A Natural Plantar Fasciitis Treatment

Natural Guide for the Treatment of Plantar Fasciitis

Welcome Dear Visitor!

I am excited to tell you that there are 100% Natural Ways to Prevent and Treat Plantar Fasciitis Foot Pain. You can learn about those methods right now!

No question, your health should be important to you! This is certainly not the place and time for experiments and foolery.

With our guide we show you the real cause, proven methods and exercises to attack and prevent your plantar fasciitis once and for all!

If you've arrived here, chances are you are suffering from fasciitis foot or heel pain, are you?

Our Guide for the All Natural Treatment of Fasciitis Foot Pain will answer all your questions!

You soon will know everything you ever wanted to know about this painful condition. You will understand what causes it and you will learn how to treat it using 100% natural methods.

The best thing about it: You will learn how to prevent it so it will never come back!

A former plantar fasciitis sufferer myself, i have written this helpful treatment guide to finally put an end to all the myths and to give every patient clear step-by-step instructions to tackle their fasciitis foot pain easily from the comforts of their home!

Our guide will show you and help you with:

100% Natural Home Treatments Plantar Fasciitis Prevention Exercises for Fasciitis What is Plantar Fasciitis? What are the signs of Plantar Fasciitis? Stretching is Vital in Your Daily Battle Against the Pain of Plantar Fasciitis Devices for Assisting with Dealing with Plantar Fasciitis Medicinal Herbs and their Benefits in the Treatment of Plantar Fasciitis Analgesic Gels and Ointments from Natural Ingredients for Pain Relief Extracorporeal Shock Wave Therapy Ten Treatments Which Help Plantar Fasciitis Sufferers Deal With Pain Essential Aromatherapy Helps With the Treatment of Plantar Fasciitis Proper Nutrition Including Vitamins How Long Does Plantar Fasciitis Last?

