What Causes Heel Pain To Flare Up

Plantar Fascitis

Overview

The plantar fascia is a band of connective tissue that runs along the sole from the heel to the ball of the foot. One of its main roles is to keep the bones and joints in position. Bruising or overstretching this ligament can cause inflammation and heel pain. A common cause is flat feet, because the ligament is forced to overstretch as the foot spreads out and the arch flattens. The pain may be worse first thing in the morning or after rest. In many cases, plantar fasciitis is associated with heel spur. The plantar fascia tears and bleeds at the heel and, over time, these injuries calcify and form a bony growth.




Causes

The cause of plantar fasciitis is poorly understood and is thought to likely have several contributing factors. The plantar fascia is a thick fibrous band of connective tissue that originates from the medial tubercle and anterior aspect of the heel bone. From there, the fascia extends along the sole of the foot before inserting at the base of the toes, and supports the arch of the foot. Originally, plantar fasciitis was believed to be an inflammatory condition of the plantar fascia. However, within the last decade, studies have observed microscopic anatomical changes indicating that plantar fasciitis is actually due to a non-inflammatory structural breakdown of the plantar fascia rather than an inflammatory process. Due to this shift in thought about the underlying mechanisms in plantar fasciitis, many in the academic community have stated the condition should be renamed plantar fasciosis. The structural breakdown of the plantar fascia is believed to be the result of repetitive microtrauma (small tears). Microscopic examination of the plantar fascia often shows myxomatous degeneration, connective tissue calcium deposits, and disorganized collagen fibers. Disruptions in the plantar fascia’s normal mechanical movement during standing and walking (known as the Windlass mechanism) are thought to contribute to the development of plantar fasciitis by placing excess strain on the calcaneal tuberosity.




Symptoms

Most patients with plantar fasciitis describe a sharp or stabbing pain on the bottom of the heel that is most severe when they first get up in the morning or after a period of resting. Some may feel like the heel is bruised while others may describe tightness or even a pulling sensation on the heel or arch.




Diagnosis

Your doctor may look at your feet and watch the way you stand, walk and exercise. He can also ask you questions about your health history, including illnesses and injuries that you had in your past. The symptoms you have such as the pain location or when does your foot hurts most. Your activity routine such as your job, exercise habits and physical activities preformed. Your doctor may decide to use an X-ray of your foot to detect bones problems. MRI or ultrasound can also be used as further investigation of the foot condition.




Non Surgical Treatment

A number of conservative measures can help take stress off the plantar fascia and encourage healing, including Icing, Taping the arch and bottom of the foot, Stretching, especially the calf, Avoiding walking with bare feet, especially on hard surfaces, Wearing orthotics or arch supports, Taking over-the-counter anti-inflammatories. If these methods fail, we generally try one of two things, A cortisone injection can help reduce swelling. Often a single injection will do the trick, but occasionally a second injection may be needed. Alternatively, we can try extracorporeal pulse activation therapy, or EPAT. This method uses sound waves to penetrate to the plantar fascia and stimulate the body’s healing response. We typically do one treatment a week for three weeks, with complete healing taking between nine to 12 weeks.

Plantar Fascitis




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.

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