Ouch! What’s that Morning Heel Pain?

Plantar fasciitis (fashee-EYE-tiss) is the most common cause of pain on the bottom of the heel.

                                                                                                                                                                             Plantar fasciitis occurs when the strong band of tissue that supports the arch of your foot becomes irritated and inflamed.

Anatomy

The plantar fascia is a long, thin ligament that lies directly beneath the skin on the bottom of your foot. It connects the heel to the front of your foot, and supports the arch of your foot.

 The plantar fascia is a thick fibrous band of connective tissue that supports the arch of the foot and assists with propulsion of the foot when walking.

• During rest (e.g. when you're asleep), the plantar fascia tightens and shortens. When body weight is rapidly applied to the foot, the fascia must stretch and quickly lengthen, causing micro-tearing of the tissue. Hence, the pain is more severe with your first steps in the morning or after sitting for a long period

Plantar fasciitis is often caused by pulling of the plantar fascia at its insertion point at the calcaneus (heel bone) and developing micro tears. The pain can also extend to the side of the heel and the arch of the foot

causes:

The plantar fascia is designed to absorb the high stresses and strains we place on our feet. But, sometimes, too much pressure damages or tears the tissues. The body's natural response to injury is inflammation, which results in the heel pain and stiffness of plantar fasciitis.

Risk Factors

In most cases, plantar fasciitis develops without a specific, identifiable reason. There are, however, many factors that can make you more prone to the condition

• Tighter calf muscles that make it difficult to flex your foot and bring your toes up toward your shin


• Obesity


• Very high arch


• Repetitive impact activity (running/sports)


• New or increased activity

Heel Spurs

Although many people with plantar fasciitis have heel spurs, spurs are not the cause of plantar fasciitis pain. Because the spur is not the cause of plantar fasciitis, the pain can be treated without removing the spur.

Heel spurs do not cause plantar fasciitis pain.

Symptoms

The most common symptoms of plantar fasciitis include:

• Pain on the bottom of the foot near the heel


• Pain with the first few steps after getting out of bed in the morning, or after a long period of rest, such as after a long car ride. The pain subsides after a few minutes of walking


• Greater pain after (not during) exercise or activity

Treatment:

• Nonsurgical TreatmentMore than 90% of patients with plantar fasciitis will improve within 10 months of starting simple treatment methods.
  

• Rest. Decreasing or even stopping the activities that make the pain worse is the first step in reducing the pain. You may need to stop athletic activities where your feet pound on hard surfaces (for example, running or step aerobics).


• Ice. Rolling your foot over a cold water bottle or ice for 20 minutes is effective. This can be done 3 to 4 times a day.


• Non steroidal anti-inflammatory medication. Drugs such as ibuprofen or naproxen reduce pain and inflammation. Using the medication for more than 1 month should be reviewed with your primary care doctor

.Cortisone injections. Cortisone, a type of steroid, is a powerful anti-inflammatory medication. It can be injected into the plantar fascia to reduce inflammation and pain. Your doctor may limit your injections. Multiple steroid injections can cause the plantar fascia to rupture (tear), which can lead to a flat foot and  chronic pain.                                                                                                                                                                                                                                                                                                      physical therapy:                                                                                                                                                                                                                                                                                                

• physical therapy intervention includes regaining proper mechanical alignment.


• modalities to reduce pain&inflammation.


• iontophorosis is the use of electrical impulses from low voltage galvanic current stimulation unit to drive topical corticosteroids in to soft tissue structures.


• ultrasound and electrical stimulation are also very effective in treating plantar fascitis


• careful flexibility exercise for triceps surae


• joint mobilization to identified restrictions.


• night splints


• strengthening of invertors of foot


• patient education regarding selection of foot wear ,and orthotic fitting.

Your doctor may suggest that you work with a physical therapist on an exercise program that focuses on stretching your calf muscles and plantar fascia.

