Painful Heel  (Plantar Fasciitis) About 10% of the population have suffered from heel pain at some time during their life.   Women   suffer   more   often   than   men   and   it   usually   affects   after   the   age   of   50. Many with diabetes may also present with a painful heel. Symptoms:    Pain   is   often   severe   1 ^st    thing   in   the   morning   when   you   get   out   of   bed and   pressure   applied   on   the   heel.   It   eases   a   little   as   you   start   walking   but   will increase   again   if   you   are   on   your   feet   for   prolonged   periods   of   time.   Pain   is   usually confined to the inner aspect of the heel. Cause   for   the   Pain:    The   condition   is   called   Plantar   Fasciitis,   meaning   inflammation   of   the   Plantar   Fascia   (at   its   attachment to   the   heel   bone).   Some   believe   that   the   inflammation   is   due   to   small   tears   of   the   fascia   near   its   attachment   to   the   bone due   to   repeated   trauma.   There   may   be   some   thickening   of   the   fascia   at   this   site.   The   exact   cause   for   the   inflammation   is still   difficult   to   understand.   If   it   occurs   in   diabetics,   its   the   obesity   that   contributes   to   the   pain.   Constant   running   or walking on hard ground can also produce the pain. Plantar   Fascia:    The   Plantar   Fascia   is   like   a   bowstring   attached   to   the   heel bone   (Calcaneus)   at   one   end   and   to   the   bones   of   mid   foot   (metatarsals) at   the   other   end.   This   helps   to   maintain   the   arch   of   the   foot   and   also   acts like a shock absorber easing the strain when you walk or run. Diagnosis:    of   Plantar   Fasciitis   is   made   by   examining   the   foot. There   will   be   localised   tenderness   at   the   inner   side   of   the   heel about   3   cms   from   the   edge.   There   should   be   no   numbness   in   the foot. Investigations :    Tests   are   rarely   necessary.   However   if   there   is   any doubt   about   the   diagnosis   an   x-ray   and   an   ultrasound   can   be   done. This   is   to   rule   out   an   infection   or   other   pathology   of   the   bone.   Ultrasound   may   show   thickened   fascia   where there is pain. X-ray   may   sometimes   show   a   bony   spur   from   the   heel   bone.   This   is   unlikely   to   contribute   to   the   pain.   Many among the population have a bony spur with no heel pain. Treatment : 1 . Rest 2 . Supportive Foot Wear 3 . Medication 4 . Physical Therapy 5 . Steroid Injection 6 . Surgery Quite   often   pain   eases   after   a   period   of   time.   However   in   some   it   does   not   ease   and those are the people who will seek treatment. Rest:   The   general   advice   should   be   to   rest   the   foot   as   much   as   possible   and   avoid   running   or   standing   on   hard surface. Footwear:   Must   wear   footwear   with   a   soft   insole   and   a   good   arch   support.   It   is   also   worth   trying   an   insole   with   a small   hole   cut   at   the   exact   area   where   the   tender   point   of   the   sole   comes   in   contact   with   the   insole.   This   would relieve   the   constant   pressure   at   the   painful   area.   Generally,   do   not   walk   barefoot   on   any   surface   particularly when it is hard. Medication:    If   the   pain   is   severe   anti-inflammatory   medication   like   Ibuprofen   would   help.   Ibuprofen   gel   applied locally two or three time a day may also help. Physical   Therapy:   A)    Ice   cubes   in   a   plastic   bag   can   be   applied   over   the   tender   area   for   10   to   15   minutes   2   or   3 times a day. It may help some. B)   Calf   Stretch:   Many   with   Plantar   Fasciitis   have   a   tight   Achilles   tendon.   This tends   to   indirectly   pull   on   the   fascia   and   perpetuate   the   inflammation   and   pain. To   break   the   cycle,   stretching   the   calf   muscle   can   help.   Stretching   can   be done in many ways. One   of   the   simplest   ways   to   stretch   a   calf   muscle   is   to   lean   against   a   wall   with outstretched   arms.   The   knee   on   the   unaffected   side   is   bent   as   shown   in   the picture   and   the   leg   and   knee   on   the   affected   side   kept   straight.   This   will   force the   calf   muscles   to   stretch. A You Tube   video   on   “Links”   under   Patient   Support will   show   you   a   simple   way   to   stretch   the   muscle.   Repeat   it   for   short   periods every day. Steroid   Injection:   If   none   of   the   above   methods   have   worked,   a   small   dose   of   steroid   injected   directly   in   to   the tender   spot   could   be   tried.   Injection   often   helps,   sometimes   a   repeat   injection   may   be   necessary   after   a   few weeks. Repeated injections at short intervals should be avoided. Surgery:   If   everything   else   fails   and   the   patient   is   desperate   for   pain   relief,   surgery   may   be   the   last   option.   As the   pain   is   caused   by   the   plantar   fascia   being   stretched   and   pulled   at   the   site   where   there   is   inflammation, releasing   the   fascia   from   its   attachment   to   the   bone   should   help.   However   there   is   no   guarantee   of   total   pain relief. Quite often pain from Plantar Fasciitis eases in a couple of years with or without treatment. Prevention:   Heel   pain   can   be   prevented   by   wearing   foot   wear   with   soft   cushioned   heel   pads.   If   the   person   is obese they should be encouraged to lose weight so that less pressure is exerted at the heel. K. Badrinath