Heel pain is a common problem which starts insidiously and gradually increases with neglect. Some people also complain of symptoms after stepping on an uneven surface. The most common presentation is in patients who walk a lot in an uncomfortable footwear. Most patient’s complaint of painful heels typically in the morning time or typically while they enter into activity from rest. Most patients belong to the age group of 20-50 years. They also commonly complaint of a knee pain and low back pain due to altered way of walking due to the pain in the heel.
Pain starts with an overuse or an inciting event that leads to a start of mild pain which eventually increases due to repetitive micro trauma. The planter fascia or the soft tissue connection between the heel and the toes gets inflamed and leads to these symptoms. The basic cause implicated is the repeated traction against a hard surface. In many cases, the swelling of the planter fascia is also associated with a planter bursitis where the symptoms become overlapping and treatment aims at controlling both together. Various patients coming to the outpatient department ask for getting an x-ray done.
X-rays are typically advised in patients with a long standing disease or elderly age group or patients not responding to conservative treatment. These x-rays may show and evidence of a calcaneal spur and or an insertional planter fascia outgrowth. Patients hold the calcification responsible for the pain but it so is not the case. As per literature, chronic pain and repeated stress leads to a reactional stress over the calcaneal bone. This is responsible for the formation of the spur.
The diagnosis remains entirely clinical which is based on history and examination. It may be supplemented with radiological confirmation in the form of Ultrasonography or an MRI scan for ruling out associated conditions which have overlapping symptoms. These include planter bursitis, retro calcaneal bursitis, insertional tendo-achillitis and mortons metatarsalgia. Most patients do well with conservative treatment done properly. Other might require an invasive intervention in the form of steroid injection or a minor surgical procedure.
Here are five steps to improve symptoms of planter fasciitis:
1. Change of footwear: Step into aesthetically poor footwear which are far more comfortable than heels or hard footwear at the office. Memory foam is an essential step to cure. Do not walk barefoot on hard surfaces even at home. One can also use a silicone made insole in the footwear to prevent worsening of symptoms.
2. Consult your orthopedic: Medical treatment decreases pain and swelling inside and around the tendon. This is essential to make the patient symptom free to continue doing activities of daily living. Analgesics and anti-inflammatories are mainstay of medical therapy.
3. Contrast Bath: Hot and cold fomentation alternated simultaneously helps relieve pain instantly. 3mins of hot dip followed by 1 minute of a cold dip repeated 3 times at a stretch is the recommended way. This can be twice or thrice in a day. Along with, frozen can exercises are also advised along with contrast bath.
4. Physiotherapy: Main role of physiotherapy is to decrease swelling and pain with early functional rehabilitation of the patient. Laser therapy and Extracorporeal Shock wave therapy have a proven role along with all other modalities. Please consult your orthopedic and physiotherapist for more information on the action of these modalities.
5. Rehabilitation: Rehabilitation focuses on stretching exercises for the planter fascia and gastro soleus muscle (calf). This should be done under supervision for first few times and should be followed up at home. Simple stretches done at frequent intervals provide long term relief.
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