Total Foot Care

Heel Pain Syndrome

Plantar Fasciitis is often referred to as heel pain and it is a common foot condition. It usually starts as a dull intermittent pain under the heel and it may progress to a sharp pain. Usually heel pain is much worse in the morning with the first few steps, or after sitting for a period of time and then standing up. The pain normally dissappears when you start walking but comes back after a period of rest. If left untreated Plantar Fasciitis may develop into a to severe and persistent pain that can stop people from normal activities such as walking, running or sports. The plantar fascia is a broad band of fibrous tissue which runs along the bottom surface of the foot from the heel bone to the toes. It is attached to the heel bone (calcaneus) and fans forward toward the ball of the foot. Plantar Fasciitis is caused by inflammation of the tissues and ligament connected to the heel bone, due to excessive pulling and stretching of the fibrous bands that support the arch of the foot. Continuation of this irritation can lead to heel pain and also arch pain. In some patients a bony growth on the bottom of the heel bone called a heel spur. Not all heel pain is plantar fasciitis, heel pain syndrome is caused by repetitive pressure placed on the heel of the foot when walking, which causes soreness of the heel. The itis part of Fasciitis is Latin for inflammation of a certain part of the body. For example, Bursitis refers to the inflammation of the Bursa - the natural cushion padding that supports the heel of the foot (the bursa). Bursitis is often associated with Plantar Fasciitis, which affects the arch and heel of the foot. Local steroid injections are effective, but can be quite painful and increase the risk of plantar fascia rupture. Surgical management is a last resort and should only be considered after 12 months of failed conservative treatment. Surgery consists of plantar fascia release, plantar nerve release and debridement of the calcaneal spur. Sore heels can also be attributed to achilles tendonitis with symptoms localised at the back of the heel.

Heel Spur Syndrome

Bursitis and Plantar Fasciitis can occur when a person increases their levels of physical activity or when the heels fat pad becomes thinner as a result of age. This means less protection for the heel and foot and more chance of injury. Poor fitting shoes, obesity, biomechanical problems such as mal-alignment of the foot, including over-pronation, gout and rheumatoid arthritis are also possible causes for plantar fasciitis problems.Treatment options include: Cold presses or ice packs, Anti-inflammatory drugs, gel heel cushioning, massage of the foot, muscle strengthening and also stretching exercises. Orthotics insoles are the most effective treatment for this type of foot condition because they address the underlying biomechanical cause. I.e. orthotics reduce the strain and tension on the injured ligament, allowing the tissue to heal much faster. It should be noted that orthotics are not the same as arch supports. Orthotics address biomechanical function of the foot, while arch supports simply support the arch. Appropriate footwear is a key consideration for the prevention of plantar fasciitis. Heel pain or plantar fasciitis is one of the most common foot complaints seen in an Orthopaedic unit. Plantar fasciitis was first described thirty years ago, but we are no closer in understanding the true medical aetiology of this condition. Theories have been proposed ranging from inflammation to nerve entrapment. Plantar fasciitis typically can occurs in people from all ages from teenagers to the elderly. The patient usually experiences uni-lateral heel pain (specifically on the anterior medial border of the calcaneal tuberosity) with their first step in the morning, this pain eases after a few steps but re-occurs by the end of the day. Calcaneal spurs have been previously associated with plantar fasciitis.

Pain the ball of the foot

The foot is a complex part of the body and features 26 different bones which are connected by many joints, muscles, tendons, ligaments and nerves. The foot is susceptible to stress and strain, leading to foot pain and other problems which may cause inflammation, injur and limited mobility. What are the different types of foot complaints? Foot pain is often caused by improper biomechanical foot function, poorly fitted shoes, diabetes or simply ageing. Footwear that does not fit properly or provides little arch support can cause irritation to the foot joints and skin. There are many types of foot complaints, affecting the heels, toes, ball of the foot, nerves, tendons, arches and ligaments or joints of the foot. Pain in the balls of the feet is very common and also referred to as metatarsalgia. It is a very common complaint in women wearing high-heeled fashion shoes, but may also be experienced by men and women whilst wearing normal flat footwear. Gaining relief from this condition starts with wearing proper footwear with support along both longitudinal and metatarsal arches. The biomechanics of metatarsalgia. Every time you take a step and put pressure on the ball of the foot the metatarsal arch begins to flatten. This allows the metatarsal (or transverse) arch to act as a natural shock absorber. As the foot goes through the gait cycle our body weight shifts from the back of the foot (the heel bone) to the front. When we step forward all of our body weight is forced onto the balls of the feet. If they are not aligned properly and supported or if we have insufficient natural fatty padding under the foot, we will experience pain and inflammation. Pain in the ball of your foot is experienced by many patients.

