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Understanding Heel Serious Pain

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Feet Pain

Heel pain is a very common condition treated in our podiatric office. Patients come in complaining of pain to the bottom of their heel, sometimes radiating into the arch area and are seeking effective treatment. Dr. Weinert often speaks with patients who thought their heel pain would just go away on its own. However, with conditions such as heel spur syndrome or plantar fasciitis, this often is not the case. If heel pain is not treated properly, symptoms will only get worse for the patient and can result in further pain and disability. This can happen not only in the foot, but in the ankle, knee, hip, lower back and even up in to the shoulder areas as well. The foot is the foundation for the whole body system and if the foot or the heel hurts, then you can feel pain all over. Foot health starts with knowing the causes of heel pain and symptoms to look out for. Early intervention will prevent further damage to the feet and Dr. Weinert offers several treatment options to help his patients suffering with heel pain.

Causes

A sharp stabbing pain, like a nail going into the bottom of the heel when first stepping on the foot after getting out of bed or after sitting for period of time, is the most common description for plantar fasciitis or heel spur syndrome. Typically the pain eases off as the day goes on but it may not go away completely. A thick ligament that attaches to the bottom of the heel and runs the length of the foot to the toes can become inflamed and swollen at the attachment site. This tends to be an overuse type of injury where poor foot structure is involved; also, wearing of shoe gear that lacks adequate support (ie: worn out shoes, boots and flip-flops) and prolonged standing or walking are often implicated. A throbbing pain that gets worse as the day goes on and can be worse at night when laying in bed is most often associated with an irritated or entrapped nerve on the inside of the ankle or heel. This is similar to carpel tunnel syndrome in the wrist and hand. Approximately 7 / 10 patients with heel pain have a component of nerve entrapment as the cause of their heel pain. This is also one of the most common causes of chronic heel pain because it is often missed as a diagnosis. When nerve entrapment is considered to be a cause, painless neurosensory testing is performed with the Pressure Specified Sensory Device? (PSSD) at The Foot & Ankle Center, PC to determine the extent of compression. A less common cause of heel pain but a stress fracture is often considered in athletes, such as long distance runners, who have heel pain. Posterior Heel Pain (Retrocalcaneal) This is pain in the back of the heel that flares up when first starting an activity. It is often associated with a large bump that can be irritated by shoes. The Achilles tendon attaches to the back of the heel and, like on the bottom, this attachment site can often become inflamed; a spur may or may not be present. Another painful area is a sac of fluid (bursa) that sits between the tendon and bone to act as a cushion for the tendon. This bursa can become inflamed often leading to significant pain called retrocalcaneal bursitis.

Symptoms

Plantar fascia usually causes pain and stiffness on the bottom of your heel although some people have heel spurs and suffer no symptoms at all. Occasionally, heel pain is also associated with other medical disorders such as arthritis (inflammation of the joint), bursitis (inflammation of the tissues around the joint). Those who have symptoms may experience ?First step? pain (stone bruise sensation) after getting out of bed or sitting for a period of time. Pain after driving. Pain on the bottom of your heel. Deep aching pain. Pain can be worse when barefoot.

Diagnosis

Your GP or podiatrist (a healthcare professional who specialises in foot care) may be able to diagnose the cause of your heel pain by asking about your symptoms and examining your heel and foot. You will usually only need further tests if you have additional symptoms that suggest the cause of your heel pain is not inflammation, such as numbness or a tingling sensation in your foot - this could be a sign of nerve damage in your feet and legs (peripheral neuropathy), your foot feels hot and you have a high temperature (fever) of 38C (100.4F) or above - these could be signs of a bone infection, you have stiffness and swelling in your heel - this could be a sign of arthritis. Possible further tests may include, blood tests, X-rays - where small doses of radiation are used to detect problems with your bones and tissues, a magnetic resonance imaging (MRI) scan or ultrasound scan, which are more detailed scans.

Non Surgical Treatment

Treatment options for plantar fasciitis include custom prescription foot orthoses (orthotics), weight loss when indicated, steroid injections and physical therapy to decrease the inflammation, night-splints and/or cast boots to splint and limit the stress on the plantar fascia. Orthotripsy (high frequency ultra-sonic shock waves) is also a new treatment option that has been shown to decrease the pain significantly in 50 to 85 percent of patients in published studies. Surgery, which can be done endoscopically, is usually not needed for over 90 percent of the cases of plantar fasciitis. (However, when surgery is needed, it is about 85 percent successful.) Patients who are overweight do not seem to benefit as much from surgery. Generally, plantar fasciitis is a condition people learn to control. There are a few conditions similar to plantar fascia in which patients should be aware. The most common is a rupture of the plantar fascia: the patient continues to exercise despite the symptoms and experiences a sudden sharp pain on the bottom of the heel and cannot stand on his or her toes, resulting in bruising in the arch. Ruptures are treated very successfully by immobilization in a cast boot for two to six weeks, a period of active rest and physical therapy. Another problem with prolonged and neglected plantar fasciitis is development of a stress fracture from the constant traction of this ligament on the heel bone. This appears more common in osteoporotic women, and is also treated with cast boot immobilization. The nerves that run along the heel occasionally become inflamed by the subsequent thickening and inflammation of the adjacent plantar fascia. These symptoms often feel like numbness and burning and usually resolve with physical therapy and injections. Patients should also be aware that heel numbness can be the first sign of a back problem.

Surgical Treatment

Surgery is a last resort in the treatment of heel pain. Physicians have developed many procedures in the last 100 years to try to cure heel pain. Most procedures that are commonly used today focus on several areas, remove the bone spur (if one is present), release the plantar fascia (plantar fasciotomy), release pressure on the small nerves in the area. Usually the procedure is done through a small incision on the inside edge of the foot, although some surgeons now perform this type of surgery using an endoscope. An endoscope is a tiny TV camera that can be inserted into a joint or under the skin to allow the surgeon to see the structures involved in the surgery. By using the endoscope, a surgeon can complete the surgery with a smaller incision and presumably less damage to normal tissues. It is unclear whether an endoscopic procedure for this condition is better than the traditional small incision. Surgery usually involves identifying the area where the plantar fascia attaches to the heel and releasing the fascia partially from the bone. If a small spur is present this is removed. The small nerves that travel under the plantar fascia are identified and released from anything that seems to be causing pressure on the nerves. This surgery can usually be done on an outpatient basis. This means you can leave the hospital the same day.

bone spur on back of heel

Prevention

Foot Pain

Maintaining flexible and strong muscles in your calves, ankles, and feet can help prevent some types of heel pain. Always stretch and warm-up before exercising. Wear comfortable, properly fitting shoes with good arch support and cushioning. Make sure there is enough room for your toes.

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