from Chris Maylor

The following articles report on research completed, in whole or in part, under a grant from ACFAOM. Thanks to all those whose voluntary contributions to ACFAOM’s Research Fund make such grants possible. Comparing Negative Casting Techniques: Foam versus Plaster of Paris Richard Berenter, DPM, FACFAOM Introduction: This study was undertaken to determine whether there was any difference in the clinical outcomes related to the type of negative casting technique utilized in the manufacture of functional foot orthoses. Those practitioners who favor foam casting blocks argue that the technique is cleaner, faster, more cost effective and just as reliable a method to produce functional foot orthoses versus the plaster of Paris technique. On the other hand, a number of practitioners have argued that the foam block technique is inferior because the foam is incapable of capturing the shape of the foot with the subtalar joint in neutral position and the midtarsal joint maximally pronated thereby leading to an inferior foot orthosis, which will be less effective at reducing patient symptoms. Materials and Methods: A total of 38 patients were enrolled in the study. All of the patients presented with lower extremity symptoms associated with abnormal lower extremity function as determined by gait evaluation. At the time of the initial visit, each patient signed a consent form and completed the top portion of the data sheet which included both personal information and the amount of pain in each extremity (patients were asked to circle the amount of pain on a scale from 0-10 with 0 being no pain and 10 being the worse pain ever felt). Upon completion of all paper work, both feet of each patient were casted via the semi-weight bearing foam block technique and by the non-weight bearing supine plaster of Paris method. Both sets of casts were sent to a professional orthotic laboratory with a prescription filled out for an orthotic shell with a medium amount of arch fill, average heel cup depth, normal orthotic width (to the lateral border of the 5th metatarsal and bisection of the 1st metatarsal shaft) and a thickness of polypropylene which would behave in a semi-rigid behavior for the patient’s stated weight. A laboratory technician was instructed to randomly select one of the two pairs of negative casts and keep track of which casts were used without the knowledge of the principal investigator. In this way, a double blind study was established since neither the principal investigator nor the patient knew which casts were used to construct the foot orthotics. Approximately 2-3 weeks following casting, the patient was dispensed a pair of functional foot orthoses and asked to walk around for a minimum of 10 minutes to gauge the comfort level of the orthotics. Each participant was asked to use one of 4 descriptive terms (very comfortable, comfortable, slightly uncomfortable or very uncomfortable) to describe the comfort level of 5 different regions on each foot orthosis corresponding to the heel region, medial arch, lateral arch, middle of the orthosis and distal edge. Patients were then sent home with standardized break-in instructions for the functional foot orthoses and returned to the clinic at intervals of 2 weeks and 4 weeks post-orthotic dispensal. At each follow-up visit, patients were asked to fill out a data sheet gauging the level of symptoms and comfort level of the orthoses. The data was then compiled and saved in a spread sheet format and upon completion of the study, the laboratory technician was contacted in order to identify which patients belonged to which study group, the foam box or plaster of Paris casting technique. Results: The data was compiled and the two study groups separated by casting technique. An independent investigator (non-podiatrist) was contacted and asked to analyze the data to answer the following questions: 1. Does the negative casting technique (foam vs. plaster) make a difference in the ability of the orthotic device to reduce symptoms? 2. Does the negative casting technique (foam vs. plaster) make a difference in how comfortable the orthotic device feels to the patient? The data was analyzed in a variety of methods such as the mean reduction of pain, Fischer exact test and Chi-square with T-tests. A simple comparison of the average reduction of pain after four weeks of orthotic therapy indicates that the plaster of Paris orthoses achieved a mean decrease of 82.43% of pain versus 61.14% reduction in pain with foam box cast orthoses, with a level of significance p< 0.01. However, further analysis of the data demonstrated that casting technique had no statistical difference in the reduction of pain in patients presenting with high levels of pain, but a significant advantage for plaster of Paris orthotics in reducing moderate amounts of pain. The difference between the comfort levels of the orthoses from different casting techniques was also extremely interesting. No statistical difference was noted in the comfort level of any of the five regions studied (the heel, medial arch, lateral arch, middle of orthosis and distal edge) at the time the orthotic was dispensed. However, after one month of orthotic wear, the orthoses manufactured from plaster of Paris casts were statistically more comfortable in the medial longitudinal arch and the distal edge regions. Another analysis performed on comfort level of the orthotic devices compared improvement of comfort level between the orthoses from the two casting techniques. In this analysis, only the medial longitudinal arch was statistically more improved in the plaster of Paris technique versus the foam box method. Final Thoughts: The analysis of the data was fascinating in that both casting techniques were able to show some marked reduction in symptoms and reasonably comfortable orthoses. However, there were some statistical advantages of the plaster of Paris orthoses over the foam box devices. Further research needs to be encouraged and might include studying the differences between orthotic devices from plaster casts versus over-the-counter pre-fabricated devices and also against orthotics constructed from computer-digitized images of the foot. The Evaluation of Cleated Shoes with the Adolescent Athlete in Soccer John H. Walter Jr. DPM, MS, Temple University School of Podiatric Medicine, Philadelphia, PA Chairman and Professor, Department of Orthopedics and Medicine 8th and Race Streets, Philadelphia, PA 19107 Gregory K. NG DPM 2nd yr. Podiatric Surgical Resident, Parkview/City Ave Hospitals, Tenet Health Systems Philadelphia, PA 19124 Abstract Thirty-six children between the ages of eight and eleven were tested to determine if soccer cleats placed their feet in a dorsiflexed or “negative heel” position at midstance while running in cleated shoes. A comparison was made between non-cleated shoes and cleated shoes using both F-scan in-shoe sensor system (Tekscan INC., Boston MA), and videotape analysis. Negative heel position is afoot that is in a dorsiflexed position, relative to the lateral aspect of the heel and forefoot greater than ninety degrees during the stance phase of running while wearing cleated shoes. It is this dorsiflexed foot position that is responsible for increases in the amount of pressure placed upon the calcaneal epiphysis or secondary growth center of the calcaneus. In addition to the increased pressures placed on the calcaneal epiphysis a dorsiflexed foot position during the stance phase increases the amount of pull from the soft tissue attachments which is primarily from the tendo achilles and secondarily from the plantar fascia The study attempts to link the negative heel position to the high incidence of inflammation of the calcaneal growth center, or calcaneal apophysitis commonly found in the youth soccer population. Treatment options for calcaneal apophysitis are also discussed Introduction A comparison was made between non-cleated shoes and cleated shoes using both F-scan in-shoe sensor system (Tekscan INC., Boston MA), and videotape analysis. When the foot is positioned in a dorsiflexed position greater than ninety degrees to the supporting surface during the stance phase of running, a negative heel position is created (figure 1). Thirty-six male test subjects between the ages of eight and eleven were tested in an effort to prove that the wearing of cleated shoes placed the foot of a young soccer player in a negative heel position more so than if wearing non-cleated shoes. Soccer is one of if not the most popular sport in the world. Currently more children in the U.S. now play soccer than Little League Baseball. 