Most adults deal with some form of heel pain during their lifetime. Many have constant, lingering problems due to genetics, overuse, or poorly choosing the correct shoes for their feet. One of the most common forms of heel pain is plantar fasciitis, which is the inflammation of the plantar fascia tissue. Orthotics like Elite Feet and Redi-THOTICS are typically the long term solution for great feeling feet. Many shoes do not provide the arch support that most people need, and that's where the orthotics shine.
The biggest issue that most people have is purchasing the wrong shoe size. Always make sure to use the tools available at the shoe store and measure correctly. Remember, not every manufacturer utilizes the same measurement standards. Always ensure there is plenty of room left in the shoe for your toes, do not buy cramped shoes as this can cause several other problems. And remember, if it's not comfortable when you try it on, it probably won't become comfortable over time; try to pick out a different model.
If the insole that comes standard with the shoe does not have adequate arch support, you may need corrective insoles. Heel pain express sells some of the top medical quality brands available, so make sure to check out our store and treat your feet! You will not regret it.
]]>Plantar fasciitis is caused from an overuse of the soft tissue on the bottom of the foot. Most children do not suffer from plantar fasciitis but rather calcaneal apophysitis or Sever’s disease. Sever’s an inflammation of the growth center of the heel bone, or calcaneus in children. It frequently occurs in boys age 10-12 and girls 9-12 who are active in sports during peak growth spurts. The condition is known as apophysitis, because this area of the heel bone in children is known at the apophysis. Symptoms of calcaneal apophysitis is pain on the bottom and around the edges of the heel bone that is aggravated by activity and relived by rest.
What causes Calcaneal Apophysitis?
How is calcaneal apophysitis treated?
See our compression socks with the gel heel cups and topical pain cream at heelpainexpress.com.
]]>A supportive heel and stiff midsole are important components of any shoe for those experiencing heel pain, softer shoes fatigue the foot. Most fashionable shoe wear (high heels, boat shoes, flip flops) often does not provide sufficient support for the arch and further exacerbates the problem. In general, lace-up tennis shoes are recommended to maximize support.
Shoe inserts typically can be used with existing shoe gear. Orthotics may be purchased over the counter or can be custom made. In general, over-the-counter (OTC) and custom-made orthoses appear to be equally effective in treating plantar fasciitis A randomized, prospective study found that more supportive orthotics resulted in better pain relief when compared with softer, non-supportive orthotics; meaning floppy insoles do not work as well as their stiffer counter parts.
Many patients with low arches experience increased stress on the plantar fascia while walking and have a decreased ability to absorb the forces that are generated by foot strike due to pronation. Mechanical corrections for pes planus include taping of the arches, OTC arch supports, and custom orthotic devices. Studies have found significant benefit to these conservative treatments when they are used in appropriate patients, Low-dye strapping with athletic tape can be used as a definitive treatment or as a trial to determine whether the expense of arch supports or orthotics is worthwhile but is difficult to do and does not give lasting results. Taping may be more cost-effective for the acute onset of plantar fasciitis, whereas OTC arch supports and orthotics are better for chronic or recurrent cases of plantar fasciitis and for the prevention of injuries. Taping is just that, tape applied to the foot which only lasts in several studies for 45 minutes of peak relief. The other issue with taping is that it usually requires a medical professional to perform which can result in costly visits.
Custom orthotic devices are designed to control biomechanical risk factors such as flat foot, high arched foot, and limb length descrepency. A lot of athletes treated with orthotic devices usually require semi-rigid full-length orthotic devices with deep heel cups to control overpronation and metatarsal head motion.The main disadvantage to the use of custom orthotic devices is the cost, which ranges from $250 to $600 or more; frequently, these devices are not covered by insurance. Several studies have suggested that over-the-counter insoles are often as effective as these custom orthotics.
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Per the journal, heel pain is caused from excessive force applied to the plantar fascia daily. The band of tissue found on the bottom of the foot (see picture) This force can be directly linked to either strenuous activity such is the case with athletes or continued deforming forces like obesity. In the elderly, the loss of cushioning on the heel can cause inflammation leading to heel pain requiring treatment. Per the journal, conservative measures are an effective treatment of heel pain and 80% of suffers get better without surgery. It can take 8 weeks before pain eases with treatment. Get the most relief without the shots by doing heel stretches, wear an Ortho Heel brace, use a night splint, and apply topical pain cream (OrthoX Pain Cream). Visit heelpainexpress.com to start your recovery today.
