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Heel Pain |
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The two most common causes of heel pain are heel spurs and plantar fasciitis.
The chief diagnostic sign of these problems is: pain in the bottom of the heel
when first standing, which gradually improves with walking. This pain may return
with continued walking. The treatment involves correcting the underlying
causative problems. Please read the following section for more information on
the problem and its treatment. Description: The two most common causes of pain in the bottom of the heel are heel spurs and plantar fasciitis. The plantar fascia is the thick ligamentous band in the bottom of the foot which is attached to the heel, and runs forward to insert into the ball of the foot. Plantar fasciitis is an inflammation of this band at its attachment to the heel. Symptoms: Heel spur and plantar fasciitis pain is usually located in the center or the inner side of the bottom of the heel. The pain is most intense when first standing, after any period of rest. Most people with this problem experience their greatest pain in the morning, with the first few steps after sleeping. After several minutes of walking, the pain becomes less intense and may disappear completely, only to return later with prolonged walking or standing. If a nerve is irritated by the spur, or inflammed due to the swollen plantar fascia, this pain may radiate into the arch or the ankle. Causes: Each time we take a step forward, all of our body weight first rests on the heel of one foot. As our weight moves forward, the entire foot begins to bear the body's weight, and the foot flattens and this places a great deal of pressure and strain on the plantar fascia. There is very little "give" to the plantar fascia, so as it stretches only slightly, it pulls on its attachment to the heel. If the foot is properly aligned this pull causes no problems. However, if the foot is "pronated" (the foot rolls inward, causing a break down of the inner side of the shoe), the arch falls excessively, and this causes an abnormal stretching of the relatively inflexible plantar fascia, which inturn pulls abnormally hard on the heel. The same pathology occurs with "supination" (the rolling of the foot outward, causing a break down of the outer side of the shoe). Supinated feet are relatively inflexible, usually have a high arch, and a short or tight plantar fascia. Thus as weight is transferred from the heel to the remainder of the foot, the tight plantar fascia does not stretch at all, and pulls with great force on its attachment to the heel. In both cases, the abnormal stress placed on the attachment of the plantar fascia to the heel usually causes pain, inflammation, and swelling. If this process continues, the plantar fascia partially tears away from the heel. The body will fill in this torn area with calcium; eventually it becomes bone, and a heel spur results. Treatment: Treatment must be directed towards realigning the foot as it goes through the gait cycle, and reversing the abnormal effects of pronation and supination on the plantar fascia and heel. In doing this, the abnormal pull of the plantar fascia on the heel will be made to disappear. This in turn, alleviates the pain and inflammtion at the heel. Realignment, or proper postioning of the foot, is accomplished through the use of custom-made Orthotics. Custom-made Orthotics gently holds the foot in a proper or neutral alignment when it strikes the ground, preventing pronation or supination. Custom-made Orthotics will also: reduce the pull of the plantar fascia on the heel, by supporting the arch; and cushion the heel, to provide an immediate decrease in pain. Custom-made Orthotics will not only relieve the pain, but they will also prevent it from returning. Immediate pain relievers: Some things you can try to give yourself immediate relief are: Before stepping down after sleeping or resting, stretch the arch of the foot by pulling up on the ball of the foot and toes, as far as you comfortably can, and holding the foot in this postion for ten seconds. Repeat at least ten times. You should feel a pull on the bottom of the foot, especially in the arch. This stretches the plantar fascia, and reduces its pull on the heel. Decrease your standing and walking as much as possible. If the pain becomes intense, applying ice will reduce it. Place the ice directly on the heel and arch for at least 30 minutes (you can keep the ice in place by wrapping the ice against your foot with an elastic bandage). Elevating the heel will reduce the pull of the plantar fascia, thus reducing the pain. Women can accomplish this by wearing a shoe with a 2-inch heel; or by placing heel pads in the shoe. These treatments will give temporary relief, but permanent relief can only be accomplished with the use of custom-made Orthotics. |
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