HEEL SPUR

PLANTAR FASCIITIS & CALCANEAL SPUR (HEEL SPUR)

INTRODUCTION:

                     Plantar fasciitis is the most common cause of pain on the bottom of the heel.  It is the most common among the people nowadays. Patients getting treatment for this complaint gradually increases. Plantar Fasciitis occurs when the strong band of tissue that supports the arch of your foot becomes irritated, calcified and inflamed.

ANATOMY:

            The Plantar Fascia is a long, thin ligament that lies directly beneath the skin on the bottom of your foot. It connects the heel to the front of your foot, and supports the arch of your foot.

          

CAUSES:

             The Plantar Fascia is designed to absorb the high stress and strain on your feet. But sometimes, too much pressure damages or tear the tissues. The body’s natural response to injury is inflammation, which results in the heel pain and stiffness of plantar fasciitis.

 

RISK FACTORS:

              On most cases Plantar fasciitis without any a specific, identifiable reason. There are however, many factors that can make prone to the condition.

• Tighter calf muscles that make it difficult to flex your foot and bring your toes up toward your shin
• Obesity
• Very high arch
• Repetitive impact activity (running/sports)
• New or increased activity

HEEL SPURS:

           Although many people with plantar fasciitis have heel spurs, spurs are not the cause of plantar fasciitis pain. One out of 10 people has heel spurs, but only 1 out of 20 people (5%) with heel spurs has foot pain. Because the spur is not the cause of plantar fasciitis, the pain can be treated without removing the spur.

SYMPTOMS:

            The most common symptoms of plantar fasciitis include:

• Pain on the bottom of the foot near the heel.
• Pain with the first few steps after getting out of bed in the morning, or after a long period of rest, such as after a long car ride. The pain subsides after a few minutes of walking.
• Greater pain after (not during) exercise or activity.

EXAMINATION:

           After you describe your symptoms and discuss your concerns, doctor will examine your foot. Doctor will look for these signs:

• A high arch.
• An area of maximum tenderness on the bottom of your foot, just in front of your heel bone.
• Pain that gets worse when you flex your foot and the doctor press/pushes on the plantar fascia. The pain improves when you point your toes down.
• Limited "up" motion of your ankle.

TESTS:

Ø  X-rays: X-rays provide clear images of bones. They are useful in ruling out other causes of heel pain, such as fractures or arthritis. Heel spur can be seen in this x-ray

Ø  Other Imaging Tests: Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not routinely used to diagnose plantar fasciitis. They are rarely ordered. An MRI scan may be used if the heel pain is not relieved by initial treatment methods.

TREATMENT:

Ø  Non-Surgical Treatment:

·         Rest

·         Contrast bath for the foot

·         NSAIDs

·         Exercise

ü  Calf strength

ü  Plantar Fascia strength

·         Cortisone Injection ( is ONLY advisable in CHRONIC stage)

·         Supportive Shoes and Orthotics: Shoes with thick soles and extra cushioning can reduce pain with standing and walking. As you step and your heel strikes the ground, a significant amount of tension is placed on the fascia, which causes micro trauma (tiny tears in the tissue). A cushioned shoe or insert reduces this tension and the micro trauma that occurs with every step. Soft silicone heel pads are inexpensive and work by elevating and cushioning your heel. Pre-made or custom orthotics (shoe inserts) are also helpful.

Orthotics for heel:   

Ø  Surgical Treatment:

·         Surgery is considered only after 12 months of aggressive nonsurgical treatment.

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