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Understanding Heel Pain

Overview

Heel Discomfort

Every time you take a step, one of your heels has to support the whole weight of your body. As you move, the load is equal to 20 times your own body weight. The load is softened by a pillow of fat under the heel and a large sinew or ligament (the fibrous tissue that joins muscle and bone together) under the sole of the foot. This sinew is called the plantar fascia and it pulls the heel bone forward (in opposition to the Achilles tendon, which pulls it backwards). If an athlete does not warm up properly or a person with a sedentary job exercises heavily during the weekends, they might overload the muscles of the calf or strain the Achilles tendon, which joins these muscles to the heel bone. When overloaded the tendon becomes tight and painfully inflamed, which places extra strain on the plantar fascia and muscles in the soles of the foot. The strained plantar fascia becomes inflamed and may even develop tiny cracks. This is known as plantar fasciitis. Every time you sit down, sleep or otherwise rest your legs, the muscles of the sole of the foot will contract in an attempt to protect the damaged sinew. The pain in the heel will then no longer be felt. But when you get up again and put weight on the foot, the foot and ankle may feel stiff (because of the inflammation) and the pain will return either at the back of the heel or on the soles of the feet. When you start to move, the plantar fascia may crack even more causing a vicious cycle of damage and pain. Inflammation at the point where the Achilles tendon (at the back of the heel) or the plantar fascia (under the heel) join the heel bone (a bone known as the Calcaneum) stimulates cells that form bone to deposit bone in this area, eventually leading to the build up of a bony prominence on the heel bone called a calcaneal spur. But it's not the spur itself that causes the pain. The spur is a sign of chronic inflammation in the connective tissues, which is the result of a prolonged overload. It should also be pointed out that heel spurs can occur on their own, without plantar fasciitis or pain, or may be linked to some types of arthritis (inflammation of the joints). And plantar fasciitis or Achilles tendonitis don't necessarily lead to spur formation.

Causes

Here are a few in-depth explanations of heel pain causes and potential remedies for those that are afflicted Plantar Fascitis, One of the most well-known causes of heel pain, plantar fascitis occurs when the thick tissue along the arch of the foot becomes tight and inflamed. The foot itself can feel cramped when this tissue is inflamed, causing the afflicted person to feel as if they have a muscle cramp that flexing the foot doesn?t seem to alleviate. Plantar fascitis is most common among men over the age of 40. Warning Signs, The first steps in the morning are extremely painful. Pain flares up after activities like stair or steep hill climbing. Pain continues to occur regardless of the type of shoes or lack of shoes worn.

Symptoms

Initially, this pain may only be present when first standing up after sleeping or sitting. As you walk around, the muscle and tendon loosen and the pain goes away. As this problem progresses, the pain can be present with all standing and walking. You may notice a knot or bump on the back of the heel. Swelling may develop. In some cases, pressure from the back of the shoe causes pain.

Diagnosis

After you have described your foot symptoms, your doctor will want to know more details about your pain, your medical history and lifestyle, including. Whether your pain is worse at specific times of the day or after specific activities. Any recent injury to the area. Your medical and orthopedic history, especially any history of diabetes, arthritis or injury to your foot or leg. Your age and occupation. Your recreational activities, including sports and exercise programs. The type of shoes you usually wear, how well they fit, and how frequently you buy a new pair. Your doctor will examine you, including. An evaluation of your gait. While you are barefoot, your doctor will ask you to stand still and to walk in order to evaluate how your foot moves as you walk. An examination of your feet. Your doctor may compare your feet for any differences between them. Then your doctor may examine your painful foot for signs of tenderness, swelling, discoloration, muscle weakness and decreased range of motion. A neurological examination. The nerves and muscles may be evaluated by checking strength, sensation and reflexes. In addition to examining you, your health care professional may want to examine your shoes. Signs of excessive wear in certain parts of a shoe can provide valuable clues to problems in the way you walk and poor bone alignment. Depending on the results of your physical examination, you may need foot X-rays or other diagnostic tests.

Non Surgical Treatment

Morning Wall Stretch. Stand barefoot in front of wall, as shown. Press into wall with both hands and lean forward, feeling stretch along back of left leg and heel. Hold for 30 seconds; switch sides and repeat. Freeze and Roll. Freeze a small water bottle. Cover it with a towel and place arch of your foot on top of it. Slowly roll bottle beneath arch of foot for about 5 minutes at a time. Switch sides and repeat. Rub It Out. Use both thumbs to apply deep pressure along arch of the feet, heel, and calf muscles, moving slowly and evenly. Continue for 1 minute. Switch sides and repeat. If you foot pain isn't improving or worsens after 2 weeks, a podiatrist or othopedist can prescribe additional therapies to alleviate discomfort and prevent recurrence.

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.

heel spur exercises

Prevention

Foot Pain

A variety of steps can be taken to avoid heel pain and accompanying afflictions. Wear shoes that fit well-front, back, and sides-and have shock-absorbent soles, rigid shanks, and supportive heel counters. Wear the proper shoes for each activity. Do not wear shoes with excessive wear on heels or soles. Prepare properly before exercising. Warm up and do stretching exercises before and after running. Pace yourself when you participate in athletic activities. Don?t underestimate your body's need for rest and good nutrition. If obese, lose weight.
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