Painful Heel (Plantar Fasciitis)About 10% of the population have suffered from heel pain at some time during their life.Womensuffermoreoftenthanmenanditusuallyaffectsaftertheageof50. Many with diabetes may also present with a painful heel.Symptoms:Painisoftensevere1stthinginthemorningwhenyougetoutofbed andpressureappliedontheheel.Iteasesalittleasyoustartwalkingbutwill increaseagainifyouareonyourfeetforprolongedperiodsoftime.Painisusually confined to the inner aspect of the heel.CauseforthePain:TheconditioniscalledPlantarFasciitis,meaninginflammationofthePlantarFascia(atitsattachment totheheelbone).Somebelievethattheinflammationisduetosmalltearsofthefascianearitsattachmenttothebone duetorepeatedtrauma.Theremaybesomethickeningofthefasciaatthissite.Theexactcausefortheinflammationis stilldifficulttounderstand.Ifitoccursindiabetics,itstheobesitythatcontributestothepain.Constantrunningor walking on hard ground can also produce the pain. PlantarFascia:ThePlantarFasciaislikeabowstringattachedtotheheel bone(Calcaneus)atoneendandtothebonesofmidfoot(metatarsals) attheotherend.Thishelpstomaintainthearchofthefootandalsoacts like a shock absorber easing the strain when you walk or run. Diagnosis:ofPlantarFasciitisismadebyexaminingthefoot. Therewillbelocalisedtendernessattheinnersideoftheheel about3cmsfromtheedge.Thereshouldbenonumbnessinthe foot. Investigations:Testsarerarelynecessary.Howeverifthereisany doubtaboutthediagnosisanx-rayandanultrasoundcanbedone. Thisistoruleoutaninfectionorotherpathologyofthebone.Ultrasoundmayshowthickenedfasciawhere there is pain. X-raymaysometimesshowabonyspurfromtheheelbone.Thisisunlikelytocontributetothepain.Many among the population have a bony spur with no heel pain.Treatment: 1.Rest 2.Supportive Foot Wear3.Medication4.Physical Therapy5.Steroid Injection 6.Surgery Quiteoftenpaineasesafteraperiodoftime.Howeverinsomeitdoesnoteaseand those are the people who will seek treatment. Rest:Thegeneraladviceshouldbetorestthefootasmuchaspossibleandavoidrunningorstandingonhard surface. Footwear:Mustwearfootwearwithasoftinsoleandagoodarchsupport.Itisalsoworthtryinganinsolewitha smallholecutattheexactareawherethetenderpointofthesolecomesincontactwiththeinsole.Thiswould relievetheconstantpressureatthepainfularea.Generally,donotwalkbarefootonanysurfaceparticularly when it is hard.Medication:Ifthepainissevereanti-inflammatorymedicationlikeIbuprofenwouldhelp.Ibuprofengelapplied locally two or three time a day may also help.PhysicalTherapy:A)Icecubesinaplasticbagcanbeappliedoverthetenderareafor10to15minutes2or3 times a day. It may help some.B)CalfStretch:ManywithPlantarFasciitishaveatightAchillestendon.This tendstoindirectlypullonthefasciaandperpetuatetheinflammationandpain. Tobreakthecycle,stretchingthecalfmusclecanhelp.Stretchingcanbe done in many ways. Oneofthesimplestwaystostretchacalfmuscleistoleanagainstawallwith outstretchedarms.Thekneeontheunaffectedsideisbentasshowninthe pictureandthelegandkneeontheaffectedsidekeptstraight.Thiswillforce thecalfmusclestostretch. A You Tubevideoon“Links”underPatientSupport willshowyouasimplewaytostretchthemuscle.Repeatitforshortperiods every day.SteroidInjection:Ifnoneoftheabovemethodshaveworked,asmalldoseofsteroidinjecteddirectlyintothe tenderspotcouldbetried.Injectionoftenhelps,sometimesarepeatinjectionmaybenecessaryafterafew weeks. Repeated injections at short intervals should be avoided. Surgery:Ifeverythingelsefailsandthepatientisdesperateforpainrelief,surgerymaybethelastoption.As thepainiscausedbytheplantarfasciabeingstretchedandpulledatthesitewherethereisinflammation, releasingthefasciafromitsattachmenttotheboneshouldhelp.Howeverthereisnoguaranteeoftotalpain relief.Quite often pain from Plantar Fasciitis eases in a couple of years with or without treatment.Prevention:Heelpaincanbepreventedbywearingfootwearwithsoftcushionedheelpads.Ifthepersonis obese they should be encouraged to lose weight so that less pressure is exerted at the heel.K. Badrinath