood is taken from the patient and separated into its components. The platelet rich part of the blood is than taken and injected into the injured area – in our case to the bottom of the foot. The special plasma helps the foot recovery process. The procedure is actually maximizing the body’s natural healing response of the treated area. Extracorporeal shock wave therapy is a procedure which sound waves are targeted at the area of heel pain to encourage healing. It is mostly used for chronic plantar fasciitis which does not respond to conservative treatments. This procedure has many possible side effects like bruising, swelling, pain or numbness and has not proved to be consistently effective. Corticosteroid injection (or cortisone shots) into the painful area may provide relief in severe cases. This kind of medication is very efficient in inflammation reduction. Corticosteroid injections usually provide short-term relief from plantar fasciitis pain. Symptom relief from the corticosteroid injection lasts for 3 to 6 weeks, but the effect often deteriorates and symptoms return. Botox Injections (botulinum toxin) are used to relieve the pain of plantar fasciitis, assist foot function recovery and the ability to walk better. Although the use of Botox injections as heel pain treatment is relatively new, there are a number of medical studies that show significant good results.

Feet Pain


Surgical Treatment

Most studies indicate that 95% of those afflicted with plantar fasciitis are able to relieve their heel pain with nonsurgical treatments. If you are one of the few people whose symptoms don’t improve with other treatments, your doctor may recommend plantar fascia release surgery. Plantar fascia release involves cutting part of the plantar fascia ligament in order to release the tension and relieve the inflammation of the ligament. Overall, the success rate of surgical release is 70 to 90 percent in patients with plantar fasciitis. While the success rate is very high following surgery, one should be aware that there is often a prolonged postoperative period of discomfort similar to the discomfort experienced prior to surgery. This pain usually will abate within 2-3 months. One should always be sure to understand all the risks associated with any surgery they are considering.


Prevention

You can help to prevent plantar fasciitis by maintaining a healthy weight, by warming up before participating in sports and by wearing shoes that support the arch and cushion the heel. In people who are prone to episodes of plantar fasciitis, exercises that stretch the heel cord (known as the Achilles tendon) and the plantar fascia may help to prevent plantar fasciitis from returning. Ice massage also can be used on the bottom of the foot after stressful athletic activities. It is possible that strict control of blood sugar will prevent plantar fasciitis in people with diabetes, although this has not been proven.

Advertisements

Posted January 17, 2015 by lilliamferlic in Plantar Fasciitis

Tagged with , ,

What Will Cause Heel Pain To Flare Up

Overview

Plantar fasciitis is a painful condition affecting the connective tissue that stretches between the heel and the middle of the foot. It is usually caused by overuse, injury or muscular abnormalities. In extracorporeal shockwave therapy, a machine is used to deliver sound waves to the painful area. It is not known exactly how it works, but it is thought that it might stimulate healing of the fascia.


Causes

Plantar fasciitis is common in sports which involve running, dancing or jumping. Runners who overpronate where their feet roll in or flatten too much are particularly at risk the plantar fascia is over stretched as the foot flattens. A common factor is tight calf muscles which lead to a prolonged or high velocity pronation or rolling in of the foot. This in turn produces repetitive over-stretching of the plantar fascia leading to possible inflammation and thickening of the tendon. As the fascia thickens it looses flexibility and strength. Other causes include either a low arch called pes planus or a very high arched foot known as pes cavus. Assessing the foot for plantar fasciitisExcessive walking in footwear which does not provide adequate arch support has been attributed. Footwear for plantar fasciitis should be flat, lace-up and with good arch support and cushioning. Overweight individuals are more at risk of developing plantar fasciitis due to the excess weight impacting on the foot.


Symptoms

The heel pain characteristic of plantar fasciitis is usually felt on the bottom of the heel and is most intense with the first steps of the day. Individuals with plantar fasciitis often have difficulty with dorsiflexion of the foot, an action in which the foot is brought toward the shin. This difficulty is usually due to tightness of the calf muscle or Achilles tendon, the latter of which is connected to the back of the plantar fascia. Most cases of plantar fasciitis resolve on their own with time and respond well to conservative methods of treatment.


