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January 17 2015

jhopson88

What Brings About Painful Heel To Surface

Heel Pain

Overview

Plantar fasciitis is a condition characterised by damage and inflammation to the plantar fascia (i.e. the connective tissue on the sole of the foot forming the inner arch. This usually occurs at the attachment of the plantar fascia to the heel bone. Plantar fasciitis is the most common cause of heel pain seen in clinical practice. During walking or running, tension is placed through the plantar fascia. When this tension is excessive (often due to poor foot biomechanics such as flat feet or if it is too repetitive or forceful, damage to the plantar fascia can occur. Plantar fasciitis is a condition where there is damage to the plantar fascia with subsequent inflammation and degeneration. This may occur traumatically due to a high force going through the plantar fascia beyond what it can withstand or, more commonly, due to gradual wear and tear associated with overuse. Occasionally, a heel spur may develop in association with plantar fasciitis.



Causes

Far and away the most common cause of plantar fasciitis in an athlete is faulty biomechanics of the foot or leg. Faulty biomechanics causes the foot to sustain increased or prolonged stresses over and above those of routine ground contacts. Throughout the phase of ground contact, the foot assumes several mechanical positions to dissipate shock while at the same time placing the foot in the best position to deliver ground forces. With heel landing the foot is supinated (ankle rolled out). At mid-stance the foot is pronated (ankle rolled in). The foot is supinated again with toe-off. The supination of the foot at heel strike and toe-off makes the foot a rigid lever. At heel strike the shock of ground contact is transferred to the powerful quads. During toe-off forward motion is created by contraction of the gastroc complex plantar flexing the rigid lever of the foot pushing the body forward.



Symptoms

When plantar fasciitis occurs, the pain is typically sharp and usually unilateral (70% of cases).Heel pain worsens by bearing weight on the heel after long periods of rest. Individuals with plantar fasciitis often report their symptoms are most intense during their first steps after getting out of bed or after prolonged periods of sitting. Improvement of symptoms is usually seen with continued walking. Numbness, tingling, swelling, or radiating pain are rare but reported symptoms. If the plantar fascia continues to be overused in the setting of plantar fasciitis, the plantar fascia can rupture. Typical signs and symptoms of plantar fascia rupture include a clicking or snapping sound, significant local swelling, and acute pain in the sole of the foot.



Diagnosis

Physical examination is the best way to determine if you have plantar fasciitis. Your doctor examines the affected area to determine if plantar fasciitis is the cause of your pain. The doctor may also examine you while you are sitting, standing, and walking. It is important to discuss your daily routine with your doctor. An occupation in which you stand for long periods of time may cause plantar fasciitis. An X-ray may reveal a heel spur. The actual heel spur is not painful. The presence of a heel spur suggests that the plantar fascia has been pulled and stretched excessively for a long period of time, sometimes months or years. If you have plantar fasciitis, you may or may not have a heel spur. Even if your plantar fasciitis becomes less bothersome, the heel spur will remain.



Non Surgical Treatment

If you walk or run a lot, cut back a little. You probably won't need to stop walking or running altogether. If you have either flatfeet or a high arch, ask your doctor about using inserts for your shoes called orthotics. Orthotics are arch supports. You will need to be fitted for them. If you are overweight, losing weight can help lessen your heel pain. If your job involves standing on a hard floor or standing in one spot for long periods, place some type of padding on the floor where you stand.

Plantar Fasciitis



Surgical Treatment

If you consider surgery, your original diagnosis should be confirmed by the surgeon first. In addition, supporting diagnostic evidence (such as nerve-conduction studies) should be gathered to rule out nerve entrapment, particularly of the first branch of the lateral plantar nerve and the medial plantar nerve. Blood tests should consist of an erythrocyte sedimentation rate (ESR), rheumatoid factor, human leukocyte antigen B27 (HLA-B27), and uric acid. It’s important to understand that surgical treatment of bone spurs rarely improves plantar fasciitis pain. And surgery for plantar fasciitis can cause secondary complications-a troubling condition known as lateral column syndrome.



Stretching Exercises

While it's typical to experience pain in just one foot, massage and stretch both feet. Do it first thing in the morning, and three times during the day. Achilles Tendon Stretch. Stand with your affected foot behind your healthy one. Point the toes of the back foot toward the heel of the front foot, and lean into a wall. Bend the front knee and keep the back knee straight, heel firmly planted on the floor. Hold for a count of 10. Plantar Fascia Stretch. Sit down, and place the affected foot across your knee. Using the hand on your affected side, pull your toes back toward your shin until you feel a stretch in your arch. Run your thumb along your foot--you should feel tension. Hold for a count of 10.

