Understanding Plantar Heel Pain Health And Social Care Essay

Plantar heel pain is a common problem which can challenge the best of clinicians. It is associated with a multitude of aetiologies with abnormal foot function linked as leading factor

Understanding of the anatomy structure of the heel is fundamental to understanding the etiology and pathology of the heel pain and helps achieving the best treatment outcomes.

Heel pain is one of the most conditions that patient frequently consult different medical provisional to diagnose and treat.(Gerwin & Ferguson 2005). it is estimated that one million patients in the USA visit medical professionals in relation to heel pain per year. Heel pain emphasizes mobility and quality of life, patient with heel pain experience walking difficulty. (Menz 2008)

Heel pain has a variety of causations. Heel spur and planter fasciitis are the common cause of heel pain. Other causes include Achilles tendinitis, neuroma: primary nerve entrapments (tarsal tunnel syndrome).(Nordin & et al 2006) Heel pain can also be caused by referred pain from the foot and cleft intrinsic muscle trigger points that caused by dysfunctions in the gait cycle. Baxter’s neuritis, compression of the posterior tibial nerve calcaneal branch, might also generate heel pain. (Gerwin & Ferguson 2005)

Heel pain frequently become chronic problems as patients delay consulting medical practitioner until the situation is worsen, and its is not easy to treat. Home treatment such as stretching exercises, off shelf orthotic and medication always complicate the situation further. (Gerwin & Ferguson 2005)

Planter fasciitis

‘’Planter fasciitis is a chronic inflammation at the site of the attachment of the planter fascia to the medial tubercle of the calcaneum’’ (Merriman& Tollafield 1999).

Planter fasciitis is the classic cause of pain on the planter surface of the heel.(Klenerman 1976) effected patient complain of tender pain in the whole sole of the foot with a particular sever pain anterior to the calcaneal tuberosity.(Inman 1973), that can be irritated by weight bearing and dorsiflexion of the toes. .(Klenerman 1976) patient experience acute pain first thing in the morning. (Merriman& Tollafield 1999)

The common cause of planter fasciitis is the overuse. Overuse caused by increased movement, excess standing and recent increase of the body weight, consider to increase the traction on the planter fascia .thus cause inflammation, swelling and pain.(Burrow & et al2006)

Other cause is lengthening of the foot during weight bearing, due to the excess of pronation, caused by rearfoot varus, anomalies of the lower extremities and mobile pes cavus, increases the tension on the planter fascia during stance and increases traction on the planter fascia attachments. (Burrow & et al 2006)

Nevertheless deficient and lack of typical pronation in mid-stance caused by fixed pes cavus and uncompensated rear foot varus, put planter fascia under continuous tension during stance. (Burrow & et al 2006)

Pes cavus

Deformity of the forefoot relatively to the rearfoot, characteristics with an increased longitudinal arch height, mild shortening of the foot, abnormal distribution of the planter weight, reduced range of motion of all joint of the feet, rigidity and lateral instability. (Inman 1973)

Excess weight put in the lateral border. High calcaneal angle and there is excessive loud during the heel strike. Heel strike forces as a result of the absent of four degrees of motion, are shifted to the planter posterior region of the heel. (Roberts 2004)

lengthening of the foot during weight bearing, due to the excess of pronation caused by pes cavus, increases the tension on the planter fascia during stance phase of the gait and increases traction on the planter fascia attachments. (Burrow & et al 2006)

the continuing extreme tensile forces cause microtears in the planter fascia thus cause the tissue to undergo changes such as collagen necrosis , exess growth of local blood vesswls and fibrous tissue and calcification in the origin i.e. an acute chronic inflammation. (Burrow & et al 2006)

spur -a hard bony growth in the calcaneus medial tuberosity- is a reaction to the plantar fascia inflammation and degeneration. The ongoing overstretching and constant inflammation of the planter fascia at its origin result in calcium deposit that stimulates bon growth.(bisio 2004)