What causes Metatarsalgia?

Dropped metatarsal bones is the major cause of this condition. Our feet have 5 metatarsals, connected to the toes. If one or more of the metatarsal heads is placed below the other bones it will bear more of body weight and pressure than it should. Often if our foot muscles and ligaments are too loose and flexible foot the bones and joints are not held in their optimal position. High-heeled ladies fashion shoes shift your weight forward onto the ball of the foot. The increased weight and pressure stretches the soft tissues allowing the metatarsal head to drop, causing inflammation and irritation and in may cases excessive callus formation. Injury such as fractured bones or foot joints that are not properly positioned also contribute to this problem. For example a very common injury is found in military and police recruits who take up walking long distances in hard footwear for the first time. Fractures of the metatarsal bones, located in the forefoot area, often do not require a cast. Sesamoid bone fractures. The sesamoid bones are 2 small, round bones at the end of the metatarsal bone of the big toe (Hallux). Usually padded soft insoles can help relieve pain, however in some cases the sesamoid bone may have to be surgically removed. Toe fractures. Fractures of the middle toes can heal without a cast. Fractures of the big toe or little toe are more complicated to treat and may require a cast or surgery. Foot pain can be debilitating to the pursuit of an active lifestyle. Foot pain can have many sources, from fractures and sprains to nerve damage. Pain in the ball of the foot, located on the bottom of the foot behind the toes may be caused by nerve or joint damage in that area of the foot. In addition, a benign growth such as Morton's Neuroma can cause pain and inflammation. Corticosteroid injections and wearing supportive shoe inserts (orthotic insoles) may help relieve the pain.

Plantar Fasciitis Treatment options

Plantar Fasciitis is generally known as pain at the bottom of the heel and can be caused by a number of factors such as speed workouts (running), walking up hills, sleeping with toes pointed away from you, over-pronation or supination, walking in hard-bottom shoes or high heels, improper shoe fit (narrow tight shoes), coming up onto toes when running, dropping the heel on the bike during the pedalstroke. It is often believed that the root of this problem is not at the bottom of the foot, but rather in the lower leg, This is why... The Tibialis Posterior is a muscle located just underneath the Soleus and Gastrocnemius and connects from the arch of the foot all the way to the back of the knee. Logic tells us to treat the muscles that are pulling on or from the insertion point rather than treating the bottom of the foot alone. By force-feeding blood and oxygen into this area of the leg, we are creating elasticity in the muscle that is needed to relieve the pulling at the insertion points. You will find that the calf region is very sensitive and it can be the real source of your foot and heel pain problem. It is best to do these stretches before and after activity and within an hour and before going to bed. Each manipulation should last about 5 minutes. It is imperative that you breathe deeply during these exercises and keep your foot relaxed. The movement is extremely slow and specific to the area above the achilles tendon. An orthotic is then prescribed. Additionally, a surgical procedure to treat plantar fasciitis can cause disability, but in very rare cases only. Approximately half of those who suffer from plantar fasciitis also have a heel spur. In addition, an estimated ten percent of adults in the country have a heel spur without pain or other foot problems. Some complications may arise from the plantar fasciitis treatment received.

Ice Therapy

Ice can help with reducing the heel inflammation. When it is necessary, place ice on the foot for a maximum of 10 minutes. Any longer and a loss of elasticity can set in. Stretching exercises are also useful but one should be careful. If you stretch without having any elasticity in the ligament, it can cause damage, adhesions and scar tissue within the muscles. If both stretching and icing are done at the same time you can lose elasticity in the muscles rapidly. Therefore please be very careful if choosing this method and consult a physical therapist or podiatrist. In very rare cases the heel spur forms a bony growth, which you can feel under the skin and creates some local pressure. Still, the actual pain once associated with this growth is explained in reality by inflammation of the fascia that in turn has caused its formation. When the inflammation is healed, the heel spur remains, but will cause no pain. Plantar fasciitis is a painful condition of the foot. It is defined as inflammation of the plantar fascia, the fibrous covering of the tendon that forms the arch of the foot (from Latin: fascia = band). The role of the plantar fascia is to support and protect the tendon of the foot. In many patients, this heel problem is the second leading cause of foot pain. Very active athletes are most often affected because they place a lot of load and pressure on their feet, especically when landing on the heel bone. People who once suffered this condition will find it can recurr after a number of months or years. Hence, prevention of heel pain is crucial. When plantar fasciitis is chronic, a heel spur can occur. It is a small bony prominence that forms where the plantar fascia joins the heel bone (calcaneus). It is also called calcaneal exostosis or spur. For example, injections of cortisone may cause a rupture of the plantar fascia. The arch of the foot collapses. The pain is most felt in the same place and with equal intensity.

