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  • Writer's pictureDr. Darshil Shah

Heel Pain

Updated: Feb 17, 2022

Heel pain or Plantar fascitis is characterized by stiffness and inflammation of the main fascia, the fibrous connective ligament-like tissue, on the bottom of the foot. Plantar fascitis is occasionally associated with a bone spur on the heel or with a partial or complete tear of the fascia of the bottom of the foot. Bone spurs themselves usually do not cause symptoms.


Common signs and symptoms

  • Pain and tenderness in the sole of the foot, mostly under the heel bone, with standing or walking

  • Pain with the first steps when getting out of bed in the morning or after sitting


Causes




  • Stress or injury to the heel, which causes inflammation and calcification of the fascia of the foot

  • Irritation of a small nerve that runs under the foot, where the main fascia attaches to the heel bone

  • Tight calf muscles or flat feet

  • Shoes that do not fit well, those that have inadequate or rigid arch supports, and shoes with soles that are too stiff

  • Activities that require sudden turns or stops


Factors that increase risk

  • Sports that require running or jogging and sudden stops or changes in direction

  • Prolonged standing

  • Poor physical conditioning (strength, flexibility)

  • Inadequate warm-up before practice or play

  • Obesity

  • Flat feet


Preventive measures

  • Appropriately warm up and stretch before practice and competition.

  • Maintain appropriate conditioning that includes calf, ankle, and foot flexibility, strength and endurance training, and cardiovascular fitness.

  • Maintain an ideal body weight.

  • Avoid activities that put a constant strain on the foot (e.g., walking, running).

  • Wear appropriate shoes with a rubber or felt heel cushion and good arches or cushioned arch supports.



General treatment considerations

Initial treatment consists of medications and ice to relieve pain, stretching exercises of the heel cord and achilles tendon, and modification of activities. A heel cup or felt insert in the shoe to relieve pressure on the heel is usually recommended. Occasionally, wearing splints at night may be offered, but chronic cases may require referral to a physical therapist or athletic trainer for further evaluation and treatment. Arch supports are helpful for people with flat feet to prevent or treat this problem. Surgery is sometimes needed to release the fascia and nerve, and it is often effective at relieving the symptoms.


Medication

  • Nonsteroidal antiinflammatory medications, such as aspirin and ibuprofen (do not take for 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician, and contact your doctor immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

  • Cortisone injections reduce inflammation; however, these should be used sparingly. The number of times cortisone may be given is limited.


Heat and cold

  • Cold is used to relieve pain and reduce inflammation for acute and chronic cases. It should be applied for 10 to 15 minutes every 2 to 3 hours as needed and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.



RANGE OF MOTION AND STRETCHING EXERCISES

These are some of the initial exercises you may use to start your rehabilitation program, until you see your physician, physical therapist, or athletic trainer again, or until your symptoms resolve. Please remember:

  • Flexible tissue is more tolerant of the stresses placed on it.

  • A gentle stretching sensation should be felt.

Range of motion ▪ Toe extension



1. Grip your toes and pull them up toward your body as shown.

2. Hold this position for 10 seconds.

3. Return to the starting position, and pull the toes down.

4. Hold this position for 10 seconds.


Range of motion ▪ Ankle dorsiflexion



1. Sit on the edge of a chair as shown, and place your injured foot closest to the chair

2. Keep your foot flat on the floor, and move your knee forward over your foot.

3. Hold this position for 10 - 15 seconds.


Flexibility ▪ Ankle (Gastrocsoleus) stretch


1. Stand one arm’s length from the wall as shown. Position the calf muscle to be stretched behind you as shown.

2. Turn the toes in and heel out of the leg to be stretched.

3. Lean toward the wall, leading with your waist and allowing your arms to bend. First do this exercise with your knee straight, then bend it slightly. Keep your heel on the floor at all times.

4. Hold this position for 10 - 15 seconds.


Flexibility ▪ Ankle (Gastrocsoleus) stretch




Note: This exercise can place considerable stress on your foot and ankle and should only be done after checking with your physician, physical therapist, or athletic trainer.

1. Place your toes and the ball of your foot on a stack of books or on the edge of a stair. Your heel should be off the ground.

2. Hold on to a chair or stair rail for balance, and allow your body weight to stretch your calf. First do this exercise with your knee straight, then bend it slightly.

3. Hold this position for 10 seconds.



STRENGTHENING EXERCISES

These are some of the initial exercises you may use to start your rehabilitation program, until you see your physician, physical therapist, or athletic trainer again, or until your symptoms resolve. Please remember:

  • Strong muscles with good endurance tolerate stress better.

  • Do the exercises as initially prescribed by your physician, physical therapist, or athletic trainer. Progress slowly with each exercise under their guidance, gradually increasing the number of repetitions and weight used.

Strength ▪ Ankle inversion


1. Attach one end of an elastic band to a fixed object, such as the leg of a table or desk. Loop the other end around your foot.

2. Turn your foot inward as far as possible, attempting to push your little toe down and in.

3. Hold this position for 10 seconds, and slowly return to the starting position. Strength ▪ Towel curls



1. Sit in a chair on a noncarpeted floor. Place a towel on the floor in front of you, and place your foot on the towel as shown. You may also stand to do this exercise.

2. Pull the towel toward you with your toes, keeping your heel on the floor. Move the towel with your toes only. Do not move your knee or ankle.

3. If this is too easy, place a light weight—a book, hand weight, or canned food—at the far end of the towel.




The above article is written to provide general information to the common public. Please consult your orthopaedic surgeon before beginning any sort of treatment. Do not attempt to self-medicate as this may lead to undesirable side effects.

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