Excerpts:
Per the Chinese Journal of Traumatology Vol 18 Issue 3, 2015; Heel Pain a Systemic Review
When the correct treatment program begins, it sometimes takes 6 up to 8 weeks before the pain begins to ease. Total pain alleviation may not happen for several months.69
The time frame for heel pain to last mostly depends on the cause. For example, heel pain that has correlation with obesity will improve gradually as the patient loses weight. Heel pain relating to a specific sporting or exercise regimen, a period of rest may bring relief. When a patient's heel is pain-free, the patient may need to modify training program to prevent reoccurrence of the pain. Most heel pain goes away after brief period of time either on its own or after treatment. Heel pain may return a patient returns too early to previous level of exercise or sports participation.2
Heel pain has long been recognized as highly prevailed in the senior population, which impacts approximately one third seniors older than 65 years.6, 7 and 8 In the senior group, foot pain is associated with decreased ability to manage the daily activities, problems of imbalance and walking pattern, and increased risks of falls.9, 10 and 11 Also as a person grows older, the pads that protect the heel from injury, like pads under a carpet, can wear down and thus fail to provide the shock absorption.12 Heel pain is the most common in active people over the age of 40. This increased prevalence may result from a decrease in the elasticity of the plantar fascia and a slowing of the healing process with age. Heel pain also is relatively common in active children and adolescents between the ages of 8 and 13. Pediatric heel pain frequently occurs on the bottom rear of the heel or the lateral. Heel pain occurs in both heels (bilaterally) in less than 30 percent of cases. The left heel is more often to be affected. The opposite heel may follow with similar symptoms, often as a result of compensation.13
Often times, athletes are the most risk to develop pain heel conditions and it is the most frequent injury in ballet dancers.14 Active routines such as running and jumping can put constant strain on the heel, various muscles, ligaments all over the foot, ankle, and calf, which can lead to significant tissue damage. Improper muscle flexibility, increased foot pronation, and leg-length discrepancy are other predisposing factors for this condition.15
In addition, other factors of a person's lifestyle, such as work that regularly requires heavy lifting, obesity can cause heel pain because excess pounds stress the heels. Flat foot conditions can adversely affect the heels of the feet and lead to damage and serious pain. Heel pain is not uncommon in pregnant mothers because as the pregnancy progresses there is weight gain and this extra weight puts more stress on the heel.16
There are many treatments options that exist when dealing with heel pain but there is lack of evidence to show which one is the most effective. Each doctor has a different treatment method. As we don't know yet which treatment works best, upgrading to better, more supportive shoes should be the important first-line treatment option.
]]>Plantar fasciitis is caused from the excessive overuse or fatigue of the soft tissue on the bottom of the foot. Other forms of heel pain can be a bruised heel from fat pad atrophy or a short Achilles tendon. These causes of heel pain can be relieved some by the gel heel cups. If a bruised heel is the problems the gel heel cups help soften the blow to the heel from standing and walking, thereby allowing the foot to heal slowly over time. If plantar fasciitis is the problem then the gel heel cups soften the point of insertion on the fascia and provide lift which reduces the strain on the fascia and shortens the heel cord too. This will give symptomatic relief but stretches are essential to the overall healing process. If your heel pain is from bruising we commonly recommend a topical pain gel such as OrthoX pain cream applied several times a day plus icing helps as well. See the pictures below for detailed explanation of the difference in the topics.
This is a typical area of plantar fascial pain which is help by gel heel cups and stretching. A lot of people find the heel cups are not as effective as they would like and need a more robust option such as a night splint and air brace to aid their recovery.
Fat pad atrophy or bruised heel
The heel pain from fat pad atrophy or bruised heel is closer to the back of the heel than the plantar fasciitis is typically seen. This type of pain does well with gel heel cups due to the cushioning effects along with icing and topical pain cream. This type of pain can lead to plantar fasciitis because people will fatigue their foot from walking on it abnormally. Stretching is usually not required with this type of pain and does not generally help. Night splints do not help this pain either. Some people find the air brace works better for this pain due to the horseshoe shape of the bladder lifts the heel off of the ground reducing impact at the patient walks. Topical pain creams and icing are essential for recovery. Sometimes a walking boot is needed for this type of heel pain as well.
]]>Plantar fascial straps or braces as they are sometimes mislabeled have been around for a long time. Doctors will sometimes dispense these in the office as a brace and charge your insurance for them even though they have no code from Medicare enabling them to do this. Buyers beware! The strap is made by multiple manufactures and is supposed to mimic the effects of a doctor tapping and strapping your foot for plantar fasciitis. Let’s review why the strap is not cost beneficial and really does not work.
First we will discuss the effects of strapping:
The doctor, physical therapist etc. will tape the foot in an attempt to decrease the pull on the plantar fascia. Although studies have shown this helps some, the tape does not hold the position on the patient for more than 45 minutes according to recent findings.
The tape is used to reduce the pull on the fascia thereby in theory reducing the strain on the fascia and decreasing heel motion or pronation and supination.
Now that we understand the mechanics behind taping let’s explore the plantar fascial strap.