Orthoses and foot orthotics

This article explains the meaning of the medical terms orthosis, orthoses and orthotics. An orthosis is defined as a orthopaedic appliance or device used to support, align or correct any deformities in the body or to improve the function of parts of the body. The plural of orthosis is orthoses. The word Ortho is Greek for to correct. Orthoses are also referred to as braces and splints. However, orthoses for the foot are often called orthotics or orthotic insoles. Here are some examples of various types of orthoses available:

Cervical Orthosis: a hard plastic device that encircles the neck and supports the chin and the back of the head, making sure it aligns with the spine. AFO: Ankle Foot Orthosis. This is a corrective device for the lower limb that encapsulates the foot and ankle usually ends above the knee. In case of weakness the ankle and foot this device helps you master your everyday activities. The risk of falling or tripping is much reduced and one can walk safely. KAFO: a knee Ankle Foot Orthosis. This device extends from above the knee to the ankle and foot. LSO or Lumbo-sacral Orthosis is a spinal corrective device that encircles the body in the lower back region. An orthotist is an allied health professional who is concerned with the design, development, fitting and manufacturing of orthoses. Foot orthotics are prescribed by a podiatrist and manufactured from a cast (or foot print) by a laboratory. Orthotic therapy is prescribed by podiatrists to help with foot and leg alignment and in turn to aid in the treatment of common foot complaints such as Pes Planus, Plantar Fasciitis, Metatarsalgia, Shin splints and in some cases lower back pain. Many athletes use foot orthotics to help them perform better and achieve optimal biomechanics during running and sports. Young children who are flat-footed also may need an orthosis prescription to help them develop a natural foot arch. They can help with typical conditions such as Sever's Disease. Your shoes need to compliment the orthotics to work as one single unit. Some features of shoes that accommodate orthotics are removable footbeds or innersoles. Enough depth around the heel area. The Gait cycle is your natural Movement Pattern. At the end of the swing phase, the foot is dynamically guided back by the orthotics so that you can once again step comfortably with your heel at the start of the standing phase. Foot orthoses are an important part of the medical treatment offered by podiatrists and sometimes chiropodists. Podiatrists are qualified at providing quality foot orthoses to the public. Orthopaedic surgeons perform operations on the foot, for exammple the removal of bunions or hallux abducto valgus and other foot disorders. The definition of a foot orthosis is a medical device to support and align the foot to prevent or correct foot deformities or to improve the functions of the foot and lower extremity. Custom made devices are manufactured to a prescription from casts taken when the foot is held in a corrected position. Fitting and breaking in of orthotics. Orthotic devices do require fitting into the footwear through the consultation process. There is usually a breaking in process for any new orthotic over a number of weeks.

Tips for the treatment of heel spurs

A typical cause heel pain and calcaneal spurs is a common condition called plantar fasciitis. It is the medical Latin term for inflammation of the Plantar Fascia ligament. This is the broad band of fibrous tissue that runs under your foot and that supports your arch. Because of a number of different factors the plantar fascia are under a lot of tension and continuous pulling may result in inflammation and pain in the heels. Usually at the point where the ligaments insert into the heel bone. Sometimes also at the back of the heel (achilles tendon). Exessive pronating of the feet and tight calf muscles, as well as the normal aging process are the main causes for the plantar fascia being tense. Also and being overweight or obese is a contributing factor. There are a number of treatment methods available. for example cortisone-steroid injections and also surgery. In most cases heel pain relief can be achieved, however, via self-treatment by doing any of the following:

1. Ball roll under the foot

Heel pain is worse in the morning because of the tightening of the fascia that occurring during sleep and rest. Stretching and massaging the plantar fascia before getting up will help ease the pain during the remainder of the day. This can be achieved by rolling a golf ball or tennis bal under your foot. (more...)