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Heel Pain Clinic

Heel pain is most often caused by plantar fasciitis, a condition that is sometimes also called heel spur syndrome when a spur is present. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation, or, rarely, a cyst.

Because there are several potential causes, it is important to have heel pain properly diagnosed. A foot and ankle surgeon is able to distinguish between all the possibilities and determine the underlying source of your heel pain.

Plantar Fasciitis and Heel Spur

What Is Plantar Fasciitis?
Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed, resulting in heel pain.

The most common cause of plantar fasciitis relates to faulty structure of the foot. For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more prone to developing plantar fasciitis.

Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly evident when one’s job requires long hours on the feet. Obesity may also contribute to plantar fasciitis.

The symptoms of plantar fasciitis are:

  • Pain on the bottom of the heel
  • Pain in the arch of the foot
  • Pain that is usually worse upon arising
  • Pain that increases over a period of months

People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they’ve been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people the pain subsides but returns after spending long periods of time on their feet.

To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis.

In addition, diagnostic imaging studies such as x-rays or other imaging modalities may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.

Non-Surgical Treatment
Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home:

  • Stretching exercises. Exercises that stretch out the calf muscles help ease pain and assist with recovery.
  • Avoid going barefoot. When you walk without shoes, you put undue strain and stress on your plantar fascia.
  • Ice. Putting an ice pack on your heel for 20 minutes several times a day helps reduce inflammation. Place a thin towel between the ice and your heel; do not apply ice directly to the skin.
  • Limit activities. Cut down on extended physical activities to give your heel a rest.
  • Shoe modifications. Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia.
  • Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.

If you still have pain after several weeks, see your foot and ankle surgeon, who may add one or more of these treatment approaches:

  • Padding and strapping. Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia.
  • Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis.
  • Injection therapy. In some cases, injections are used to help reduce the inflammation and relieve pain.
  • Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal.
  • Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.
  • Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.

When Is Surgery Needed?
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.

Long-term Care
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.


Heel Spurs

Heel Spurs are often the cause of serious pain in the heel of the foot. Heel spurs can easily interfere and disrupt your daily lifestyle as they generate aching pain with every step. Many factors can contribute to the development of a spur, but luckily there are conservative ways to stop pain and reverse the condition.

Pain that results from a heel spur is usually characterized by a sharp poking and is localized to the heel or under the heel. Aching pain can become very severe and inflammation and bruising can also occur. When taking a step or when putting pressure on the heel, pain can escalate, particularly after prolonged periods of rest like the first step after getting out of bed in the morning.

A heel spur is a growth of bone that extends from the heel bone (calcaneous). The spur itself has no feeling. However, these bony outgrowths usually extend from the heel bone into the soft tissue surrounding the bottom of the foot, causing inflammation of the plantar fascia (fasciitis) and pain throughout the heel of the foot.

The heel spur is composed of calcium deposits. This bony deposit develops when the plantar fascia stretches abnormally due to stress factors and occurs where the ligament attaches and stretches away from the heel bone. These pointed outgrowths, which can be visible through an X-ray, are often hooked and extend forward toward your toes as much as half an inch.

In most cases, heel spurs occur in persons over the age of 40 and can result from a number of different reasons. Spurs can begin to form as a result of obesity or sudden weight gain, such as during pregnancy, which can place continuous and excessive weight on the heel of the foot. Another common cause of heel spurs is wearing ill-fitting shoes which fail to properly support the heel and other important areas of the foot. Pronation, which is the abnormal motion and misalignment of the foot, can also contribute to this condition. With excessive pronation, the plantar fascia, which is a bow-like ligament along the bottom of the foot, could be stretched and forced to pull away from the heel bone, contributing to the development of a spur. Other causes of heel spurs may be attributed to gout, and rheumatoid arthritis.

Due to the heel spur’s protrusion into the tendons and nerves of the foot, aching pain may be severe and continuous. Although the formation and subsequent pain of the heel spur may be caused from stress on the area around the heel, the pain actually decreases after walking. This is because the capillaries and nerves adjust around the spur, which is why pain is usually most severe when pressure is put on it after periods of rest. This pain may also increase when walking on hard surfaces or when carrying heavy objects.

Stop the pain and get your heel spurs checked. Call +65 6471 2744 (24 Hours) or Email to: info@boneclinic.com.sg

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