Treatment use of felt heel pad in the form of eonvex wedgr in order to stabilize the heel in varus position and to relax the tension in the planter fascia. (Klenerman 1976) stretching exercises that trigger the achilles tendon and massage. (Bisio 2004) inti-inflammatory agents and local steroid injection. (Inman 1973) extracorporal shock wave therapy with success rate of 90% (Roberts 2004). At sever cases where the other treatments are not effective, surgery intervention such as proximal plantar fascia release can be considered. (Gerwin & Ferguson 2005)

Achilles tendinitis Is a painful and incapacitating inflammation of the Achilles tendon, (burrow & et al 2006) variable symptoms of pain, swelling and tenderness appear over the attachment of the Achilles tendon and proximal to the attachment. (Klippel & et al 2008)

Leadbetter’s (1992) mechanical theory stated that ‘’when a tendon is repeatedly brought to 4-8% beyond its normal length, fatigue occur in the tendon tissues. This fatigue limits the tendon tissues ability to repair itself , and the microtrumatic process takes over.’’(Starky & Johnson 2006)

Usually resulting from sudden increase in the level of activity, improperly fitting shoe, training in hard surfaces, inflammation condition such as reactive arthritis gout hyperpronation, and leg-length discrepancy. (Klippel & et al 2008)

hyperpronation is the most common cause. During mid-stance the foot moves to supination, whereas the hyperpronation foot dose not, so the Achilles over-stretched to push the body forward. This stress is dominant alongside the medial tendon where the vascular supply is fewer. (Starky & Johnson 2006)

The excessive pull on the Achilles tendon causes a reflex contraction of the posterior calf muscles with increase tension, thus formation of microtears within the heel cord. (Burrow & et al 2006)

Treatment

Orthosis, heel rise and splint with slight planter flexion, to prevent the Achilles from rupture, and to minimize the pull on the Achilles tendon. Immobilization cast below the knee might be required to allow heeling of the tendon .(Burrow & et al 2006)Steroid injection and NSAIDs along with heavy load eccentric calf muscle training.

Surgical intervention might be needed when pain is acute. Dissecting of the tendon sheath and removing nonviable degenerative tissue and bone spurs. (Starky & Johnson 2006)

Tarsal tunnel syndrome

This is uncommon entrapment neuropathy, involving burning pain in the planter portion of the foot, numbness, paraesthesia in the sole of the foot and associated with a pronated type of foot. (Menz 2008)

As the foot pronate , the tibial nerve become compressed within the fibro –osseos tunnel inferior to the laciniate ligament. (Roberts 2004)

Other caused of tarsal tunnel syndrome is local chronic inflammation caused by underlying rheumatoid disease, resulting a swelling of the tendon synovial sheath, as it passes below the sustentaculum tali. The developed fibrosis makes the tibial nerve compressed within the fibro-osseous tunnel formed by the flexor retinaculum of the medial malleolus and the ankle. (Burrow & et al 2006) Additionally subcutaneous scarring ,caused by heavy weight item falling on the dorsum of foot.(Inman 1973).

Treatment, anti-inflammatory injection used to decrease swelling and relive pain. Othrosis, valgus pad with varus post will limit pronation and help to reduce nerve contraction and stretching (Roberts 2004) surgical release is needed if other treatments are not effective. (Inman 1973)

Fat pad atrophy

The heel planter fat pad is a decidedly structured tissue designed to resist continuous impact loads i.e. shock absorption. After long-period overuse the structure fails resulting in reduction of the tissue capacity of shock-absorption and soft flattened heel pad, thus causing pain.

Treatment

Silicon pad help to absorb the pressure therefore relive the pain

In the conclusion

Heel pain is one of the most conditions that patient frequently consult different medical provisional to diagnose and treat.(Gerwin & Ferguson 2005). Heel pain emphasizes mobility and quality of life, patient with heel pain experience walking difficulty. (Menz 2008)

Abnormal foot function is one of the main causes of the heel pain. Nevertheless there is other causation associated with the heel pain.

Understanding of the anatomy structure of the heel is fundamental to understanding the etiology and pathology of the heel pain and helps achieving the best treatment outcomes.

Treatment