Heel Pain

Overview

Foot Pain

The heel is a padded cushion of fatty tissue around the heel bone (the calcaneus) that holds its shape despite the pressure of body weight and movement. It serves to protect the structures of the foot, including the calcaneus, muscles and ligaments. Heel Pain is a very common foot complaint. Anyone can suffer from heel pain, but certain groups seem to be at increased risk, including Middle-aged men and women, Physically active people, People who are overweight or obese, People who are on their feet for long periods of time, Children aged between eight and 13 years (particularly boys), Women during pregnancy.

Causes

While heel pain has many causes, it is usually the result of faulty biomechanics (abnormalities in the way we walk). This can place too much stress on the heel bone and the soft tissues attached to it. The stress may also result from injury, or a bruise incurred while walking, running or jumping on hard surfaces; wearing poorly constructed footwear; or being significantly overweight. Systemic diseases such as arthritis and diabetes can also contribute to heel pain. A common cause of heel pain is the heel spur, a bony growth under the heel bone. There are no visible features on the heel, but a deep painful spot can be found in or around the middle of the sole of the heel (see diagram). Approximately 10 per cent of the population may have heel spurs without any pain. Heel spurs result from strain on the muscles of the foot. This may result from biomechanical imbalance, a condition occurring in many people. Both heel pain and heel spurs are frequently associated with an inflammation of the long band of tissue that connects the heel and the ball of the foot. The inflammation of this arch area is called plantar fasciitis. The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.Excessive rolling in of the feet when walking. An inflamed bursa (bursitis), a small, irritated sack of fluid at the back of the heel. A neuroma (a nerve growth). Other soft-tissue growths. Heel bumps or ?pump bumps?, a bone enlargement at the back of the heel bone. Bruises or stress fractures to the heel bone.

Symptoms

Symptoms include a dull ache which is felt most of the time with episodes of a sharp pain in the centre of the heel or on the inside margin of the heel. Often the pain is worse on first rising in the morning and after rest and is aggravated by prolonged weight bearing & thin soled shoes.

Diagnosis

Depending on the condition, the cause of heel pain is diagnosed using a number of tests, including medical history, physical examination, including examination of joints and muscles of the foot and leg, X-rays.

Non Surgical Treatment

If pain and other symptoms of inflammation?redness, swelling, heat?persist, you should limit normal daily activities and contact a doctor of podiatric medicine. The podiatric physician will examine the area and may perform diagnostic X-rays to rule out problems of the bone. Early treatment might involve oral or injectable anti-inflammatory medication, exercise and shoe recommendations, taping or strapping, or use of shoe inserts or orthotic devices. Taping or strapping supports the foot, placing stressed muscles and tendons in a physiologically restful state. Physical therapy may be used in conjunction with such treatments. A functional orthotic device may be prescribed for correcting biomechanical imbalance, controlling excessive pronation, and supporting of the ligaments and tendons attaching to the heel bone. It will effectively treat the majority of heel and arch pain without the need for surgery. Only a relatively few cases of heel pain require more advanced treatments or surgery. If surgery is necessary, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa, or removal of a neuroma or other soft-tissue growth.

Surgical Treatment

Extracorporeal shockwave therapy (EST) is a fairly new type of non-invasive treatment. Non-invasive means it does not involve making cuts into your body. EST involves using a device to deliver high-energy soundwaves into your heel. The soundwaves can sometimes cause pain, so a local anaesthetic may be used to numb your heel. It is claimed that EST works in two ways. It is thought to have a "numbing" effect on the nerves that transmit pain signals to your brain, help stimulate and speed up the healing process. However, these claims have not yet been definitively proven. The National Institute for Health and Care Excellence (NICE) has issued guidance about the use of EST for treating plantar fasciitis. NICE states there are no concerns over the safety of EST, but there are uncertainties about how effective the procedure is for treating heel pain. Some studies have reported that EST is more effective than surgery and other non-surgical treatments, while other studies found the procedure to be no better than a placebo (sham treatment).

Prevention

Painful Heel

Before you get out of bed in the morning, and then periodically throughout the day, do the following exercises to increase flexibility and ease pain. Slowly flex your foot and toes to stretch the tissue on the bottom of your sore foot. Hold the stretch for 10 counts. Relax and repeat. Do gentle ankle rolls to keep the tissues around the ankle and on the back of the heel flexible. Sit on the edge of your bed and roll your foot back and forth over a tennis ball.

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