A Family Doctor's Tale - PLANTER FASCILITIS

DOC I HAVE HEEL PAIN

Heel pain is very common among women and usually present a pain in the heel especially stepping on the floor from a lying position in the morning. 
If the pain disappear after a period of walking it may be due to a blood clot which presses against a nerve but disappear when the blood clot dissolved after walking.
If the pain is persistent during walking a diagnosis of Plantar fascilitis or calcaneal spur may be diagnosed. 
An X ray may be necessary to confirm the diagnosis of calcaneal spur.
A injection of lignocaine and hydrocortisone may help to reduce the inflammation.


Plantar Fascilitis (also known as Painful Heel Syndrome) is a inflammation of the plantar fascia (which stretch from the calcaneum to the toes) characterised by the pain in the heel especially in the morning and weight bearing exercises.


It is more common in women.


The cause of Plantar Fascilitis is the non-specific inflammation of the plantar fascia as a result of repetitive injury to the fascia.
In some cases the plantar fascilitis occurs as a result of a calcaneal spur impinging on the fascia.
Both heels can be affected.


Symptoms:
1.Pain in the heel of one or both feet


2.Pain usually is worse in the morning on getting and stepping on the floor.


3.Certain weight bearing exercises like jogging or brisk walking makes the pain worse


4.Pain is described as constant and aching


5. Pain is felt most beneath the calcaneal bone but may be present in the area of the medial arch.


Signs:

1.local tenderness in the calcaneal bone area of the heel.


2. Pain is aggravated by direct pressure.


3. It can become more painful by movement which put the fascia under strain such as dorsiflexion of the toes or ankles.


4.Xrays of the heel usually show no abnormally. Sometimes there is calcaneal spur which may be due to traction of the muscle or fascia on the calcaneum bone. 

A stress fracture may need to be ruled out in chronic cases.


Conservative treatment:

Initial phase:
1.rest of the heel-avoid jogging or strenuous exercises


2.Cold or ice may help reduce inflammation


3.Heel cups, cushions, tapes, pads may help to reduce the pain


4.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain


5.Muscle relaxant to relax muscles


6.Injection of local anesthetic and long acting steroid into the tender area of the plantar fascia may help to relieve pain.


7.Usage of a short leg walking cast for a few weeks help to avoid exertion on the inflamed fascia.


8.A cushion lined night splint which hold the foot in slight dorsiflexion is helpful.


Mobilisation phase:
Physiotherapy such as traction of the fascia and heel cord, shortwave diathermy may help once there is no pain


Surgery is usually not indicated in plantar fascilitis.

Rarely surgery is used to remove the calcaneal spur and to release the plantar fascia at its attachment to the calcaneum bone.


Prognosis is usually good although healing is slow and takes up to 1-2 years.