Does your heel feel painful when you get up from bed every morning, or when you get up after sitting down for a long period of time? If you often experience this sort of pain, known as first step pain, you could be suffering from plantar fasciitis (pronounced fash-ee-eye-tus), an inflammation of the plantar fascia, or the band of muscle under the foot. Plantar fasciitis is the most common cause of Heel Pain.
Achilles tendon rupture, the tendon of the heel cord behind the ankle is torn. Bone bruise. Bone cyst, a solitary fluid-filled cyst (cavity) in a bone. Gout, levels of uric acid in the blood rise until the level becomes excessive (hyperuricemia), causing urate crystals to build up around the joints. This causes inflammation and severe pain when a gout attack happens. Neuroma (Morton's neuroma) a swollen nerve in the ball of the foot, commonly between the base of the second and third toes. Osteomyelitis , osteomyelitis means infection of the bone or bone marrow; inflammation of the bone due to infection. Osteomyelitis sometimes occurs as a complication of injury or surgery. In some cases, the infection may get into bone tissue from the bloodstream. Patients with osteomyelitis typically experience deep pain and muscle spasms in the inflammation area, as well as fever. Peripheral neuropathy, neuropathy is a collection of disorders that occurs when nerves of the peripheral nervous system (the part of the nervous system outside of the brain and spinal cord) are damaged. The condition is generally referred to as peripheral neuropathy, and it is most commonly due to damage to nerve axons. Neuropathy usually causes pain and numbness in the hands and feet. It can result from traumatic injuries, infections, metabolic disorders and exposure to toxins. One of the most common causes of neuropathy is diabetes. Problems with your gait, wrong posture when walking/running. Rheumatoid arthritis, rheumatoid arthritis, sometimes referred to as rheumatoid disease, is a chronic (long lasting), progressive and disabling auto-immune disease condition that causes inflammation and pain in the joints, the tissue around the joints, and other organs in the human body. Rheumatoid arthritis usually affects the joints in the hands and feet first, but any joint may become affected. Patients with rheumatoid arthritis commonly have stiff joints and feel generally unwell and tired.
Usually worse with the first few steps in the morning or at the initial point of activity. The latter usually gets better with continued activity (squeaky hinge analogy). Walking, running, sprinting, hill running and jumping will increase the pain. Often, the natural response is to walk on the outside of the foot - in supination - to lessen the stress on the plantar fascia - resulting in new problems.
Your doctor will listen to your complaints about your heel and examine you to see what is causing the pain, and whether anything else has started it off. If the cause of your pain seems obvious, your doctor may be happy to start treatment straight away. However, some tests may be helpful in ruling out other problems. Blood tests may be done for arthritis. An Xray will show any arthritis in the ankle or subtalar joint, as well as any fracture or cyst in the calcaneum. (It will also show a spur if you have one, but as we know this is not the cause of the pain.) Occasionally a scan may be used to help spot arthritis or a stress fracture.
Non Surgical Treatment
Orthotics, by treating the cause of the problem, lead to the cure bette than 90% of the time. A small number of patients have waited so long that the plantar fascia has become thickened and filled with scar tissue and are not helped by ?conventional? means. Those are the patients that have, traditionally, required surgical treatment in which the plantar fascia is cut off the heel bone. Luckily, most surgery has been replaced by a relatively new mode of treatment, ESWT or Extracorporeal Shockwave Therapy. ESWT involves the application of multiple shockwaves to the diseased tendon or ligament and has an approximately 85 to 90% success rate. Keep in mind we are talking about this success rate in patients who are ?tough cases,? that is, already had the conventional treatment. The ESWT machines look like miniature renal lithtripsors (kidney stone crushers). There are virtually no side effects to ESWT other than the price as only about 30% of insurance companies are paying for it. They realize that it is less costly and safer than surgery but also know that many more people who would avoid surgery would have no problem getting ESWT so the volume of services would go up. You don?t have to live with painful heels.
Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you. No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.
It is not always possible to prevent heel pain, but there are measures you can take to help avoid further episodes. Being overweight can place excess pressure and strain on your feet, particularly on your heels. This increases the risk of damaging your feet and heels. If you are overweight, losing weight and maintaining a healthy weight by combining regular exercise with a healthy, balanced diet can be beneficial for your feet. You can calculate your body mass index (BMI) to find out whether you are a healthy weight for your height and build. To work out your BMI, divide your weight in kilograms by your height in metres squared. A BMI of less than 18.5 means that you are underweight, 18.5-24.9 means that your weight is healthy, 25-29 means that you are overweight, 30-40 means that you are obese, over 40 means that you are morbidly obese. You can also use the BMI healthy weight calculator to work out your BMI.