What Causes Heel Pain To Flare Up

Foot Pain

Overview

Plantar Fasciitis is the most common condition of heel pain. This condition occurs when the long fibrous plantar fascia ligament along the bottom of the foot develops tears in the tissue resulting in pain and inflammation. The pain of plantar fasciitis is usually located close to where the fascia attaches to the calcaneous, also known as the heel bone. The condition is often misspelled as: plantar fascitis, plantar fasciatis, planters fasciitis, plantar faciatis, and plantar faciaitis. Plantar fasciitis causes the inflammation of the plantar fascia ligament which runs along the bottom of the foot. The plantar fascia ligament is made of fibrous bands of tissue and runs between the heel bone and your toes and stretches with every step. Inflammation develops when tears occur in the tissue. The most common complaint from plantar fasciitis is a burning, stabbing, or aching pain in the heel of the foot. Most sufferers will be able to feel it in the morning because the fascia ligament tightens up during the night while we sleep, causing pain to diminish. However, when we climb out of bed and place pressure on the ligament, it becomes taut and pain is particularly acute. Pain usually decreases as the tissue warms up, but may easily return again after long periods of standing or weight bearing, physical activity, or after getting up after long periods of lethargy or sitting down. In most cases, plantar fasciitis does not require surgery or invasive procedures to stop pain and reverse damage. Conservative treatments are usually all that is required. However, every person’s body responds to plantar fasciitis treatment differently and recovery times may vary.


Causes

Plantar fasciitis is the most common injury of the plantar fascia and is the most common cause of heel pain. Approximately 10% of people have plantar fasciitis at some point during their lifetime. It is commonly associated with long periods of standing and is much more prevalent in individuals with excessive inward rolling of the foot, which is seen with flat feet. Among non-athletic populations, plantar fasciitis is associated with obesity and lack of physical exercise.


Symptoms

The pain associated with plantar fasciitis is typically gradual in onset and is usually located over the inner or medial aspect of the heel. Occasionally, the pain will be sudden in onset, occurring after missing a step or after jumping from a height. The pain is commonly most severe upon arising from bed in the morning, or after periods of inactivity during the day. Thus, it causes what is known as “first-step pain.” The degree of discomfort can sometimes lessen with activity during the course of the day or after “warming-up”, but can become worse if prolonged or vigorous activity is undertaken. The pain is also often noted to be more severe in bare feet or in shoes with minimal or no padding at the sole.


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

Treatment of heel pain caused by plantar fasciitis begins with simple steps. There are a number of options for treatment of plantar fasciitis, and almost always some focused effort with nonsurgical treatments can provide excellent relief. In rare circumstances, simple steps are not adequate at providing relief, and more invasive treatments may be recommended. Typically, patients progress from simple steps, and gradually more invasive treatments, and only rarely is surgery required.

Heel Pain


Surgical Treatment

Surgery should be reserved for patients who have made every effort to fully participate in conservative treatments, but continue to have pain from plantar fasciitis. Patients should fit the following criteria. Symptoms for at least 9 months of treatment. Participation in daily treatments (exercises, stretches, etc.). If you fit these criteria, then surgery may be an option in the treatment of your plantar fasciitis. Unfortunately, surgery for treatment of plantar fasciitis is not as predictable as a surgeon might like. For example, surgeons can reliably predict that patients with severe knee arthritis will do well after knee replacement surgery about 95% of the time. Those are very good results. Unfortunately, the same is not true of patients with plantar fasciitis.


Prevention

Make sure you wear appropriate supportive shoes. Don’t over-train in sports. Make sure you warm up, cool down and undertake an exercise regime that helps maintain flexibility. Manage your weight, obesity is a factor in causing plantar fasciitis. Avoid walking and running on hard surfaces if you are prone to pain. You should follow the recognized management protocol – RICED-rest, ice, compression, elevation and diagnosis. Rest, keep off the injured ankle as much as possible. Ice, applied for 20 minutes at a time every hour as long as swelling persists. Compression, support the ankle and foot with a firmly (not tightly) wrapped elastic bandage. Elevation, keep foot above heart level to minimize bruising and swelling. Diagnosis, Consult a medical professional (such as a Podiatrist or doctor) especially if you are worried about the injury, or if the pain or swelling gets worse. If the pain or swelling has not gone down significantly within 48 hours, also seek treatment. An accurate diagnosis is essential for proper rehabilitation of moderate to severe injuries.

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