Heel Pain Early In The Morning When I Walk
Plantar fasciitis is a very common problem I encounter as an orthopaedic surgeon in clinic.
The plantar fascia is a long fascial band that runs the length of the sole from heel to toe that acts as a shock absorber for the arch of your foot.
What is Plantar Fasciitis?
Excessive walking or standing , tissue tension or strain gives rise to small tears in the fascia. This occurring on a repetitive basis can lead to Plantar fasciitis.
The first few steps in the morning or after prolonged periods of rest.are very painful, this is because the fascia contracts while you sleep or rest .
When you get up and take the first few steps, the fascia stretches causing excruciating pain.
Risk Factors
Tight calf muscles, making its difficult to forward flex the ankle
High arch foot
Obesity
Repetitive impact activity ( sports / home ) long-distance running, ballistic jumping activities, ballet dancing and aerobic dance
Profession which requires prolonged standing
SYMPTOMS
Pain while getting out of bed in the morning or after prolonged sitting, prolonged walking.
Pain is usually severe and stabbing in nature.
Pain after and not during exercises is a classic finding.
DIAGNOSIS
Diagnosis is usually made clinically on examination.
Rarely x-ray or MRI is required to rule out other causes.
Occasionally x-rays reveal heel spurs and are just an incidental finding.
TREATMENT
In most cases it is treated with conventional treatments such as rest, ice packs on the affected area and also ankle stretching.
Medication
Anti inflammatory medications for pain control. This helps to decrease the inflammation and relieves pain.
Physical Therapy
Exercises for stretching and strengthening of the heel cord and fascia are taught to the patient and should be done by them every single day.
Night Splints: If the pain is excessive, night splints help, as they stretch the fascia and hold it in a lengthened position overnight.
Orthotics: Custom made medial arch supports help relieve the pain while walking and should be used inside the shoes.
Local Injections
For cases not responding to conservative management, local injections can be given into the inflamed region. This procedure is quick, easy and ensures dramatic pain relief.
Surgery
For severe recalcitrant cases surgical release of the fascia can be done though rarely employed.
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