1 Not only has there been an increase of young soccer athletes; there has been an increase in the frequency of play. During the 1990′s there has been an increasing trend of single sport youth athletes who train year round. Many young soccer players now participate in all four seasons of the year playing both indoors and outdoors. With the increase in the number of young athletes playing soccer and the increase in the amount of playing time, there has been, significant rise in the incidence of young players presenting with foot pain such as inflammation of the calcaneal epiphysis, more commonly known as Sever’s Disease (osteochondritis). Other common names for the calcaneal epiphysis are traction epiphysis or apophysis. *This study was made possible from a grant from The American College of Foot and Ankle Orthopedics and Medicine and a soccer shoe donation from NIKE. Three etiological factors which can lead to the inflammation of the calcaneal epiphysis are: increased pressure, increased pull, and overuse are the factors that cause an inflammation of the calcaneal epiphysis.2 A negative heel position would increase the direct pressure and tendinous pull, while the repetitive nature of soccer would introduce the third factor listed, overuse. Thus, the sport of soccer exposes young participants to three main factors that can lead to Sever’s disease. Soccer shoe design has remained relatively unchanged when compared to other types of athletic shoe gear such as with running shoes (figure 2). Current designs in soccer cleats lack pressure absorption and motion control which can at times place the foot in an unstable position leading to injuries such as: stress fractures, sprains, strains, tibial fasciitis (shin splints), exertional compartment syndrome, ankle capsulitis/impingement, patelia-femoral dysfunction, and heel pain (figure 3). Lack of motion control, improper arch support can lead to skeletal misalignment leading to postural symptomatology such as medial/lateral knee pain, iliotibial hand syndrome, hip, and lower back pain. Prepubertal long-bone growth spurts often exceed the growth of muscles and tendons. Shortening of the triceps surae group, as a result of the rapid growth of the tibia, may diminish ankle dorsiflexion to less than 10 degrees, possibly creating a strain on the tendon especially at the area of its insertion (calcaneal secondary growth center). 3,4 Negative heel position created by the cleated shoe can increase the amount of heel cord pull on the calcaneal epiphysis, by dorsiflexing an ankle joint which may already be limited due to muscle contracture secondary to growth spurts. A combination of repetitive overuse through soccer practice and games, with the negative heel position created by the use of cleated shoes, place the young athlete at risk for developing not only calcaneal apophysitis but also tendinitis of the posterior heel cord (tendo Achilles), and plantar fasciitis. Very few epidemiology studies to date have been done which look at the relationship between the use of cleated shoes and foot injuries sustained by young athletes. Micheli LJ, Fehlandt AF Jr., reviewed 724 cases of tendinitis or apophysitis that were diagnosed in 445 patients seen in the Sports Medicine Division at Boston Children’s Hospital between 1980 and 1990. Age of the patients ranged between 9-19 years. Of the 38 soccer injuries noted in boys dealing with tendiits or apophysitis, 18(47%) were diagnosed as calcaneal apophysitis, 9(24%) were diagnosed as Aehilles tendinitis, 4(11%) were diagnosed with tibialis posterior tendinits. A total of 82% were due to either calcaneal apophysitis or heel cord tendinitis. Of the 26 soccer injuries noted in girls dealing with tendinitis or apophysitis, 8(31%) were diagnosed as calcaneal apophysitis, 6(23%) were diagnosed as tibialis posterior tendinitis, 4(15%) were diagnosed as Achilles tendinitis. Results totaling 69% were due to either calcaneal apophysitis or heel cord tendinitis. According to Micheli and Fehlandt, both Sever’s disease and heel cord tendinitis make up the majority of youth soccer injuries resulting from either tendinitis or apophysitis (boys=42% girls=69%). Methodology Frame by frame video analysis of 36 male test subjects was performed on soccer fields, to study the length of time for the test subjects to move from heel strike to heel lift while running in both cleated and non-cleated shoes. Freeze frame comparisons were also made of the same video to evaluate the dorsifiexed foot position in cleated shoes. Video was obtained of test subjects that ran past at a moderate running pace commonly seen in soccer play. F-scan pressures vs. time pedobaragraphs were taken of both cleated and non-cleated shoes (running shoes) to note pressure distribution while running. All test subjects were between the ages of eight and eleven, weighing from 75 to 110 lbs, and had standard biomechanical, gait, and postural exams performed. Results Of the 36 test subjects, 11 were determined to have cavus or high arched foot types, 14 with rectus or normal foot types, and the remaining 11 with pes planus or low arched foot types. All test subjects had adequate ranges of motion at the subtalar joint (STh, midtarsal joint (MTJ), first metatarsal phalangeal joint, and ankle joint with the exception of 5 subjects who had limited ankle joint dorsiflexion. All testing was performed on outdoor soccer fields. For consistency the same researcher performed the biomechanical exams. 187 questionnaires were gathered noting foot and leg pain among young soccer players between the ages of eight to thirteen years old. (figure 4) When compared to non cleated shoes, frame by frame video analysis revealed that 23 test subjects took a longer period of time to move from heel strike to heel lift while running in cleated shoes. (Figure 5). Freeze frame analysis demonstrated a more dorsiflexed foot position during full foot contact (an average of 7 degrees) during stance phase while running in cleated shoes in 26 subjects (figures 6a, 6b). F-scan sensor data was able to capture a characteristic plantar pressure “foot print” of very highly focused pressures in the rearfoot as well as a rough transition from rearfoot to forefoot while running in cleated shoes (figures 7a, 7b). A characteristic footprint was reproducible in 21 of the 36 test subjects. It should be noted that the “foot print” was most reproducible in test subjects who had pes planus foot types with limited ankle dorsiflexion. The “foot print” was least reproducible in test subjects with cavus foot types. The average plantar pressure was noted to be in the 3O-psi(pounds per square inch) range in non-cleated shoes, and in the 70 psi range wearing cleated shoes. See also figures 8a, 8b. Discussion Data gathered from both the video and F-scan analysis between running shoes and soccer cleats confirms the negative heel hypothesis. It is this negative heel that plays a crucial role in the high percentages of young soccer players who develop Sever’s disease, by not only increasing the direct pressure placed on the calcaneal epiphysis, but by also increasing the traction on the epiphysis primarily via the tendo achilles. In addition to the increased pull and pressure on the calcaneal epiphysis, the repetitive nature of the sport, constant running in cleated shoes, must also be considered as a factor. If one is able to decrease the amount of negative heel (via. Heel lifts, orthotic management, soccer shoe redesign, etc…), then one can decrease the tendency for young soccer players to develop heel pain and or posterior heel cord tendinitis. Treatment options for mild heel pain or calcaneal apophysitis should include 1/8″ to ¼” heel lifts in both shoes, elastic ankle bracing, ice massage before, during and after play, and warm up stretching exercises. If the pain persists or increases than turf or non-cleated shoes should be worn with heel lifts, bracing, and a reduction in both playing and training time should be implemented. When the symptoms persist and the player is noticeably limping from the pain, discontinuation of play is recommended with immobilization of the foot and anide in a short leg walking cast, cast boot, or soft cast. For more information visit http://www.TallTall.com

