What Is Pain Under The Heel

posted on 10 Jan 2015 14:14 by kone468
Plantar Fascitis

Overview

If your first few steps out of bed in the morning cause severe pain in the heel of your foot, you may have plantar fasciitis, an overuse injury that affects the sole of the foot. A diagnosis of plantar fasciitis means you have inflamed the tough, fibrous band of tissue (fascia) connecting your heel bone to the base of your toes.




Causes

Plantar fasciitis is the most common cause of heel pain, accounting for around four out of five cases. Plantar fasciitis is when the thick band of tissue that connects the heel bone with the rest of the foot (the plantar fascia) becomes damaged and thickened. Damage to the plantar fascia is thought to occur following sudden damage, for example, damaging your heel while jogging, running or dancing; this type of damage usually affects younger people who are physically active, gradual wear and tear of the tissues that make up the plantar fascia - this usually affects adults who are 40 years of age or over. You are at an increased risk of gradual wear and tear damaging your plantar fasciitis if you are overweight or obese, if you have a body mass index (BMI) of 30 or over, you are considered to be obese, have a job that involves spending long periods of time standing, wear flat-soled shoes, such as sandals or flip flops. Less common causes of heel pain are a stress fracture. A stress fracture can occur if your heel bone is damaged during an injury. Fat pad atrophy. Fat pad atrophy is where the layer of fat that lies under the heel bone, known as the fat pad, starts to waste away due to too much strain being placed on the pad. Women who wear high-heeled shoes for many years have an increased risk of developing fat pad atrophy. Bursitis. Bursitis is inflammation of one or more bursa (small fluid-filled sacs under the skin, usually found over the joints and between tendons and bones). It's possible to develop bursitis anywhere inside the body, not just in the foot. Tarsal tunnel syndrome. The nerves in the sole of your foot pass through a small tunnel on the inside of the ankle joint, known as the tarsal tunnel. If a cyst forms or the tunnel is damaged, the nerves can become compressed (squashed). This can cause pain anywhere along the nerve, including beneath your heel. Sever's disease. Sever's disease is a common cause of heel pain in children. It's caused by the muscles and tendons of the hamstrings and calves stretching and tightening in response to growth spurts. The stretching of the calf muscle pulls on the Achilles tendon. This pulls on the growing area of bone at the back of the heel (growth plate), causing pain in the heel. The pain is further aggravated by activities such as football and gymnastics. The pain often develops at the side of the heel, but can also be felt under the heel. Calf and hamstring stretches and, if necessary, heel pads are usually effective treatments for Sever's disease. Bone spurs. Bone spurs are an excess growth of bone that forms on a normal bone. Bone spurs can develop on the heel (a heel spur) and are more common in people with heel pain. However, they can also occur in people without heel pain. A heel spur does not cause heel pain.




Symptoms

When a patient has plantar fasciitis, the connective tissue that forms the arch of the foot becomes inflamed (tendonitis) and degenerative (tendinosis)--these abnormalities cause plantar fasciitis and can make normal activities quite painful. Symptoms of plantar fasciitis are typically worsened early in the morning after sleep. At that time, the arch tissue is tight and simple movements stretch the contracted tissue. As you begin to loosen the foot, the pain usually subsides, but often returns with prolonged standing or walking.




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

Anti-inflammatory agents used in the treatment of plantar fasciitis include ice, NSAIDs, iontophoresis and cortisone injections. Ice is applied in the treatment of plantar fasciitis by ice massage, ice bath or in an ice pack. For ice massage, the patient freezes water in a small paper or foam cup, then rubs the ice over the painful heel using a circular motion and moderate pressure for five to 10 minutes. To use an ice bath, a shallow pan is filled with water and ice, and the heel is allowed to soak for 10 to 15 minutes. Patients should use neoprene toe covers or keep the toes out of the ice water to prevent injuries associated with exposure to the cold. Crushed ice in a plastic bag wrapped in a towel makes the best ice pack, because it can be molded to the foot and increase the contact area. A good alternative is the use of a bag of prepackaged frozen corn wrapped in a towel. Ice packs are usually used for 15 to 20 minutes. Icing is usually done after completing exercise, stretching, strengthening and after a day's work.

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.

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