January 14 2015

jhopson88

What Is Heel Pain And Best Ways To End It

Foot Pain

Overview

Plantar fasciitis is a common foot disorder that affects more than two million people every year, especially runners. It is inflammation of the plantar fascia, a thick band of tissue on the bottom of the foot. The most common area of pain is directly on the bottom of the heel, although some people may only have pain in the arch of the foot. Diagnosis of plantar fasciitis is typically done through a physical examination, which includes listening to the patient history, palpation of the heel and possibly x-rays.



Causes

Plantar Fasciitis often leads to heel pain, heel spurs, and/or arch pain. The excessive stretching of the plantar fascia that leads to the inflammation and discomfort can be caused by the following: Over-pronation (flat feet) which results in the arch collapsing upon weight bearing A foot with an unusually high arch A sudden increase in physical activity Excessive weight on the foot, usually attributed to obesity or pregnancy Improperly fitting footwear Over-pronation (flat feet) is the leading cause of plantar fasciitis. Over-pronation occurs in the walking process, when a person's arch collapses upon weight bearing, causing the plantar fascia to be stretched away from the heel bone. With Plantar Fasciitis, the bottom of your foot usually hurts near the inside of the foot where the heel and arch meet. The pain is often acute either first thing in the morning or after a long rest, because while resting the plantar fascia contracts back to its original shape. As the day progresses and the plantar fascia continues to be stretched, the pain often subsides.



Symptoms

Patients with plantar fasciitis typically experience pain underneath the heel and along the inner sole of the foot. In less severe cases, patients may only experience an ache or stiffness in the plantar fascia or heel that increases with rest (typically at night or first thing in the morning) following activities which place stress on the plantar fascia. These activities typically include standing, walking or running excessively (especially up hills, on uneven surfaces or in poor footwear such as thongs), jumping, hopping and general weight bearing activity. The pain associated with this condition may also warm up with activity in the initial stages of injury. As the condition progresses, patients may experience symptoms that increase during sport or activity, affecting performance. In severe cases, patients may walk with a limp or be unable to weight bear on the affected leg. Patients with this condition may also experience swelling, tenderness on firmly touching the plantar fascia (often on a specific spot on the inner aspect of the heel) and sometimes pain on performing a plantar fascia stretch.



Diagnosis

Your doctor may look at your feet and watch the way you stand, walk and exercise. He can also ask you questions about your health history, including illnesses and injuries that you had in your past. The symptoms you have such as the pain location or when does your foot hurts most. Your activity routine such as your job, exercise habits and physical activities preformed. Your doctor may decide to use an X-ray of your foot to detect bones problems. MRI or ultrasound can also be used as further investigation of the foot condition.



Non Surgical Treatment

Anti-inflammatory medications can help decrease the inflammation in the arch and heel of your foot. These medications include Advil, Mtrin, Ibuprofen, and Aleve. Use the medication as directed on the package. If you tolerate it well, take it daily for two weeks then discontinue for one week. If symptoms worsen or return, resume for two weeks, then stop. You should eat when taking these medications, as they can be hard on your stomach. Ach Support. Over the counter inserts provide added arch support and soft cushion. Based on the individual needs of your foot, you may require custom inserts. Achilles Tendon Stretch. Pace a shoe insert under your affected foot. Place your affected leg behind your unaffected leg with the toes of your back foot pointed towards the heel of your other foot. Lean into the wall. Bend your front knee while keeping your back leg straight with your heel firmly on the ground. Hold the stretch for a count of 10. A set is 10 repetitions. Perform the stretch at least three times a day.

Pain Under The Heel



Surgical Treatment

In cases that do not respond to any conservative treatment, surgical release of the plantar fascia may be considered. Plantar fasciotomy may be performed using open, endoscopic or radiofrequency lesioning techniques. Overall, the success rate of surgical release is 70 to 90 percent in patients with plantar fasciitis. Potential risk factors include flattening of the longitudinal arch and heel hypoesthesia as well as the potential complications associated with rupture of the plantar fascia and complications related to anesthesia.



Prevention

While there are no sure ways to prevent plantar fasciitis, these prevention tips may be helpful. Keep your weight under reasonable control. Wear comfortable, supportive shoes. Use care when starting or intensifying exercise programmes.

January 10 2015

jhopson88

What Leads To Pain Under The Heel And The Way To Deal With It

Foot Pain

Overview

The plantar fascia is a thick fibrous band that runs the length of the sole of the foot. The plantar fascia helps maintain the complex arch system of the foot and plays a role in one's balance and the various phases of gait. Injury to this tissue, called plantar fasciitis, is one of the most disabling running injuries and also one of the most difficult to resolve. Plantar fasciitis represents the fourth most common injury to the lower limb and represents 8 -10% of all presenting injuries to sports clinics (Ambrosius 1992, Nike 1989). Rehabilitation can be a long and frustrating process. The use of preventative exercises and early recognition of danger signals are critical in the avoidance of this injury.