from anonymous

urress was searching for an answer to his chronic foot and ankle pain. He makes his living running routes and catching balls for the Super Bowl champions New York Giants with a nagging ankle injury, flat feet and a new pair of orthotics. Burress is breaking in his orthotics at practice and expects to be ready for the season opener this week.

In May, Burress was advised to use orthotics to help improve the function of his feet. He said it took time to get fitted, and he did not start using them until recently. He admits that he is sore after running but is getting much better. Functional orthotics are improving his gait so he will not be as prone to injury as he has been in the past.

55 million Americans experience one or more foot problems every year! Failure to seek medical advice early can cause many to develop more complicated foot conditions that can be severe and difficult to treat.

One of the most common foot problems is heel pain. It is estimated that 15% of the adult population complains of heel pain, which includes one million runners who experience heel pain (plantar fasciitis) every year. The American College of Foot and Ankle Surgeons has stated that heel pain has reached epidemic proportions in weekend athletes. This common condition is typically ignored, especially by athletes. People tend to seek treatment only after the problem becomes severe and disabling or when they just can’t run. When foot health concerns are ignored, simple conditions can develop into more serious problems affecting the ankles, knees, hips or the back. A simple functional orthotic is the answer for many people experiencing this kind of foot pain.

Orthotics are devices which fit into the shoe to aid the foot and allow it to function more optimally. Relatively rigid in shoe braces that are designed to control motion and correct the function of the foot are “Functional orthotics”. Individuals with flatfeet, tendonitis, plantar fasciitis, knee, hip and back problems and certain foot deformities, may benefit from functional orthotics.

Will orthotics help my foot problems? The goal of the functional orthotic is to control the abnormal motion in the foot, improve foot function, decrease the pain in the foot, ankle, knee, hip or back and to add support. The orthotic should make standing, walking, or running more comfortable. The orthotic must be rigid to help control the motion in the foot and add support. If the orthotic is soft, the weight of the body would collapse the device and it would no longer function.

Functional orthotics are a successful treatment for many problems affecting the lower extremity. In a recent article in the Journal of the American Podiatric Medical Association, 75% of patients surveyed had good to excellent results from functional orthotics. This includes 17% who felt the orthotics “cured” their pain. Less than 10% had no relief. A painful heel was the most commonly treated condition in the study. Over 20% of patients surveyed were treated for a painful heel and 20% were treated for a painful arch. Fourteen percent of the individuals were using orthotics for flatfeet. Other conditions treated with orthotics were knee, hip and back pain, foot arthritis, bunions and high arches. Tendonitis was not specifically evaluated.

Individuals with plantar fasciitis (heel and arch pain) who also have flatfeet usually respond best to orthotics. People with high arches may require orthotics as well, but they do not respond as well. Orthotics can help slow the progression of bunions and hammertoes, but they will not prevent this process. Orthotics may help with some pain at a bunion, but they will not “cure” the bunion. When the motion in the foot is contributing to the problem, orthotics are generally recommended.

Podiatrists are the most common prescribers of orthotics, but pedorthotists, orthotists, physical therapists and sometimes chiropractors will also provide orthotics. Remember that the device is only as good as the doctor taking the mold and writing the prescription. Make sure that your practitioner is trained in foot biomechanics and experienced in orthotic therapy.

Orthotics are indicated in the treatment of the majority of foot pain. When utilized for the correct indications, orthotics are highly successful in controlling foot pain and can add pep to your step! Orthotics have helped Plaxico Burress conquer his chronic injuries and they may help you!

from Dave Wilson

If bunions aren’t getting you down, maybe the arch of your foot is causing you pain. Arch pain or arch strain occurs when the tissues in the middle of the foot become inflamed and results in a burning sensation.

The arch of the foot is shaped by a firm band of tissue that joins the toes to the heel bone. This band of tissue plays a vital role in the proper mechanics of the foot and assists in the transfer of weight from the heel to the toes. Thus, when this tissue becomes inflamed, even the slightest movement can cause pain.

There are many different factors that can lead to arch pain. Often arch pain can result from a direct cause such as a foot injury or a structural imbalance of the foot, such as flat feet or a low or high arch. However, the most frequent cause of arch pain is a common condition known as plantar fasciitis.

