Heel Pain (Plantar Fasciitis) in People with Diabetes

BAMILA.S, MPT.MIAP(NEUROLOGY)

What is Plantar Fasciitis?

The plantar fascia ligament runs between the heel bone and the toes and stretches with every step. It acts like a bowstring to maintain the arch of the foot .Inflammation develops when tears occur in the tissue.


Causes
1.Those who have very flat feet or very high-arched feet are at greater risk .
2.Abnormal stretching of the plantar fascia ligament.
3.Abnormal strain on the plantar fascia by wearing non-supportive footwear on hard, flat surfaces especially for jobs that require long hours on the feet or when a person is obese.
4.Inflammation of tendons due to certain types of arthritis, especially among the elderly.
5.Diabetes is also a factor that can contribute to heel pain and damage, especially among the aged. Prolonged high levels of blood glucose may result in the stiffening of soft tissues. Small tears can occur in the foot due to stress (load bearing) .Peripheral neuropathy makes the person unable to feel any injury and it could become ulcerated and get infected.
6.Athletes who do extreme exercises are also at risk for this damage.
7.Abnormal ways of walking can adversely affect the way weight is distributed on the feet. This can put added stress on the plantar fascia.
8.Wearing shoes that are thin-soled or loose, or those that do not have good arch support or the ability to absorb shock, don't protect the feet. Regular use of high-heeled shoes can contract and shorten the Achilles tendon which is attached to the heel, causing strain on the tissue around it.

Symptoms

The symptom of plantar fasciitis is PAIN …
•- that is on the bottom of the heel
•- that is usually worse upon getting up
•- that increases over a period of months

Treating Plantar Fasciitis
Plantar Fasciitis should be treated immediately. Treatment involves correcting the underlying problems. Some of the most common treatments are:
1)Stretching the calf muscles several times a day, especially in the morning and after prolonged sitting.
2)Putting an ice pack on the heel for 20 minutes several times a day to reduce inflammation.
3)Stretching the plantar fascia in the morning.
4)Rest .
5)Losing weight.
6)Not walking barefoot. Walking without shoes causes undue strain and stress on the plantar fascia.
7)Slowing down extended physical activities to give the heel a rest.
8)Temporarily changing to moderate activities such as swimming and/or bicycling instead of sports that involve running and jumping.
9)Modifying or wearing supportive shoes that have good arch support and a slightly raised heel to reduce stress on the plantar fascia and wearing shoes with soft heels and insoles.











10)Using medication.
Despite treatment, the underlying causes that brought on this condition may remain. Therefore, you will need to continue with preventive measures. Your podiatrist may suggest treatment such as…using orthotic devices that fit into the shoe to correct the fault; using padding, strapping or night splints; or physical exercises for relief. Stretching the plantar fascia can help decrease the symptoms of plantar fasciitis.

11)Plantar Fasciitis Taping
Plantar fasciitis taping is often used to alleviate stress on the plantar fascia ligament since it limits the movement of the fascia.

Athletic tape can be applied in the morning do reduce strain throughout the day, or just before exercise to keep the fascia from moving too much during physical activity. It is recommended that the tape not be left on the foot all day as well as all night because this prevents the skin from being able to breathe.



12)NIGHT SPLINTS
Night splints are usually designed to keep a person's ankle in a neutral position overnight. Most individuals sleep with the feet plantar-flexed, a position that causes the plantar fascia to tighten. A night dorsiflexion splint allows passive stretching of the calf and the plantar fascia during sleep. Theoretically, it also allows any healing to take place while the plantar fascia is in an elongated position, thus creating less tension with the first step in the morning.






Heel pain exercises: before getting out of bed
1)Before sitting up, stretch your foot by flexing it up and down 10 times.
2)While seated, roll a rolling pin or tennis ball with the arch of your foot. If you are able to, progress to doing this exercise while you are standing up.


After these exercises, put on your shoes (with orthotics inside them) or wear supportive sandals. Do not start the day walking barefoot on hard floors or tiles, or your heel pain will return.




Heel pain relief exercises: during the day
Calf Stretch


Stand facing a wall with your hands on the wall at about eye level. Put the leg you want to stretch about a step behind your other leg. Keeping your back heel on the floor, bend your front knee until you feel a stretch in the back leg.

Hold the stretch for 15 to 20 seconds. Repeat 4 times.


Achilles Tendon Stretch

Stand on a step as shown. Slowly let your heels down over the edge of the step as you relax your calf muscles.
Hold the stretch for about 15 to 20 seconds, then tighten your calf muscle a little to bring your heel back up to the level of the step. Repeat 4 times.

Hamstring Stretch


Extend one leg in front of you with the foot flexed. Bend your other knee and lean back slightly. Your pelvis should be tilted forward. Keep your upper body upright as you hold the stretch for 10-20 seconds, then switch sides.
You should feel the stretch all the way up the calf and thigh of your extended leg.

Marble Lifts



Place marbles on the floor next to a cup, as shown. Using your toes, try to lift the marbles up from the floor and deposit them in the cup. Repeat exercise 15 times.




Towel Stretch

Grab a rolled towel at both ends, holding it under the ball of your foot. Gently pull the towel toward you while keeping your knee straight. Hold this position for 15 to 20 seconds. Repeat 4 times.


Prevention
You can take some simple steps now to prevent painful steps later.
Maintain a healthy weight. This minimizes the stress on your plantar fascia.
Choose supportive shoes. Don’t use high- heeled shoes or shoes with very low heels. Buy shoes with a low to moderate heel, good arch support and anthe ability to absorb shocks. Don't walk barefoot, especially on hard surfaces.
Don't wear worn-out sports shoes. Replace your old ones before they stop supporting and cushioning your feet. If you're a runner, buy new shoes after about 400 miles.
Warm up before starting any athletic activity or sport, and start a new exercise program slowly.
Wake up with a stretch. Before you get out of bed in the morning, stretch your calf muscles, arch and Achilles tendon by reaching for your toes and gently flexing your foot. This helps reverse the tightening of the plantar fascia that occurs overnight.

References

1. Plantar fasciitis and bone spurs. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00149. Accessed Feb. 2, 2011.
2. Sheon RP, et al. Plantar fasciitis and other causes of heel and sole pain. http://www.uptodate.com/home/index.html. Accessed Jan. 27, 2011.
3. Pasquina PF, et al. Plantar fasciitis. In: Frontera WR, et al. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2008. http://www.mdconsult.com/das/book/body/208746819-6/0/1678/0.html. Accessed Feb. 2, 2011.
4. Thomas JL, et al. The diagnosis and treatment of heel pain: A clinical practice guideline — Revision 2010. The Journal of Foot & Ankle Surgery. 2010;49(suppl):S1.
5. http://www.yogaawayoflife.net/plantar_fasciitis.htm
6. http://www.footminders.com/plantar-fasciitis-exercises.html
7. http://www.sportsinjuryclinic.net/cybertherapist/front/foot/plantarfasciitis/plantartaping.php