Diagnosis

During the physical exam, your doctor checks for points of tenderness in your foot. The location of your pain can help determine its cause. Usually no tests are necessary. The diagnosis is made based on the history and physical examination. Occasionally your doctor may suggest an X-ray or magnetic resonance imaging (MRI) to make sure your pain isn’t being caused by another problem, such as a stress fracture or a pinched nerve. Sometimes an X-ray shows a spur of bone projecting forward from the heel bone. In the past, these bone spurs were often blamed for heel pain and removed surgically. But many people who have bone spurs on their heels have no heel pain.


Non Surgical Treatment

If conservative treatments fail, and the symptoms of plantar fasciitis have not been relieved, the doctor may recommend one of the following treatments. Cortisone, or corticosteroids, is medications that reduce inflammation. Cortisone is usually mixed with local anesthetics and injected into the plantar fascia where it attaches to the heel bone. In many cases this reduces the inflammation present and allows the plantar fascia to begin healing. Local injections of corticosteroids may provide temporary or permanent relief. Recurrence of symptoms may be lessened by combining steroid injections with other forms of treatment such as orthotics, changes in shoe gear, weight loss, stretching exercises, and rest. Repeated cortisone injections may result in rupture of the plantar fascia, thinning of the heel’s fat pad, and other tissue changes. Extracorporeal Shock Wave Therapy (ESWT) devices generate pulses of high-pressure sound that travel through the skin. For reasons that are not fully understood, soft tissue and bone that are subjected to these pulses of high-pressure energy heal back stronger. There is both a high-energy and low-energy form of ESWT; and both forms of shock wave therapy can be used in the treatment of plantar fasciitis. Research studies indicate ESWT is a safe and effective treatment option for plantar fasciitis. The recovery period is shorter than traditional invasive surgery and the procedure eliminates many of the risks associated with traditional surgery.

Plantar Fascia


Surgical Treatment

Most patients have good results from surgery. However, because surgery can result in chronic pain and dissatisfaction, it is recommended only after all nonsurgical measures have been exhausted. The most common complications of release surgery include incomplete relief of pain and nerve damage.


Prevention

To reduce your risk of getting plantar fasciitis take these steps. Wear appropriate and well-fitted footwear during sports and exercise. Do stretching exercises for the Achilles tendon and plantar fascia. Increase the intensity and duration of exercise gradually. Maintain an appropriate weight.

Posted January 13, 2015 by lilliamferlic in Plantar Fasciitis

Tagged with , ,

What Triggers Pain In The Heel To Appear

Plantar Fascitis

Overview

Plantar fasciitis is one of the most common sources of heel pain. Your plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes. Your plantar fascia acts as a passive limitation to the over flattening of you arch. When your plantar fascia develops micro tears or becomes inflammed it is known as plantar fasciitis.


Causes

Plantar fasciitis occurs when the ligament in your foot arch is strained repeatedly, which causes tiny tears and significant pain. There are several possible causes for this condition. Excessive pronation, or overpronation, which happens when your feet roll excessively inward as you walk. Flat feet or high arches. Walking, standing, or running for long periods of time, particularly on hard surfaces (a common problem for athletes). Excess weight, such as overweight or obesity. Shoes that are worn out or don’t fit well. Tight calf muscles or Achilles tendons.


Symptoms

Symptoms of plantar fasciitis can occur suddenly or gradually. When they occur suddenly, there is usually intense heel pain on taking the first morning steps, known as first-step pain. This heel pain will often subside as you begin to walk around, but it may return in the late afternoon or evening. When symptoms occur gradually, a more long-lasting form of heel pain will cause you to shorten your stride while running or walking. You also may shift your weight toward the front of the foot, away from the heel.


Diagnosis

Most cases of plantar fasciitis are diagnosed by a health care provider who listens carefully to your description of symptoms. During an examination of your feet, your health care provider will have to press on the bottom of your feet, the area most likely to be painful in plantar fasciitis. Because the pain of plantar fasciitis has unique characteristics, pain upon rising, improvement after walking for several minutes, pain produced by pressure applied in a specific location on your foot but not with pressure in other areas, your health care provider will probably feel comfortable making the diagnosis based on your symptoms and a physical examination. Your health care provider may suggest that you have an X-ray of your foot to verify that there is no stress fracture causing your pain.