Plantar fasciitis is a condition that results from excessive stretching of the plantar fascia. This is a wide band of fibrous tissue that runs along the bottom surface of the foot. The inflammation of the plantar fascia usually causes pain to occur in the heel and arch areas. If Plantar fasciitis isn’t effectively treated promptly, further strain can be placed on the arch and a heel spur (a bony growth) may develop on the bottom of the heel.

The most common symptoms of arch pain are tenderness and pain in the arch region of the foot. Pain is usually severe when pressure is applied to the foot after a prolonged period of rest, such as after waking up from sleep.

The most common treatments used to help alleviate arch pain include:

• Supportive shoes – Avoid wearing high-heels as these shoes place a particular amount of stress on the arch region. Instead, wear footwear that properly fits your foot and provides it with proper support including shock absorbing soles, and a moderate, supportive heel. Furthermore, you should wear shoes to support your feet as much as you can. Also, limit the amount of time you walk barefoot, and don’t walk barefoot on hard surfaces.

• Insoles – Special insoles you can insert in your shoes known as orthotics help to alleviate pain by providing your foot with the support it needs to move normally.

• Stretches – Stretching your calf muscle and Achilles tendon causes you to flex your foot, which in turn allows you to stretch the arch. Stretching encourages circulation.

• Massage – Ice massages before bed can help ease sore feet and reduce inflammation. Another effective massage is to rub the bottom of your foot by moving it back and forth over a rolling pin. This helps ease pain caused by plantar fascia.

• Night splint – A night splint can help stretch the plantar fascia while you sleep and prevent stiffness.

• Anti-inflamatory medication – To help ease the pain you can take nonsteroidal anti-inflamatory medication such as ibuprofen. Acetaminophen is also often recommended.

If the above treatments fail to help your arch pain, or pain increases, it’s time for you to visit your doctor – or even better – a podiatrist. Remember, if you want to help heal your feet, you need to be good to them.

from Nathan Wei

Heel pain is one of the most common painful conditions seen in an arthritis clinic. This article discusses the various types of problems that cause heel pain and what can be done to make the situation better.

It’s estimated that more than 1 million persons in the United States suffer from heel pain at any given time.

When a patient complains of heel pain, it must be clarified by history whether the pain is in the bottom of the heel or the back of the heel because the diagnosis and treatment are very different.

Pain in the bottom of the heel is often due to plantar fasciitis (PF). The plantar fascia is a tough band of tissue that begins at the medial (inside) part of the bottom of the heel and extends forward to attach at the ball of the foot. The fascia is responsible for maintaining the normal arch. When an excessive load is placed on the fascia, pain can develop at the origin (the heel) as well as the mid-portion (arch) of the fascia.

PF can develop in anyone but is more common in certain groups such as athletes, people older than 30 years of age, and obese individuals.

PF must be distinguished from other causes of bottom of the heel pain such as nerve entrapment, atrophy of the normal heel fat pad, stress fracture of the calcaneus (heel bone), rupture of the plantar fascia, bone cyst, bone tumor, and bone infection.

The history typically describes a gradual onset of symptoms with no prior trauma. The most telling symptom is severe pain in the bottom of the heel when taking the first morning step. Patients may report difficulty walking to the bath room. The pain tends to lessen with more walking. This “first step” pain is also present during the day if the patient has been sitting for awhile, then getting up to walk.

On exam, pain is noted with pressure applied to the medial bottom of the heel. Tenderness is worsened by pointing the toes and ankle toward the head. This is because the plantar fascia is being stretched. Pain in the arch may also be present.

One in older patients should be ruled out and that is heel pad atrophy. Normally the heel has a thick feeling to it. In older patients the heel pad may lose this thickness and flatten out. The pain is located more centrally.

Another “fooler” is entrapment of the lateral plantar nerve. Pain is felt in the medial heel but may be present at rest as well. There may be weakness spreading the toes.

Fracture of the calcaneus (heelbone) causes pain at rest that is worsened with walking. Tenderness is present along the sides of the heel. Magnetic resonance imaging (MRI) can confirm the presence if fracture.

But what about “bone spurs”? The presence of a bone spur by itself means nothing. They are very common and by themselves are not a cause of pain. Some patients with inflammatory forms of arthritis such as psoriatic arthritis, ankylosing spondylitis, or Reiter’s disease have a specific type of spur that should prompt further evaluation looking for systemic forms of arthritis.

Diagnostic studies such as ultrasound and magnetic resonance imaging can be used to confirm the presence of plantar fasciitis. Electromyography (EMG) may be needed to rule out lateral plantar nerve entrapment.

So how is this condition treated?

The first thing is to institute a stretching regimen. Most people with PF also have a shortened Achilles tendon and the ability to dorsiflex (point the toes up) is limited. The plantar fascia is continuous with the Achilles fascia. Stretching the plantar fascia and the Achilles decreases the tension in the plantar fascia and helps relieve inflammation.

A temporary reduction in activity is important in athletes, particularly runners. Cross training with swimming and cycling can help maintain cardiovascular fitness while sparing the plantar fascia from pounding. Runners should avoid hills and make sure that any foot abnormality be corrected with custom orthotics.

Ice massage with ice cubes applied to the plantar fascia can also be helpful.

