KOCHI: Heel pain is a commonly enquired problem in Foot and Ankle Orthopaedic Clinic. This pain can be varying from minimal to severe or from an irritating pain to debilitating pain. Morning pains to continuous pain. Heel pain can occur due to various causes.
What causes pain in the heel?
The commonest cause is plantar fasciitis. However other causes include:
• Injury to the plantar fascia
• Constantly being on your feet, especially on a hard surface like concrete and wearinghard-soled footwear
• Thinning or weakness of the fat pads of the heel
• Injury to the bones or padding of the heel
• Arthritis in the ankle or heel (subtalar) joint
• Irritation of the nerves on the inner or outer sides of the heel
• Fracture of the heel bone (calcaneum)
What is plantar fasciitis?
The function of the heel in walking is to absorb the shock of your foot when it touches the ground and to start springing you forward. The heel is attached to the front of the foot by a number of strong ligaments which run between the front part of the heel bone and various other parts of the foot. The strongest ligament is the plantar fascia, which attaches the heel to the toes and helps to balance various parts of the foot as you walk. It, therefore, takes a lot of stress.
In some people, the plantar fascia becomes painful due to small micro tears. This usually happens where it is attached to the heel bone, although sometimes it happens in the mid-part of the foot. This condition is called plantar fasciitis.
Is it likely that pain is caused by bone spur?
These “heel spurs” are commoner in people with plantar fasciitis, but they can be found in people with no heel pain. The heel spur forms in response to injury. The body tends to overproduce calcium to repair the defect due to the injury. Since Plantar Fasciitis causes pain and swelling to the tissue along the bottom of the foot by pulling on the heel where it connects, this is where heel spurs tend to form in response to that injury.
What to do?
You can try to avoid the things that cause heel pain to start:
• Avoid becoming overweight
• Minimise the shock to your feet from constant pounding on hard surfaces by choosing footwear with some padding or shock-absorbing material in the heel
• Customised footwears
• Simple stretching exercises and rehab helps the stretch and repair of the Plantar fascia.
When to take professional advice?
If your heel pain is affecting your normal activities and not getting better with simple self-
treatment, you should visit a Foot and Ankle surgeon.
Some tests may be helpful in ruling out other problems. Blood tests may be done for arthritis.
An X- ray will show any arthritis in the ankle or subtalar joint, as well as any fracture or cyst
in the calcaneum. (It will also show a spur if you have one, but as we know this is not the
cause of the pain.) Occasionally a scan may be used to help spot arthritis or a stress fracture.
How to treat?
• Weight loss Reduce stress
• Customised footwear
• Soft heel pad is useful to wear in your shoe to act as a shock-absorber when you walk.
• Stretching the Achilles tendon and plantar fascia
• Pain-killers such as paracetamol or anti-inflammatory medicines can help reduce the pain.
• Ask advice from your doctor or pharmacist before taking anti-inflammatory medicines as they can have troublesome side-effects in some people.
If you still have pain then further investigation should be done. If no other medical problem or cause of stress in your heel is found, a number of other treatments can be tried;
• Further physiotherapy
• Wearing a plaster cast to rest the inflamed tissues
• Pain control treatments such as transcutaneous nerve stimulation (TENS) or acupuncture
• