Heel Pain When You Step: Likely Plantar Fasciitis

There are many people complaining of foot pain when they make their first few steps after getting down from bed. If you have this problem, then you may have a condition calls "plantar fasciitis".

Plantar fasciitis is the commonest cause of foot pain or heel pain. The pain is sharp and can be so severe until you can't put your foot on the floor. 

Plantar fascia is flat sheet of ligament that supports our foot arch from toes to heel. When this fascia is inflamed, it will cause pain. There are many reasons for inflammation of plantar fascia, and almost all of them are related to injury to the fascia, especially at the heel area where the pain is commonest.

The injury to plantar fascia is likely to be caused by repeated minor trauma to the foot. The risk factors include

• overweight
• prolonged standing
• frequent walking, running, jumping esp on hard surface or bare-footed
• wearing ill-fitting or inappropriate shoes
• abnormal foot arch
• previous foot injury
• tight calf muscles

In many cases, the cause of plantar fasciitis is multiple factors.

The heel pain is more obvious when you start walking after the foot does not bear weight for some time, such as after sleep or prolonged sitting. It may be worse when climbing stairs or at the end of the day.

Nevertheless, not all heel pain is plantar fasciitis. Sometimes it can be due to other reasons such as foot bone fracture, nerve entrapment, bone pathology etc. Thus, a foot X-ray is sometimes essential when the diagnosis is in doubt.

As plantar fasciitis occurs after prolonged repetitive trauma, it also takes quite a long time to recover, as the damaged ligament takes time to heal. The healing time takes longer because we are unable to rest the plantar fascia completely for it to heal as we still need to walk everyday.

To facilitate healing or to relieve the heel pain, you may take the measures listed below, depends on what your problems are. If you wish to prevent plantar fasciitis before you have it, you may also do these.

• lose weight
• avoid prolonged standing
• reduce exercise intensity (walking, running, jumping)
• avoid exercise on hard surface
• avoid bare-footed on hard surface
• wear proper shoes
• replace worn-out shoes
• put proper shoes in-sole

Other methods to relieve heel pain

• ice therapy (for 15 min/day)
• stretching 
• toe stretching (extend the toes with your hand and hold for 30 sec)
• calf stretching (hands against wall with affected side knee straight & other side knee bend, hold for 30 sec)
• orthoses - custom made shoes or insole
• night splinting - ankle fixed at 90 degree
• medication
• oral anti-inflammatory drugs (NSAIDs, steroids)
• steroids injection
• surgery

The first few methods to do are usually ice therapy and stretching exercise for 6 weeks, apart from those preventive measures. If the pain does not get any better, then you can add in orthoses, night splinting & medication. If nothing works for a period of 12 months, then you may consider surgery.

Study shows that 90% of plantar fasciitis cases can heal within 12 months. It can heal by itself if you give your foot enough chance to rest. 

Chicken Pox: How Does It Looks Like?

Chicken pox is a very common childhood virus infection. It is caused by varicella zoster virus and is extremely contagious. The virus spreads through droplets (exhaled air, coughing, sneezing) and contact with fluid from skin lesion (direct contact, sharing towel etc). The virus can survive outside human body in the environment for few hours.

Once you know that your child's schoolmate has chicken pox with skin rash, it is usually too late to avoid infection to your child unless there is no real close contact between them. This is because the infected child is able to spread the virus even 2 days before the rash appears.

If after contact with a chicken pox child for one week and your child still seems alright, it still does not mean that your child is not infected, as the incubation period for the virus is between 10-21 days. Usually the first symptoms to appear are rather non-specific such as mild fever, body ache, minor cough or flu symptoms. Most people only aware of the infection after the body rash appears.

Chicken pox rash is quite obvious and there are generally three stages. The first rash to appear is like a red dot, which will then progress to blisters that will eventually burst and become crusted (scabs). Typically the rash appears in crops, which means that at one time these three types of rash will appear together.

      Rash appears in crops

       Typical chicken pox rash

Chicken pox rash usually will last for 5 days. The infected child is considered non-contagious once all rashes have become scabs (dry). The infected child usually can return to school/nursery 1 week after the rash first appears.

There is no specific treatment for chicken pox other than symptomatic relief for fever/pain and itchiness. Antiviral is indicated only in some special circumstances such as in immuno-compromised child or when complication occurs.

Chicken pox can be prevented through vaccination. Young children can get the vaccine after 12 months old. For children more than 12 years old or adult, two doses given 6-10 weeks apart is recommended.