Non Surgical Treatment

Treatment initially involves offloading the plantar fascia by aoiding aggravating factors, such as running. Taping, this can work very well to alleviate pain, and can be almost immediate. It isn’t a long-term solution, but can relieve symptoms in the beginning. Using a night splint to stretch the calf, so that less load is placed on the plantar fascia (if tightness in the calf is a factor). Using a gel heel cup, this can act to increase shock absorption, and by raising the heel there is also less stretch on the calf. So, temporarily, this may relieve pain in someone who has a tight calf. Massage, but this depends if the plantarfascia is actually tight or just painful. If it is tight, then massage can temporarily relieve the pain, but if it is irritated then taping and corrective footwear is preferable.

Heel Discomfort


Surgical Treatment

Surgery is rarely needed in the treatment of plantar fasciitis. The vast majority of patients diagnosed with plantar fasciitis will recover given ample time. With some basic treatment steps, well over 90% of patients will achieve full recovery from symptoms of plantar fasciitis within one year of the onset of treatment. Simple treatments include anti-inflammatory medication, shoe inserts, and stretching exercises. In patients where a good effort with these treatments fails to provide adequate relief, some more aggressive treatments may be attempted. These include cortisone injections or extracorporeal shock wave treatments.


Stretching Exercises

You may begin exercising the muscles of your foot right away by gently stretching them as follows. Prone hip extension, Lie on your stomach with your legs straight out behind you. Tighten up your buttocks muscles and lift one leg off the floor about 8 inches. Keep your knee straight. Hold for 5 seconds. Then lower your leg and relax. Do 3 sets of 10. Towel stretch, Sit on a hard surface with one leg stretched out in front of you. Loop a towel around your toes and the ball of your foot and pull the towel toward your body keeping your knee straight. Hold this position for 15 to 30 seconds then relax. Repeat 3 times. When the towel stretch becomes too easy, you may begin doing the standing calf stretch. Standing calf stretch, Facing a wall, put your hands against the wall at about eye level. Keep one leg back with the heel on the floor, and the other leg forward. Turn your back foot slightly inward (as if you were pigeon-toed) as you slowly lean into the wall until you feel a stretch in the back of your calf. Hold for 15 to 30 seconds. Repeat 3 times. Do this exercise several times each day. Sitting plantar fascia stretch, Sit in a chair and cross one foot over your other knee. Grab the base of your toes and pull them back toward your leg until you feel a comfortable stretch. Hold 15 seconds and repeat 3 times. When you can stand comfortably on your injured foot, you can begin standing to stretch the bottom of your foot using the plantar fascia stretch. Achilles stretch, Stand with the ball of one foot on a stair. Reach for the bottom step with your heel until you feel a stretch in the arch of your foot. Hold this position for 15 to 30 seconds and then relax. Repeat 3 times. After you have stretched the bottom muscles of your foot, you can begin strengthening the top muscles of your foot. Frozen can roll, Roll your bare injured foot back and forth from your heel to your mid-arch over a frozen juice can. Repeat for 3 to 5 minutes. This exercise is particularly helpful if done first thing in the morning. Towel pickup, With your heel on the ground, pick up a towel with your toes. Release. Repeat 10 to 20 times. When this gets easy, add more resistance by placing a book or small weight on the towel. Balance and reach exercises, Stand upright next to a chair. This will provide you with balance if needed. Stand on the foot farthest from the chair. Try to raise the arch of your foot while keeping your toes on the floor. Keep your foot in this position and reach forward in front of you with your hand farthest away from the chair, allowing your knee to bend. Repeat this 10 times while maintaining the arch height. This exercise can be made more difficult by reaching farther in front of you. Do 2 sets. Stand in the same position as above. While maintaining your arch height, reach the hand farthest away from the chair across your body toward the chair. The farther you reach, the more challenging the exercise. Do 2 sets of 10. Heel raise, Balance yourself while standing behind a chair or counter. Using the chair to help you, raise your body up onto your toes and hold for 5 seconds. Then slowly lower yourself down without holding onto the chair. Hold onto the chair or counter if you need to. When this exercise becomes less painful, try lowering on one leg only. Repeat 10 times. Do 3 sets of 10. Side-lying leg lift, Lying on your side, tighten the front thigh muscles on your top leg and lift that leg 8 to 10 inches away from the other leg. Keep the leg straight. Do 3 sets of 10.

Posted January 10, 2015 by lilliamferlic in Plantar Fasciitis

Tagged with , ,