The strap is made up of typically two pieces of nylon or Velcro stretchy material. One piece wraps around the ankle as a supportive upright. This top piece is only here to act as an anchor for the strap so it will not slip down. This piece does not do anything for the plantar fascia. The second strap which attaches to the top strap then is directed down and around the bottom of the foot to lift up on the fascia as the user walks and stands. Now, if we review the above taping method none of this comes into play when addressing the mechanics of plantar fasciitis. Seemingly the idea behind this madness is it will pull on the fascia, pulling on the fascia does nothing to help the fascia! We have tried these straps in a clinical setting and find they do not stay in place; do nothing to help alleviate the heel pain and are cumbersome to wear. We do not recommend these straps and feel they are a waste of time and money when so many other treatment options are available. Good luck with your heel pain journey.
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A recent review of the treatment of plantar fasciitis by the Journal of American Family Physician suggested resting, night splints, prefabricated orthotics and NSAIDs are effective treatments with an evidence rating of B. Diagnosis of plantar fasciitis is based on patient history and physical examination findings. Most patients have heel pain and tightness after standing up from bed in the morning or after they have been seated for a prolonged time. Typically, the heel pain will improve with ambulation but could intensify by day’s end if the patient continues to walk or stand for long time.
Risk Factors for Plantar fasciitis:
Excessive foot pronation (pes planus)
Excessive running
High arches (pes cavus)
Leg length discrepancy
Obesity
Prolonged standing/ walking occupation
Sedentary lifestyle
Tightness of Achilles tendon and intrinsic foot muscles
On physical examination, patients may walk with their affected foot in elevated to relieve putting pressure on the heel. Palpation of the medial plantar calcaneal region will elicit a sharp, stabbing pain. Passive ankle/first toe dorsiflexion can cause discomfort in the proximal plantar fascia; it can also assess tightness of the Achilles tendon.
Medial Plantar region of the heel where most pain is elicited
Treatment planning for plantar fasciitis
Rest and analgesics treatments:
A patient directed treatment to relieve plantar fasciitis pain consists of rest, activity modification, ice massage, and acetaminophen or nonsteroidal anti-inflammatory drugs. There are few studies to support the benefit of these individual treatments used alone.
Stretching and Physical therapy modalities:
Multiple physical therapy modalities are used for the management of recalcitrant plantar fasciitis. Most therapies are used in combination; therefore, there is poor evidence on which modality is best. Progressive plantar fascia and intrinsic foot muscle stretching techniques have been shown to reduce plantar fasciitis pain.
Eccentric Stretch used for plantar fasciitis
Arch supports, heel cups and night splints:
Foot orthotics are commonly recommended for persons with plantar fasciitis to aid in preventing over pronation of the foot and to unload tensile forces on the plantar fascia. There are many different orthotics available, including viscoelastic heel cups, prefabricated longitudinal arch supports, and custom made full length shoe insoles. A recent met analysis and comparative trial examined the effectiveness of foot orthosis in patients with plantar fasciitis and found that prefabricated and custom foot orthotics can decrease rear foot pain and improve function. A Cochrane review found that custom foot orthotics may not reduce foot pain any more than prefabricated foot orthotics.
Night splints prevent plantar fascia contracture by keeping the foot and ankle in a neutral 90 degree position, preventing foot plantar flexion during sleep. Anterior night splints seemed to be better tolerated than posterior night splints.
Supportive arch taping, usually tried during physical therapy, may provide relief in first step heel pain, but is inconsistent for long term plantar fasciitis pain.
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A general overview of the article recommended guidelines expressly relates to the importance of stretching exercises as a factor in the healing process and could take several months to improve symptoms. The authors felt dry needling, inserting a needle into the heel and moving it around to cause injury to the fascia, was not warranted; thank goodness. Physical therapy was also recommended as a possible treatment alternative. Anti-pronation devices were important in the recovery process, like bracing with the Ortho Heal along with the use of night splints. Night splints provide a static stretch to the bottom of the heel and the calf muscles while at rest. The highlight of the article did mention it unfortunately takes several months of treatment with these items to gain full recovery. Hang in there a stay with your treatment plan. Losing weight will help with your overall recovery process. Visit heelpainexpress.com for further information.
The brace is made out of comfortable spandex and is easy to wear.
Patented pneumatic air chambers surround the painful areas, cushioning each step, and providing a massaging effect to the affected areas. The brace comforts you while on your feet, limiting pronation and helps stimulate the healing process. The brace helps to align the heel to its natural position to reduce stress on the fascia during the day and let the stretching excercises work.
Wearing the brace feels like walking on memory foam, but not on the painful areas. The pressure is relieved due to the shape of the air bladder. I was no longer putting all my weight on the most painful part of my heels, as they were cushioned by the memory foam and air in the bladder.
Shop for the Ortho Heal on Heel Pain Express.
We think this brace is a tremendous value based on what it does for your quality of life, as well as healing your plantar fasciitis.
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