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