• Plantar fasciitis is aggravated by tight muscles in your feet and calves. Stretching your calves and plantar fascia is the most effective way to relieve the pain that comes with this condition.

•  calf stretch:                                                                                                                       
• Lean forward against a wall with one knee straight and the heel on the ground. Place the other leg in front, with the knee bent. To stretch the calf muscles and the heel cord, push your hips toward the wall in a controlled fashion. Hold the position for 10 seconds and relax. Repeat this exercise 20 times for each foot. A strong pull in the calf should be felt during the stretch.

                               Plantar fascia stretch 

1. Cross your problem leg over your other leg.

   2. Using the hand on your problem side, take hold of your problem foot and pull your toes back towards shin. This creates tension/stretch in the arch of the foot/plantar fascia.

   3. Check for the appropriate stretch position by gently rubbing the thumb of your unaffected side left to right over the arch of the affected foot. The plantar fascia should feel firm, like a guitar string.

   4. Hold the stretch for a count of 10. A set is 10 repetitions.

   5. Perform at least 3 sets of stretches per day. You cannot perform the stretch too often.

Try doing this stretch before taking your first steps in the morning and after sitting for a prolonged period.

• Plantar Fascia
  
  Long Flexors of the toes (Flexor Hallucis Longus and FlexorDigitorumLongus)stretch:                                                                                                                                                                         Kneel down with your toes bending upwards Lower your buttocks towards your heels

  Apply pressure to your heels until a stretch in the arch of your foot and the Achilles tendon region is felt 

                                            Taping:

• several ways to do a low-Dye taping, even its most basic form is effective. The magnitude of the effect, however, is small, so arch taping is only one part of a rehabilitation plan

 

Instructions for a low-Dye taping.

 The lateral straps (lower left, lower right) should be pulled reasonably firmly and should always come FROM the outside of the foot TO the inside.

Soft heel pads can provide extra support.

Supportive shoes and orthotics.

• Shoes with thick soles and extra cushioning can reduce pain with standing and walking. As you step and your heel strikes the ground, a significant amount of tension is placed on the fascia, which causes micro trauma (tiny tears in the tissue).

• A cushioned shoe or insert reduces this tension and the micro trauma that occurs with every step.


• Soft silicone heel pads are inexpensive and work by elevating and cushioning your heel. Pre-made or custom orthotics (shoe inserts) are also helpfull.


• Night splints. Most people sleep with their feet pointed down. This relaxes the plantar fascia and is one of the reasons for morning heel pain. A night splint stretches the plantar fascia while you sleep. Although it can be difficult to sleep with, a night splint is very effective and does not have to be used once the pain is gone.

                        

            

                Exercises

                                                 Elgin Arch exerciser Foot Strengthening Device                                                                                                                                                                                                                                                                                                                        

Extracorporeal shockwave therapy (ESWT):     
                                                                                                                                   During this procedure, high-energy shock wave impulses stimulate the healing process in damaged plantar fascia tissue.

 ESWT has not shown consistent results and, therefore, is not commonly performed. ESWT is noninvasive—it does not require a surgical incision. Because of the minimal risk involved, ESWT is sometimes tried before surgery is considered

 surgical treatment:

Surgery is considered only after 12 months of aggressive nonsurgical treatment.

• Gastronemius recession. This is a surgical lengthening of the calf (gastronemius) muscles. Because tight calf muscles place increased stress on the plantar fascia, this procedure is useful for patients who still have difficulty flexing their feet, despite a year of calf stretches.Complication rates for gastronemius recession are low, but can include nerve damage.


• Plantar fascia release. If you have a normal range of ankle motion and continued heel pain, your doctor may recommend a partial release procedure. During surgery, the plantar fascia ligament is partially cut to relieve tension in the tissue.


• Complications. The most common complications of release surgery include incomplete relief of pain and nerve damage.

Disclamier:

This information might have been copied from different sources to give the best accessible