Causes of Heel Pain Other than Plantar Fasciitis

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Plantar fasciitis symptoms involve two areas — the arch and the inside heel area the latter is more common. Therefore, you will need to continue with preventive measures. Try to cushion your foot.

You will, however, often need to modify activity so you are not pounding so hard on your heel and arch. This will put less pressure on your plantar fascia and the other related muscles at the bottom of your foot. If you engage in activity without adequate arch support the plantar fascia will get inflamed.

Plantar Fasciitis: Its Causes, Symptoms, and Prevention

Plantar fasciitis is a well-known pathology to most foot and ankle specialists. A systematic review performed by Landorf and Menz found that heel pain affects 7 percent of people over 65, makes up one-quarter of all foot injuries in runners, and accounts for 1 million physician visits per year. In the United States, there are an estimated 23,000 ankle sprains per day and 5,000 in the United Kingdom. The peroneal tendons, specifically, play an important role in preventing excess supination of the foot on uneven terrain and therefore protect against lateral ankle injuries. A study in the Journal of Athletic Training looked at muscle activation in patients with or without chronic ankle instability. The study found that the peroneus longus was firing earlier in the gait cycle and 13 percent longer than those with healthy ankles. The authors believed that because the tendon was firing earlier, there was less protection against pathological inversion motion at the point of heel strike and the tendon would become more easily fatigued. We believe that to compensate for an unstable ankle, the increased activation of the peroneal tendons places a pronatory effect on the foot, causing increased strain on the plantar fascia and resulting in plantar fasciitis symptoms. A Guide To The Diagnostic Workup And Conservative Treatment When a patient presents to our institution with plantar heel pain, we perform a relatively common evaluation including testing the location of pain. If the ankle is unstable, we have the patient stand to evaluate proprioception and balancing. We often find ankle instability and plantar fasciitis coexist quite frequently. Physical therapy for this patient would not only be geared toward addressing the tight posterior musculature and thickened plantar fascia, but ankle instability as well. In a patient with plantar fascia pain whose ankle is also symptomatic, grossly unstable or fails first-line treatment, we will then provide an ankle brace. Our theory is that with additional ankle support, the peroneal tendons do not have to activate earlier and fire longer. This would then halt extra pronatory movement and decrease strain to the medial plantar fascia. Key Pearls On Effective Surgical Treatment For those patients with ankle instability, peroneal spasm and chronic plantar fasciitis who fail conservative treatment, we recommend not only addressing the chronic plantar fascia pain but the ankle instability as well. Preoperatively, obtain magnetic resonance imaging MRI to evaluate the plantar fascia tissue as well as the ankle ligaments, peroneal tendons and talar dome. Tendon and ankle pathology often occur with patients who have chronic ankle instability along with multiple inversion injuries. Therefore, it is important to address those associated pathologies at the time of surgery. In surgery, we first perform the lateral ankle stabilization followed by the plantar fascia treatment. In the absence of tendon pathology, we perform a slightly curved incision around the anterior aspect of the fibula. Dissection protects the sural nerve inferiorly. Once the retinaculum is visible, transect it along the anterior fibula. This allows visualization of the anterior talofibular and calcaneofibular ligaments, and protection of the peroneal tendons inferiorly. Then incise the ligaments at the fibular attachment and resect the excessive, diseased ligament tissue. We then perform a pants-over-vest suturing technique using the attached 2-0 FiberWire Arthrex to reapproximate the ligament to the fibula all while maintaining the foot in a dorsiflexed position. Then repair the retinaculum using another 2-0 FiberWire in a pants-over-vest technique. Approximate the skin and direct attention to the plantar fascia. In a patient who has mild scarring of the fascia and short-term symptoms, we would perform a Topaz Smith and Nephew microplantar fasciotomy along with ankle stabilization. Then after a sterile prep, draw a 20- to 24-hole grid over the area of maximal pain at the medial origin of the plantar fascia. The holes are approximately 5 mm apart. We then puncture the skin with a 0. Then introduce the wand to the level of fascia and activate the wand, extending it through the fascia. Do this at each hole in the grid. For patients who have experienced long-term symptoms and severe thickening of the fascia visible on MRI, we recommend a medial band release. Our preferred method is to perform an endoscopic plantar fasciotomy. We make a small 1 cm incision to the medial aspect of the heel at the insertion of the plantar fascia and then bluntly dissect to the fascia itself. We then insert the Centerline Arthrex arthroscope and blade to allow for direct visualization, and subsequently transect the medial half of the plantar fascia. What An Appropriate Postoperative Protocol Entails Postoperatively, place the patient in a cast and emphasize strict non-weightbearing to protect the ankle repair for three weeks. Gradually transition the patient to a weightbearing cast or boot to complete a five- to six-week total healing period. Physical therapy usually begins at weeks three to five. After six to eight weeks, the patient will continue with physical therapy and will transition to a supportive shoe with full-time use of an ankle brace. At 10 to 12 weeks, patients will gradually return to normal activities and continue use of the ankle brace during exercise or increased activity for six months to a year. In Conclusion We believe plantar fasciitis can be caused or aggravated by the pronatory forces of the peroneal tendon that attempt to stabilize an unstable ankle. Evaluating a patient with plantar fasciitis for ankle instability takes very little time and can answer many questions regarding the cause of pain and lack of improvement with initial conservative care. Furthermore, improvement in pain while using an ankle brace is a good indication that the patient will do well with lateral ankle stabilization. In addition to addressing the cause of the pathology lateral ankle instability to prevent recurrence, one also needs to treat the chronic thickening and scarring of the plantar fascia by stimulating healing with a micro-fasciotomy or complete medial band fascia release. Bohman is a Fellow at University Foot and Ankle Institute in Los Angeles. Baravarian is an Assistant Clinical Professor at the UCLA School of Medicine. He is the Chief of Podiatric Foot and Ankle Surgery at the Santa Monica UCLA Medical Center and Orthopedic Hospital, and is the Director of the University Foot and Ankle Institute in Los Angeles. Plantar heel pain and fasciitis. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. Oper Tech Sports Med. Lower extremity muscle activation in patients with or without chronic ankle instability during walking.

You can learn more about. Your doctor can also apply corticosteroids to the difference of your heel or the arch of your foot, and then apply a painless electrical current to let the steroid pass through your skin and into the muscle. Plantar fasciitis usually develops slowly, although in some cases the pain can appear instantly and be very intense. Wearing civil shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. Huppin have a better than 95% success rate. This damage causes inflammation but when you met around during the day, the act of walking and your muscles contracting plus pressure from the ground pressing on the heel acts like a massage and prevents inflammation from building up in the heel. You're more likely to feel it after not during exercise. After a few caballeros of walking, the pain decreases because walking stretches the fascia. Ask your employer about installing rubber floor mats to help reduce fatigue on your feet, back, and joints.