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Pain under the heels (or at the back of the heel) is quite common in both adults and children. The condition is more common amongst males than female patients, probably because of body weight. Children aged between 8 and 14 may also experience pain in the heel area, this condition is referred to as Severe's Disease. In the UK alone and estimated 2 million people will suffer from plantar fasciitis (or inflammation of the plantar fascia), commonly associated with sore heels. They are many other foot complaints such as Metatarsalgia, Morton's Neuroma, Ankle Pain, Hammer toes etc. Physiology Pain in the heel comes about as a result of excess tension of the plantar fascia. Continuous loading of the fascia will lead to micro trauma of the tissue which in turn will lead to, irritation, inflammation and degeneration of the connective tissue. The term fasciitis makes sense as we are dealing with inflammation (-itis indicates inflammation in Latin) of the tissue . The inflammatory process includes redness, swelling and pain. plantar fasciitis treatment is recommend in in its early stages, because the condition may lead to calcification in the attachment of the fascia on the heel bone, known as calcaneal spurs. Contributing factors The condition is common in athletes. When putting a high load on the plantar fascia ligaments during running, jumping etc there's an increased risk of injury. Especially if the training surface is hard and flat. Continuous pounding of the feet during contact phase of gait increases the chances of plantar problems. Other contributing factors include increased weight gain or obesity, age, pregnancy and most importantly faulty foot biomechanics is often associated with this complaint. Long periods of standing, especially if wearing shoes that do not provide enough support for the arch of the foot. Increased training program e.g. running/walking a lot, especially if wearing inappropriate footwear, poor foot biomechanics, for instance having flat feet increases the load on the plantar fascia and can lead to overuse, standing or walking a lot of hard surfaces. Achilles tendonitis Pain at the back of the heel is also very common. The medical term is Achilles tendonitis, or latin for inflammation of the achilles tendon which connects the calf muscles with the foot. When the calf muscles contract, they pull on the achilles tendon. Achilles Pain is experienced just above the back of the heel and patients may also experience tightness in the calf. The affected area can be thickened and very tender to the touch. Achilles Tendonitis develops gradually without any history of trauma. Excessive subtalar joint pronation during the walking process means the arch collapses upon weight bearing placing stress on the achilles tendon. Useful exercises If the exercises below do not provide any relief from your heel problems please consult your podiatrist or a chiropodist (foot specialist). Plantar roll exercise: this exercise is designed to make the ligaments under the foot more flexible. Towel foot stretch, this is an excellent exercise for plantar fascial problems. Calf stretching: tight calf muscles are an important contributing factor to this condition. Flexible calf muscles will assist with reducing the tension on the fascia. Other forms of treatment include ice therapy (5 - 10 minutes), shockwave therapy, taping, orthotic insoles (made by a podiatrist or orthothist, or pre-made) and wearing a night splint to pull the calf and foot muscles during the night. Furthermore anti-inflammatories may be used for several weeks. Sometimes a local injection with cortico-steroids may be given if there is persistent pain.
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