Heel Pain The Causes, Warning Signs And Treatment Choices

Overview

More than 20 percent of patients visit foot specialists because of Heel Pain, and approximately one-third of all patients I see come because of this problem. Over 50 percent of Americans will experience heel pain during their lifetime. The most common form of heel pain is known as plantar fasciitis or “heel spur syndrome.” The plantar fascia is a thick ligament on the bottom of your foot spanning from your heel to the base of your toes. It supports the arch and several muscles under the bones that support the foot. Overtime, most people will develop some degree of calcification within these muscles on the bottom of their heel called a “spur.”

Causes

Here are a few in-depth explanations of heel pain causes and potential remedies for those that are afflicted Plantar Fascitis, One of the most well-known causes of heel pain, plantar fascitis occurs when the thick tissue along the arch of the foot becomes tight and inflamed. The foot itself can feel cramped when this tissue is inflamed, causing the afflicted person to feel as if they have a muscle cramp that flexing the foot doesn?t seem to alleviate. Plantar fascitis is most common among men over the age of 40. Warning Signs, The first steps in the morning are extremely painful. Pain flares up after activities like stair or steep hill climbing. Pain continues to occur regardless of the type of shoes or lack of shoes worn.

Symptoms

Symptoms of plantar fasciitis vary, but the classic symptom is pain after rest–when you first get out of bed in the morning, or when you get up after sitting down for a while during the day. The pain usually diminishes after a few minutes of walking, sometimes even disappearing, but the pain is commonly felt again the longer you’re on the foot. Fasciitis can be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation of long-periods of standing, especially on concrete, by being overweight. It doesn’t help that fascia doesn’t heal particularly quickly because it has relatively poor circulation (which is why it’s white in colour).

Diagnosis

In most cases, your GP or a podiatrist (a specialist in foot problems and foot care) should be able to diagnose the cause of your heel pain by asking about your symptoms and medical history, examining your heel and foot.

Non Surgical Treatment

Treatment of heel pain generally occurs in stages. At the earliest sign of heel pain, aggressive calf muscle stretching should be started. Additionally, taking an oral anti-inflammatory medication and over-the- counter arch supports or heel cushions may be beneficial. The next phase of treatment might consist of continued calf muscle stretching exercises, cortisone injections and orthopedic taping of the foot to support the arch. If this treatment fails, or if there is reoccurrence of the heel pain, then functional foot orthotics might be considered. A functional orthotic is a device that is prescribed and fitted by your foot doctor, which fits in normal shoes like an arch support. Unlike an arch support, however the orthotic corrects abnormal pronation of the subtalar joint. Thus orthotics address the cause of the heel pain – abnormal pronation of the foot. Pump bump, treatment is similar to the treatment of bursitis and heel spurs. In rare cases, the bony growth at the heel may need to be removed surgically. Heel bruises can be treated by applying an ice pack for the first few minutes after injury. Achilles tendonitis, this condition is treated conservatively with rest, NSAIDs and physical therapy. If a sprain, fracture or other injury has caused the trapped nerve, this underlying problem must be treated first. In rare cases, surgery may be done to release the trapped nerve.

Surgical Treatment

It is rare to need an operation for heel pain. It would only be offered if all simpler treatments have failed and, in particular, you are a reasonable weight for your height and the stresses on your heel cannot be improved by modifying your activities or footwear. The aim of an operation is to release part of the plantar fascia from the heel bone and reduce the tension in it. Many surgeons would also explore and free the small nerves on the inner side of your heel as these are sometimes trapped by bands of tight tissue. This sort of surgery can be done through a cut about 3cm long on the inner side of your heel. Recently there has been a lot of interest in doing the operation by keyhole surgery, but this has not yet been proven to be effective and safe. Most people who have an operation are better afterwards, but it can take months to get the benefit of the operation and the wound can take a while to heal fully. Tingling or numbness on the side of the heel may occur after operation.

Prevention

A variety of steps can be taken to avoid heel pain and accompanying afflictions. Wear shoes that fit well-front, back, and sides-and have shock-absorbent soles, rigid shanks, and supportive heel counters. Wear the proper shoes for each activity. Do not wear shoes with excessive wear on heels or soles. Prepare properly before exercising. Warm up and do stretching exercises before and after running. Pace yourself when you participate in athletic activities. Don?t underestimate your body’s need for rest and good nutrition. If obese, lose weight.

What Could We Do About Achilles Tendinitis ?

Overview

Achilles tendinitis is an irritation/inflammation in the achilles tendon, which attaches to the back of the heel. It is often a result of overuse and occurs frequently in runners who have altered their training suddenly, either with regard to duration or intensity. This injury is also prevalent in middle-aged people who are active.

Causes

Some of the causes of Achilles tendonitis include, overuse injury – this occurs when the Achilles tendon is stressed until it develops small tears. Runners seem to be the most susceptible. People who play sports that involve jumping, such as basketball, are also at increased risk. Arthritis – Achilles tendonitis can be a part of generalised inflammatory arthritis, such as ankylosing spondylitis or psoriatic arthritis. In these conditions, both tendons can be affected. Foot problems – some people with flat feet or hyperpronated feet (feet that turn inward while walking) are prone to Achilles tendonitis. The flattened arch pulls on calf muscles and keeps the Achilles tendon under tight strain. This constant mechanical stress on the heel and tendon can cause inflammation, pain and swelling of the tendon. Being overweight can make the problem worse. Footwear – wearing shoes with minimal support while walking or running can increase the risk, as can wearing high heels. Overweight and obesity – being overweight places more strain on many parts of the body, including the Achilles tendon. Quinolone antibiotics – can in some instances be associated with inflammatory tenosynovitis and, if present, will often be bilateral (both Achilles), coming on soon after exposure to the drug.