Causes

Far and away the most common cause of plantar fasciitis in an athlete is faulty biomechanics of the foot or leg. Faulty biomechanics causes the foot to sustain increased or prolonged stresses over and above those of routine ground contacts. Throughout the phase of ground contact, the foot assumes several mechanical positions to dissipate shock while at the same time placing the foot in the best position to deliver ground forces. With heel landing the foot is supinated (ankle rolled out). At mid-stance the foot is pronated (ankle rolled in). The foot is supinated again with toe-off. The supination of the foot at heel strike and toe-off makes the foot a rigid lever. At heel strike the shock of ground contact is transferred to the powerful quads. During toe-off forward motion is created by contraction of the gastroc complex plantar flexing the rigid lever of the foot pushing the body forward.



Symptoms

If you are concerned that you may have developed this syndrome, review this list of symptoms to see if they match with your experience. Aching, sharp or burning pain in the sole of your foot, often centering in the heel area. Foot pain that occurs as soon as you step out of bed or get to your feet after prolonged periods of sitting. Pain that may decrease eventually after you've been on your feet for awhile, only to return later in the day. Sudden heel pain or pain that builds gradually. Foot pain that has lasted for more than a few days, or which you experience periodically over the course of months or years. Pain in just one foot, though it is possible to have Plantar Fasciitis affect both feet. Swelling, redness, or feelings of heat in the heel area. Limping.



Diagnosis

Your doctor can usually diagnose plantar fasciitis just by talking to you and examining your feet. Rarely, tests are needed if the diagnosis is uncertain or to rule out other possible causes of heel pain. These can include X-rays of the heel or an ultrasound scan of the fascia. An ultrasound scan usually shows thickening and swelling of the fascia in plantar fasciitis.



Non Surgical Treatment

If conservative treatments fail, and the symptoms of plantar fasciitis have not been relieved, the doctor may recommend one of the following treatments. Cortisone, or corticosteroids, is medications that reduce inflammation. Cortisone is usually mixed with local anesthetics and injected into the plantar fascia where it attaches to the heel bone. In many cases this reduces the inflammation present and allows the plantar fascia to begin healing. Local injections of corticosteroids may provide temporary or permanent relief. Recurrence of symptoms may be lessened by combining steroid injections with other forms of treatment such as orthotics, changes in shoe gear, weight loss, stretching exercises, and rest. Repeated cortisone injections may result in rupture of the plantar fascia, thinning of the heel's fat pad, and other tissue changes. Extracorporeal Shock Wave Therapy (ESWT) devices generate pulses of high-pressure sound that travel through the skin. For reasons that are not fully understood, soft tissue and bone that are subjected to these pulses of high-pressure energy heal back stronger. There is both a high-energy and low-energy form of ESWT; and both forms of shock wave therapy can be used in the treatment of plantar fasciitis. Research studies indicate ESWT is a safe and effective treatment option for plantar fasciitis. The recovery period is shorter than traditional invasive surgery and the procedure eliminates many of the risks associated with traditional surgery.

Pain Under The Heel



Surgical Treatment

In unusual cases, surgical intervention is necessary for relief of pain. These should only be employed after non-surgical efforts have been used without relief. Generally, such surgical procedures may be completed on an outpatient basis in less than one hour, using local anesthesia or minimal sedation administrated by a trained anesthesiologist. In such cases, the surgeon may remove or release the injured and inflamed fascia, after a small incision is made in the heel. A surgical procedure may also be undertaken to remove bone spurs, sometimes as part of the same surgery addressing the damaged tissue. A cast may be used to immobilize the foot following surgery and crutches provided in order to allow greater mobility while keeping weight off the recovering foot during healing. After removal of the cast, several weeks of physical therapy can be used to speed recovery, reduce swelling and restore flexibility.



Stretching Exercises

In one exercise, you lean forward against a wall with one knee straight and heel on the ground. Your other knee is bent. Your heel cord and foot arch stretch as you lean. Hold for 10 seconds, relax and straighten up. Repeat 20 times for each sore heel. It is important to keep the knee fully extended on the side being stretched. In another exercise, you lean forward onto a countertop, spreading your feet apart with one foot in front of the other. Flex your knees and squat down, keeping your heels on the ground as long as possible. Your heel cords and foot arches will stretch as the heels come up in the stretch. Hold for 10 seconds, relax and straighten up. Repeat 20 times. About 90 percent of people with plantar fasciitis improve significantly after two months of initial treatment. You may be advised to use shoes with shock-absorbing soles or fitted with an off-the-shelf shoe insert device like a rubber heel pad. Your foot may be taped into a specific position. If your plantar fasciitis continues after a few months of conservative treatment, your doctor may inject your heel with steroidal anti-inflammatory medication. If you still have symptoms, you may need to wear a walking cast for two to three weeks or a positional splint when you sleep. In a few cases, surgery is needed for chronically contracted tissue.
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