A common painful condition affecting the heel and underside of the foot
Foot problems plague people with diabetes and approximately 25% will develop foot problems over time because consistently high levels of blood glucose result in two main conditions, peripheral artery disease (PAD) and peripheral neuropathy. They are responsible for the increased risk of foot problems as they can cause poor blood flow and nerve damage.
In addition, people with diabetes are also at risk of other foot problems such as bunions, corns, calluses, blisters, hammer toes, fungal infections, dry and cracked skin, ingrown toenails, plantar warts, and athlete’s foot .Nerve damage due to diabetes can further lead to structural changes in the shape of feet. Foot muscles become weak and imbalanced and the bones of feet and toes may shift. Heel pain in people with diabetes can be due to overweight, muscle degeneration, structural changes in the foot and changes in the walking gait pattern after diabetic neuropathy sets in.
It can also be due to increased physical activity and overload, bad shoes and poor footwear choice, flat feet, long hours on feet causing excessive pressure, or stress and strain to muscles of the feet.
Plantar fasciitis is the gradual tearing and inflammation of the plantar facial ligament .The Plantar fascia supports the arch of the foot and absorbs shocks. It connects the heel bone to the toes. Too much tension can create small tears in the fascia and can cause the facial ligament to separate from the heel bone very slowly.
People who suffer from Plantar fasciitis feel a stabbing or burning pain in their heels that is usually worse in the morning. It decreases after the first 5-10 steps, but may reoccur after long periods of standing or after getting up from a seated position.
Plantar fasciitis usually develops suddenly and often occurs after repeated trauma as in sports or a long day standing on the feet. Although it can affect both feet, it more often presents in only one foot at a time.
Sharp pain inner part of the bottom of the heel, as if a knife has been stuck into the bottom of the foot.
Heel pain that tends to be worse with the first few steps after waking, when climbing stairs or when standing on tiptoe.
Heel pain after long periods of standing or after getting up from a seated position.
Heel pain after, but not usually during, exercise (unless there is a larger tear present).
Mild swelling in the heel.
If the symptoms appear, meet a podiatrist or physical therapist immediately. An early diagnosis will help in getting relief by using conservative treatments.
The physiotherapist can recommend analgesics to relieve pain and decrease inflammation, change of footwear, provision of orthotics and physiotherapy with the use of manual procedures like MFR, taping techniques, inserting pain relieving drugs at the point of tenderness or at the most painful point on the foot for improving healing.
A few stretches must be done regularly at home to avoid pain and prevent shortening of fascia due to repeated trauma.
Before you get up from bed or before any activity, gently stretch the arch. It helps reverse the tightening of the plantar fascia that occurs overnight and encourages dexterity.
A towel stretch can be done using a towel, or a sheet. Holding the ends of the towel, loop the middle around your toes. Keep your knee straight with your toes pointing up. Pull the towel ends, pulling your toes towards your body. This will stretch both the back of your leg and the bottom of your foot. Hold this position for 15 to 30 seconds. Repeat 2 to 4 times.
Stand about 1 to 2 feet from a wall. Lean against the wall with arms stretched out.Place one foot under your shoulders, and one foot behind your body.Keep your back foot flat on the ground and feel a stretch in the back of your heel .Hold the stretch for a count of 10, and repeat. Do both sides. This exercise helps to loosen the calf muscles and is an important part of stretching for plantar fasciitis.
*Dr. Avnee Sarin is Physiotherapist and Assistant Professor, DAV Institute of Physiotherapy and Rehabilitation, Jalandhar.