Most pain associated with the heel can be tied to one disorder: plantar fasciitis . "There is a ligament called the plantar fascia which attaches at the heel bone and then runs through the arch and into the toes," explains podiatrist Lowell Scott Weil, Jr. "Its function is to support the arch in an arch position. If you bend your toes back, you can feel a tight band in your arch. That is the plantar fascia."
Forces acting on the foot while walking or running cause the arch to flatten out. At the same time, the plantar fascia is trying to keep this from happening. These opposing forces put tremendous stress on the tissue. When enough continuing stress exceeds the body’s ability to heal itself, the tissue under the heel becomes injured and painful.
The symptoms of plantar fasciitis include severe pain, especially first thing in the morning. Most people say that it hurts from "the instant their heel touches the ground." Some even feel pain and stiffness when starting to walk after sitting for a while.
Plantar fasciitis is often seen in persons over 40 years old or in those who are overweight. There is also an increase in visits to doctors during the spring and summer months as people resume activities involving walking or running. Among runners and other athletes, shoes that do not support the foot properly commonly lead to plantar fasciitis.
"We see a lot of shoe gear problems, especially with runners," notes Douglas Hale, a podiatrist in the Seattle area. "However, bad shoe selection also can cause heel pain in people who walk for exercise or who are on their feet a lot in their jobs. It should be stressed that price alone is not an indicator of quality in shoes."
He suggests three things people should look for in a shoe (whether for walking or running):
Another preventive measure is to do stretching exercises 2-3 times a day. One stretch you can do is to place one foot behind you and lean forward keeping your knee stiff. Hold that position for 15-20 seconds, then switch. Repeat this on each leg at least three times per session.
Diagnosis is most often made by assessing the place (middle of the bottom of the heel) and timing (eg, early morning) of the pain. The doctor will also question you on your activity levels and your weight.
While fractures , infection, and arthritis can also occur, the place and timing of the pain is usually different. Sometimes an x-ray or other imaging test is needed to exclude these other causes.
Some treatment options include:
"Stretch splinting” at night can be tried to improve symptoms and reduce the duration of activity limitation. Other treatments could include:
RESOURCES:
American Orthopedic Foot and Ankle Society
http://www.aofas.org/
American Podiatric Medical Association
http://www.apma.org/
CANADIAN RESOURCES:
Canadian Podiatric Medical Association
http://www.podiatrycanada.org/
Podiatrists in Canada
http://www.podiatrycanada.org/
References:
DynaMed Editorial Team. Plantar fasciitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated May 2010. Accessed May 7, 2010.
Heel and arch pain. Foot and Ankle Center website. Available at: http://www.footankle.com/heel-arch-pain2.htm . Accessed September 4, 2008.
Plantar fasciitis. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81 . Updated November 2007. Accessed September 4, 2008.
Last reviewed May 2010 by Brian Randall, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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