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HEEL PAIN



Heel Pain

Heel pain may start gradually and progressively get worse. Because it is often not really noticeable at first, many people ignore it. In some cases, it goes away on its own but If it hasnít gone in weeks, then a professional opinion is needed so that an accurate diagnosis can be made and appropriate treatment started.



Plantar Fasciitis

Plantar Fasciitis is an inflammation of the plantar fascia and is probably the commonest cause of heel and arch pain in adults. The plantar fascia runs from your heel underneath the arch and inserts into the base of your toes. The site of pain may be directly underneath the heel where the plantar fascia originates or anywhere along its length. Typically a severe pain is felt first thing in the morning when taking the first few steps or on rising from rest.



So what causes this painful condition?
Whilst plantar fasciitis can be associated with an incident of trauma or excessive / unusual activity, there is often no obvious cause. However we do find that patients with unstable or mis-aligned feet are far more prone to this condition. Those with an excessively high or low arch are prone to this condition as are those with tight achilles tendon and calf muscles. Plantar faciitis is often misdiagnosed or confused with other heel conditions such as calcaneal bursitis, tarsal tunnel syndrome, calcaneal spur or severs disease (children and adolescents) and an accurate diagnosis is important before treatment begins.

Treatment
This condition responds well to rest. However this doesn't mean sitting with your feet up all day! The plantar fascia can be rested if it is not being overstretched. Wear supportive lace-up shoes such as trainers and avoid walking barefooted or in backless sandles .

An unstable foot is constantly straining the plantar fascia and this has to be recognised if a long term solution is to be achieved. Most patients respond well when the underlying mechanical foot fault is treated, usually with orthotic therapy.(specialised shoe inserts designed to allow the foot to function correctly). Stretching exercises also have a place in the treatment regime, especially when the calf and achilles tendon is excessively taught.

When conservative treatments prove ineffective, a mixture of steroid and local anaesthetic is injected into the plantar fascia and whist this can be very effective, pain relief is sometimes short lived.

Is there anything I can do to treat myself?
Gentle calf stretches can help loosen muscles and ease pain. Standing barefoot and leaning forward with your hands on a wall, with one foot forward and the other back. The back leg should be straight and your heel flat on the floor. Then lean slowly forward, bending the front leg. The stretch should be felt in the middle of your calf. Hold the stretch for 30 seconds and repeat on the other leg. This should be repeated three times on each leg.

Tips to relieve the pain include:
  • Roll an iced bottle of water up and down on the sole of the foot to reduce inflammation.
  • Roll a tennis ball on the floor with your foot to massage the deep tendons of your foot.
  • A course of anti-inflammatory medications (NSAIDS) can help and these are available on prescription from your GP.


Other conditions causing pain in the heel :-
  • Tarsal Tunnel Syndrome
    Compression of the tibial nerve as it passes the inside of the ankle can cause a burning sensation or tingling sensation within the heel and arch of the foot.
  • Calcaneal Bursitis
    The fluid filled fibrous sac (bursa) under the heel bone becomes inflamed. The pain is typically in the centre of the heel and becomes worse during the day. This condition often responds to ultrasound therapy but like plantar fasiitis, there is often also an underlying mechanical fault with the foot and therefore an orthotic is needed for long term relief.
  • Achilles Tendonosis
    Small tears can develop within the Achilles tendon causing a gradual swelling and pain within the heel. Exercises to strengthen the tendon and a increase in heel height with an insole can relieve the tendon to allow healing to take place.
  • Severs Disease
    This painful condition of the heel occurs in children, usually between the ages 8-12. It occurs when there is a temporary loss of blood supply to the heel bone. Whilst painful at the time, the condition often rectifies itself but may require protective padding in its acute stage.
  • Chronic Inflammation of the heel pad
    The heel pad may become reduced in thickness giving rise to to a dull ache in the heel when standing and walking. Ultrasound therapy followed by a shock absorbing insert in the shoes is often beneficial.
Remember Ė Your feet shouldn't hurt just because you have been standing or walking all day. If they are are troublesome seek professional help.

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