Shoes with soft heels and inner soles can relieve discomfort. Rigid heel cups and arch supports are generally not recommended. The patient may gradually resume normal activities over an eight week period of time. Rushing rehabilitation is not advised.

If there is no improvement, a night splint which holds the ankle in 10 degrees of dorsiflexion prevents the shortening of the plantar fascia.

If the night splint fails or the pain does not lessen, injection of glucocorticoid (cortisone) using ultrasound guidance is recommended. Injections should be limited to a maximum of two given over four weeks.

Patients who do not get better need to be reevaluated for systemic disease or other conditions causing heel pain.

Surgery is the last resort. Transverse release of the plantar fascia is the procedure of choice. This can be done using arthroscopic guidance.

Pain in the back of the heel is an entirely different condition.

The major structure here is the Achilles tendon which extends down from the gastrocnemius muscle to attach at the rear of the calcaneus.

Inflammation of the Achilles tendon can occur, usually in athletes or in people in engage in overxuberant physical activity involving running or jumping. Patient who are overweight are also at risk. The pain is usually described as a soreness. There is localized swelling and tenderness. Ultrasound can be used to differentiate an inflamed Achilles tendon from one that is partially or fully torn. The treatment involves anti-inflammatory medicines, physical therapy, and stretching exercises. Glucocorticoid injection is not recommended because of the danger of weakening the Achilles tendon leading to rupture. Using a foam rubber lift to elevate the heel in a shoe can help with symptoms.

Achilles rupture is handled surgically and requires a long recuperation.

Haglund’s syndrome, which is a condition where a spur develops at the back of the calcaneus and is often associated with localized Achilles tendonitis can also cause pain in the back of the heel. Ill-fitting shoes are the most common cause. Typically a bump develops at the back of the heel. Because of its association with ill-fitting shoes, this is sometimes referred to as a “pump bump.” Physical therapy, anti-inflammatory medicines, and stretching can often be of benefit. Glucocorticoid injection should be sparingly employed because of the danger of Achilles rupture. Wearing proper fitting shoes are an obvious adjunctive treatment.

Bursitis involving the retrocalcaneal bursa (the small sack that lies between the Achilles tendon and the calcaneus is a cause of pain behind the heel. Treatment involves the use of physical therapy modalities such as ultrasound. Sometimes glucocorticoid injection may be needed. It is important to limit the injection to one because of the danger of possible weakening of the Achilles tendon leading to rupture. Ultrasound needle guidance is advised to ensure proper localization of the injection.

The diagnosis is made by history and physical examination. Both MRI and ultrasound can be used for confirmation.

from Nathan Wei

The diagnosis of heel pain is best done by looking at the location of the pain… “where does it hurt?”

Heel pain can occur in two major locations: the back of the heel and the bottom of the heel.

Pain at the back of the heel has three major causes.

Achilles tendonitis is the most common. It is usually the result of injury or overuse. An example is the weekend warrior who decides to go out and run 4 or 5 miles going up hills… or a person who goes on a long walk in flat shoes, shoes with little or no heel. In both cases, stress is placed on the Achilles tendon- the large thick cord located in the back of the heel.

This tendon- the largest in the body- connects the gastrocnemius (calf) muscle to the back of the heel.

The likelihood of Achilles tendonitis developing is increased if a person has flat feet. Older patients taking corticosteroid medications and people treated wtih quinolone antibiotics like ciprofloxacin (Cipro) also are at increased risk of Achilles tendonitis and even Achilles tendon rupture.

Haglunds syndrome presents with a bony bump located at the back of the heel. A bursa (small sack of fluid) located near the bump may contribute to the swelling. The Achilles tendon insertion near the bony swelling may become inflamed. Because of the location, this syndrome is often referred to as “pump bumps” and the cause often attributed to womens’ shoes.

Inflammation of the Achilles tendon at its insertion into the heel can be seen with certain types of arthritis, specifically the spondyloarthropathy group which consists of Reiter’s disease, psoriatic arthritis, and ankylosing spondylitis. Other signs of disease such as low back pain and stiffness, rash, and joint swelling may provide clues to diagnosis.

Pain in the bottom of the heel is usually due to plantar fasciitis.

Pain in the plantar fascia presents with sharp stabbing pain in the bottom of the heel. Plantar fasciitis is a common problem that is due to repetitive trauma to the soft tissue in the heel.

Typically a patient will feel fine so long as they are lying down or sitting. But if they get up to walk, the pain feels like an ice pick is being jammed into the bottom of the heel.

This pain gets better over several minutes but occurs again after inactivity followed by weight-bearing.

Causes of plantar fasciitis include:

• An abrupt increase in activity

• Worn footwear,

• Footwear with no arch support (eg., flip-flops)

• Obesity

• Recent rapid weight gain such as with pregnancy

• Overuse as in excessive running and over-training

• Systemic inflammatory arthritis (particularly ankylosing spondylitis and other spondyloarthropathies such as Reiter’s disease and psoriatic arthritis).

Treatment involves first establishing the diagnosis. Most of the time, the diagnosis can be suspected by the history and physical examination.

