Heel Pain Management

Heel Pain Management  

heel pain/foot pain/feet pain/leg pain 

Well. I'm blogging after quite long gap..Nothing much too say,just can't find the proper time to write.Life here is so hectic.Most of the time ,some idiots out there having rally and strikes.I really don't know what's the point.because this, most of the time,no internet connection,yet I still have to pay for it..and my fucking college life..Everyday have to go and stand there like a chicken,don't understand a single word.Then why they said this is an English medium.So.let me come the point.The topic I'm going to write today is foot pain.I'm sure many of you having the same problem.(even my mum having this pain).

Plantar fascitis , also known as Plantar Heel Pain (PHP) is a painful inflammatory process of the plantar fascia, the connective tissue or ligament on the sole (bottom surface) of the foot. It is often caused by overuse of the plantar fascia, increases in activities, weight or age. It is a very common condition and can be difficult to treat if not looked after properly.

Longstanding cases of plantar fasciitis often demonstrate more degenerative changes than inflammatory changes, in which case they are termed plantar fasciosis. Since tendons and ligaments do not contain blood vessels, they do not actually become inflamed. Instead, injury to the tendon is usually the result of an accumulation over time of microscopic tears at the cellular level.

The plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes. It is commonly associated with long periods of weight bearing and much more prevalent with hyper-pronation (flat feet). Among non-athletic populations, it is associated with a high body mass index. The pain is usually felt on the underside of the heel and is often most intense with the first steps of the day. Another symptom is that the sufferer has difficulty bending the foot so that the toes are brought toward the shin (decreased dorsiflexion of the ankle). A symptom commonly recognized among sufferers of plantar fasciitis is an increased probability of knee pains, especially among runners

An incidental finding associated with this condition is a heel spur, a small bony calcification on the calcaneus heel bone, in which case it is the underlying plantar fasciitis that produces the pain, and not the spur itself. The condition is responsible for the creation of the spur; the plantar fasciitis is not caused by the spur.

Sometimes ball-of-foot pain is mistakenly assumed to be derived from plantar fasciitis. A dull pain or numbness in the metatarsal region of the foot could instead be metatarsalgia, also called capsulitis. Some current studies suggest that plantar fasciitis is not actually inflamed plantar fascia, but merely an inflamed flexor digitorum brevis muscle (FDB) belly. Ultrasound evidence illustrates fluid within the FDB muscle belly, not the plantar fascia.

Treatment

Physical treatments

Based on current research, recommendations for immediate relief and reduction of inflammation include heel and foot stretching exercises as can be tolerated, microcurrent treatment, rest, wearing shoes with good support and cushions. Other steps to relieve pain include: applying ice or ice-heat-ice, and/or using night splints to stretch the injured fascia. Customized functional foot orthotics can offer a decrease in the pain associated with plantar fasciitis and may provide an additional benefit in terms of increased functional ability in patients with the condition.

Some evidence shows that stretching of the calf and plantar fascia may provide up to 2–4 months of benefit. One study has shown improvement over a four-month period with stretching. One study has shown high success rates with a stretch of the plantar fascia, but has been criticized because it was not blinded, and contained a bias because the analysis did not use the intention to treat method. Because it is impractical to do double-blind experiments involving stretching, such studies are vulnerable to placebo effects.

Pain with the first steps of the day can be markedly reduced by stretching the plantar fascia and Achilles tendon before getting out of bed. Night splints can be used to keep the foot in a dorsi-flexed position during sleep to improve calf muscle flexibility and decrease pain on waking. These have many different designs. The type of splint has not been shown to affect outcomes.

Surgery 

Surgery carries the risk of nerve injury, infection, rupture of the plantar fascia, and failure to improve the pain.This allows more space for the inflamed muscle belly, thus, relieving pain/pressure. An ultrasound-guided needle fasciotomy can be used as a minimally invasive surgical intervention for plantar fasciitis. A needle is inserted into the plantar fascia and moved back and forwards to disrupt the fibrous tissue.Coblation surgery  has been used successfully in the treatment of recalcitrant plantar fasciitis. This procedure utilizes radiofrequency ablation and is a minimally invasive procedure.

Medication 

To relieve pain and inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are often used but are of limited benefit.Dexamethasone 0.4 % or acetic acid 5% delivered by iontophoresis(Iontophoresis is a physical process in which ions flow diffusively in a medium driven by an electric field  to treat of excessive sweating of the hands and feet )    combined with low Dye strapping and calf stretching has been shown to provide short term pain relief and increased function.

Local injection of corticosteroids often gives temporary or permanent relief, but may be painful, especially if not combined with a local anesthetic and injected slowly with a small-diameter needle.(Injecting dexamethasone and lidocaine ,but dont try yourself).Recurrence rates may be lower if injection is performed under ultrasound guidance.Repeated steroid injections may result in rupture of the plantar fascia.

by Lakdhes..