Foot Pain - Heel Pain

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Causes of Plantar Fasciitis. The cause of plantar fasciitis is often unknown. It is usually associated with overuse during high-impact exercise and sports and accounts for up to 9% of all running injuries. Because the condition often occurs in only one foot, however, factors other than overuse are likely to responsible in many cases. Other causes of this injury include poorly-fitting shoes, lack of calf flexibility, or an uneven stride that causes an abnormal and stressful impact on the foot.

Treatment Goals. The three major treatment goals for plantar fasciitis are:

• Reducing inflammation and pain
• Reducing pressure on the heel
• Restoring strength and flexibility

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Embarking on an exercise program as soon as possible and using NSAIDs, splints, or heel pads as needed reduces the risk for future surgery. Pain that is not relieved by NSAIDs may require more intensive treatments, including leg supports and even surgery.

Exercises to Restore Strength and Flexibility. Stretching the plantar fascia is the mainstay therapy for restoring strength and flexibility. One exercise involves the following:

• Put the hands on a wall and lean against them.
• Place the uninjured foot on the floor in front of the injured foot. The injured foot in back should have the heel off the floor.
• Stretch the back leg and foot gently.

With stretching treatments, the plantar fascia nearly always heals by itself but it may take as long as a year, with pain occurring intermittently. A moderate amount of low-impact exercise (such as walking, swimming, or cycling) also seems to be beneficial.

Medications to Relieve Pain and Reduce Inflammation.

• NSAIDs. Inflammation and pain is most commonly treated with ice and over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen (Advil).
• Corticosteroids. Corticosteroids, or steroids, are powerful anti-inflammatory agents. An injection of a steroid plus a local anesthetic (such as xylocaine) may provide relieve in severe cases of plantar fasciitis. (Steroid injections are not used for pain that is only due to heel spurs). For athletes or performers who need immediate relief, an effective method is to administer the steroid dexamethasone using a procedure called iontophoresis, which introduces the drug into the foot's tissue using an electrical current.