Imaging tests such as diagnostic ultrasound and magnetic resonance imaging can confirm the diagnosis, if necessary. X-rays may reveal the presence of a heel spur. A heel spur, by itself, is not the cause of pain in the bottom of the heel and heel pain should not be attributed to “a heel spur”.

Once the diagnosis has been made, treatment options include:

• Identifying likely causative factors such as excessive weight, inappropriate footwear, and errors in training.

• Non-steroidal anti-inflammatory drugs (NSAIDs) sometimes provide symptomatic relief.

• Therapeutic taping gives short-term symptom relief.

• Exercises to stretch the heel cord and plantar fascia.

• Orthotic devices can help in the short-term reduction of pain. These can be off-the-shelf or custom made. For people with Achilles tendonitis, having the patient wear a lift in the shoe to elevate the heel will help reduce symptoms.

• Glucocorticoid (steroid) injection may also work for plantar fasciitis and should be used if the patient has not responded to conservative measures. The use of diagnostic ultrasound to guide the injection is recommended.

Caution should be observed with the Achilles tendon as far as steroid injection. The tendon can be weakened if steroids are directly injected. This then can lead to Achilles rupture.

The bursitis that occasionally accompanies Achilles tendonitis (retrocalcaneal bursitis) will respond to steroid injection.

If a patient is taking a quinolone antibiotic (such as ciprofloxacin), it should be discontinued and the patient should be monitored for tendonitis and tendon rupture.

Night time braces are sometimes used for plantar fasciitis.

Often the best treatment for heel pain, whether it is located in the back or on the bottom, is rest.

A surgical solution should be considered for those patients with intractable pain which remains despite conservative treatment.

from Janet Martin


Most people do not really pay attention to their heels even if they are hurting. Many just shrug off the pain, thinking that it’s just temporary and is just caused by walking long miles or by standing up in line for hours. Although feeling a little discomfort in your heels can be quite common especially if you had a long day or after a strenuous activity, persistent or acute heel pains should not be overlooked. There are some serious conditions or diseases that may be causing your heel woes.

To know more about the common types of heel pains, read on and learn.

Plantar Fasciitis

Heel and arch pain is common in people who are suffering from plantar fasciitis, or an inflammation or irritation of the plantar fascia, the tissue on the base of your foot that joins your heels to your toes. Usually, people with this problem feel a burning and stabbing sensation in their feet or heels, particularly in the morning, because the tissue concerned contracts or tightens during the night. Pain is also imminent after a strenuous activity, such as jogging or a tennis match.

Plantar Fasciitis is not really a serious problem particularly if you just encounter it every once in a while. However, for people who have circulation problems or diabetes, it is advised that you seek medical attention for recurring heel pains.

Stretching, applying ice on the problem area, or putting your feet up for a few minutes are some of the ways to help ease pain caused by this condition. It is also wise to find shoes that give your arch some support.

Heel Spur

Often confused with plantar fasciitis, heel spur is actually an entirely different condition. Basically, a heel spur is just a bony growth on the heel. Almost 70% of patients diagnosed with heel spur also suffer from plantar fasciitis. In fact, experts believe that inflammation or degeneration of the plantar fascia tissue is a major cause of the development of heel spur.

Basically, the treatment for heel spur is quite similar to plantar fasciitis: resting, stretching, applying ice packs, and using shoe inserts.

Gout

More common in men than in women, gout is an extremely painful condition that is characterized by unusually high levels of uric acid in the body and recurring joint aches. In case of gout, crystallized uric acids form in joints, such as the heels, and cause tremendous pain. You can usually get rid of this problem, albeit slowly, by eating a diet that is low in uric acid, minimizing alcohol intake, losing weight and drinking plenty of water.

Arthritis

Basically, arthritis is a joint problem characterized by inflammation. Gout, osteoarthritis, and rheumatoid arthritis are just some of the common types of this condition. Since the heels are considered as joints, it is not surprising that you can also suffer from arthritis in that area. Aside from pain, other symptoms of arthritis include swelling, stiffening of the joints, and feeling warm temperature on the area.

Prevention is better than cure when it comes to arthritis. Eating a healthy diet, exercising regularly, maintaining your normal weight, and drinking plenty of water are all helpful in minimizing your risk of developing this problem. However, if you already have one, the best think to do is take natural supplements that contain glucosamine sulfate and chondroitin sulfate, which are known to help alleviate stiffness of the joints and ease pain.

Also, you need Methylsulfonylmethane (more commonly known as MSM) for preventing further wear and tear of muscles and joints, Omega 3 to lubricate the joints, and trypsin, bromelain and rutin to ease pain and improve joint function. One product that contains the above ingredients and much more is Flexcerin. For additional information about how Flexcerin can help ease your joint and bone pains, just visit http://www.flexcerin.com/.

from Ray Davies

The First Signs & Causes of heel pain.

So often heel pain is dismissed by non-sufferers as just a pain in the foot. If only they knew of the searing pain that can be experienced if you are unfortunate enough to become a victim

The sad fact is that it is one of those things that creeps up on you and the early warnings can be missed. It is not like a sudden sprain or break in a limb. Instead,it’s a gradual breakdown of tissue.