Symptoms

People with Achilles tendinitis may experience pain during and after exercising. Running and jumping activities become painful and difficult. Symptoms include stiffness and pain in the back of the ankle when pushing off the ball of the foot. For patients with chronic tendinitis (longer than six weeks), x-rays may reveal calcification (hardening of the tissue) in the tendon. Chronic tendinitis can result in a breakdown of the tendon, or tendinosis, which weakens the tendon and may cause a rupture.

Diagnosis

Laboratory studies usually are not necessary in evaluating and diagnosing an Achilles tendon rupture or injury, although evaluation may help to rule out some of the other possibilities in the differential diagnosis. Imaging studies. Plain radiography: Radiographs are more useful for ruling out other injuries than for ruling in Achilles tendon ruptures. Ultrasonography: Ultrasonography of the leg and thigh can help to evaluate the possibility of deep venous thrombosis and also can be used to rule out a Baker cyst; in experienced hands, ultrasonography can identify a ruptured Achilles tendon or the signs of tendinosis. Magnetic resonance imaging (MRI): MRI can facilitate definitive diagnosis of a disrupted tendon and can be used to distinguish between paratenonitis, tendinosis, and bursitis.

Nonsurgical Treatment

Ask your Pharmacist for advice. 1) Your Pharmacy stocks a range of cold packs which may be applied to the area to decrease inflammation. 2) Ask your Pharmacist about a temporary heel raise or pad which can be inserted into footwear to decrease the force absorbed by the tendon when the feet land heavily on the ground. 3) Gently massaging a heat-producing liniment into the calf can help to relieve tension in the muscle which may relieve the symptoms of Achilles Tendinitis. Ask your Pharmacist to recommend the most appropriate type. 4) Gels, sprays or creams which help to reduce inflammation are available and may be applied to the injured area. Ask your Pharmacist for advice. 5) Your Pharmacist can advise you on analgesic, anti-inflammatory medications such as Aspirin which may be of assistance. Aspirin should be avoided in children under the age of 12 and those aged 12 to 15 who have a fever. 6) Strapping the ankle can help restrict movement and minimise further injury. Your Pharmacist stocks a range of athletic strapping tape and ankle guards which may assist your injury.

Surgical Treatment

If non-surgical treatment fails to cure the condition then surgery can be considered. This is more likely to be the case if the pain has been present for six months or more. The nature of the surgery depends if you have insertional, or non-insertional disease. In non-insertional tendonosis the damaged tendon is thinned and cleaned. The damage is then repaired. If there is extensive damage one of the tendons which moves your big toe (the flexor hallucis longus) may be used to reinforce the damaged Achilles tendon. In insertional tendonosis there is often rubbing of the tendon by a prominent part of the heel bone. This bone is removed. In removing the bone the attachment of the tendon to the bone may be weakened. In these cases the attachment of the tendon to the bone may need to be reinforced with sutures and bone anchors.

Prevention

Maintaining strength and flexibility in the muscles of the calf will help reduce the risk of tendinitis. Overusing a weak or tight Achilles tendon makes you more likely to develop tendinitis.

The Facts Not Misguided Beliefs Regarding Ruptured Achilles Tendons

Overview

An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity. Forceful jumping or pivoting, or sudden accelerations of running, can overstretch the tendon and cause a tear. An injury to the tendon can also result from falling or tripping. Achilles tendon ruptures are most often seen in ?weekend warriors? – typically, middle-aged people participating in sports in their spare time. Less commonly, illness or medications, such as steroids or certain antibiotics, may weaken the tendon and contribute to ruptures.

Causes

Your Achilles tendon helps you point your foot downward, rise on your toes and push off your foot as you walk. You rely on it virtually every time you move your foot. Rupture usually occurs in the section of the tendon located within 2 1/2 inches (about 6 centimeters) of the point where it attaches to the heel bone. This section may be predisposed to rupture because it gets less blood flow, which also may impair its ability to heal. Ruptures often are caused by a sudden increase in the amount of stress on your Achilles tendon. Common examples include increasing the intensity of sports participation, especially in sports that involve jumping, falling from a height, stepping into a hole.

Symptoms

Typically patients present with sudden onset of pain and swelling in the achilles region, often accompanied by a audible snap during forceful dorsiflexion of the foot. A classic example is that of an unfit ‘weekend warrior’ playing squash. If complete a defect may be felt and the patient will have only minimal plantar flexion against resistance.

Diagnosis

An Achilles’ tendon injury can be diagnosed by applying the Thompson Test (or Calf Squeeze Test) this is where the person who has suffered the injury lies on their front with their legs bent. Whoever is performing the test, usually a doctor, will then squeeze the calf muscle. If the tendon has not ruptured then the foot should point briefly away from the leg.

Non Surgical Treatment

Your doctor may advise you to rest your leg and keep the tendon immobile in a plaster cast while it heals. Or you may need to have an operation to treat an Achilles tendon rupture. The treatment you have will depend on your individual circumstances, such as your age, general health and how active you are. It will also depend on whether you have partially or completely torn your tendon. If you have a partial tear, it might get better without any treatment. Ask your doctor for advice on the best treatment for you. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Surgical Treatment

Surgical repair is a common method of treatment of acute Achilles rupture in North America because, despite a higher risk of overall complications, it has been believed to offer a reduced risk of rerupture. However, more recent trials, particularly those using functional bracing with early range of motion, have challenged this belief. The aim of this meta-analysis was to compare surgical treatment and conservative treatment with regard to the rerupture rate, the overall rate of other complications, return to work, calf circumference, and functional outcomes, as well as to examine the effects of early range of motion on the rerupture rate.