Heel pain and Plantar Fasciitis are not necessarily the same thing although any heel pain is likely to be caused by the latter. Various causes of heel pain are known many of which are not fully understood. Although there are many different apparent causes of heel pain, the usual culprit is plantar fasciitis (plantar fash-ee -eye-tis).

The plantar fascia is a broad, flat ligament that runs along the underside of the foot from the heel to the front of the foot. The foot derives support from this.

Plantar Fasciitis heel pain can appear in all age groupsbut is commoner in people of advanced years and in those of us who are overweight.

There are other possible causes of foot pain such as rheumatoid arthritis and gout, but Plantar Fasciitis probably makes up about 95 percent of the cases of severe heel pain. Quite often shoes are thought to be the cause. Although shoes often play a part, the cause in a particular case can be elusive.

Common triggers for heel pain or plantar fasciitis include the following.

Obesity.

Tight calf muscles.

The Achilles Tendon is two tight.

Stress in the instep.

Running or other exercise without warming up.

Unsuitable footwear.

An extended walk.

Plantar fasciitis heel pain is frequently felt at the front of the heel and the pain then spreads along the underside of the foot towards the big toe.

A searing pain in the heel when standing after a period of lying down is one of the signs of this illness. If you are unfortunate enough to suffer this, then the chances are high that you have joined the ranks of those suffering from Plantar Fasciitis.

Some of the first steps to relieving heel pain can be as simple as stretching your foot before getting out of bed in the morning. It is also essential to ensure that footwear is of the correct design and sufficiently supportive for whatever you intend participating in.

A variety of gentle calf and Achilles Tendon stretches can also ease early stage heel pain.

Reduce, or avoid altogether activities that increase the discomfort. This should be approached sensibly. Some common everyday activities such as climbing a staircase and walking are not possible to avoid. Whilst strenuous pursuits that involve running or lifting need to be suspended. All of these can make the degree of pain in the heel worse.

Plantar fasciitis is the most usual type of heel pain and is an important manifestation of a physical disability that renders the exercise; that is so important for weight loss, impossible.

Most of the time, heel problems Do not directly cause obesity. There is no doubt though, that relieving heel pain can be a major contribution to weight loss and better health for a large number of people. If you have plantar fasciitis, you must discontinue running and minimise walking until you are no longer in pain.

When you resume your running program, you must commence to just jog very slowly each day until you feel a little discomfort. You must then cease for 24 hours.

Exercise is important for everybody. It is incredibly galling to reach a good level of fitness only to be laid low by something as simple as heel pain. In view of this, it is essential to build up to your full program over time.

from Dave Wilson

If you find that your heel hurts, feels hot and is swelling, relax. It is likely your problem is not related to peripheral neuropathy. It is more probable that the condition you are suffering from is either Plantar Fasciitis or Bone (heel) spurs.

Plantar fasciitis is a condition that results when the plantar fascia (a thin layer of strong tissue that supports the arch of the foot) is repeatedly torn. These microscopic tears may be caused by stressing out the arch, muscles weakness within the foot, tightening of the calf or foot, wearing shoes that are too small, overusing your feet by running too hard, too fast and too soon, and obesity. People who have flat feet, low arches or high arches in their feet are at a higher risk of developing plantar fasciitis.

Sometimes, plantar fasciitis is mistakenly called “heel spurs”. Although it is possible for a heel spur to develop from plantar fasciitis, they are not always a factor of the condition. Furthermore, heel spurs are actually bone spurs that occur on the feet. A bone spur is a bony growth that forms on natural bone. Bone spurs are often smooth but can be painful if they are pressed or rub against other bones, tendons, ligaments and other nerves in the body.

Bone spurs usually occur on the sole or back of the heel. Most bone spurs that appear on the bottom of the heel are the result of plantar fasciitis, while those that occur on the back of the heel are often caused by rubbing shoes. The most common shoe to cause bone spurs are high heels. That is why these types of bone spurs are known as “pump bumps”. The forming of a bone spur is the body’s effort to try and repair itself in response to prolonged rubbing, pressure or stress in the affected area.

People who suffer from plantar fasciitis and/or bone spurs can seek many different forms of treatment to help them cope with the condition and relieve symptoms. When treatment is started early most people experience relief of symptoms within six weeks, and avoid the need for surgery. However, successfully easing symptoms in some people may be difficult if the type of job they do is demanding of their feet (IE. constant walking, standing or bearing weight, etc.)

The main goal of treatment is to find a way to help an affected heel absorb shock. The best way to achieve this is to provide the heel with cushioning and elevation. This helps to divert pressure away from the plantar fascia. Special shoe inserts known as Orthotics are highly recommended for treatment. They are designed to absorb shock, elevate the back of the foot, and cradle the heel.

Wearing the right footwear is also important when it comes to treating plantar fasciitis and bone spurs. The best shoes are those that offer good arch support and a firm heel at the appropriate height. A podiatrist may be able to recommend a good shoe for your foot. However, the best person to visit is a shoe specialist known as a pedorthist.

Other forms of effective treatment include: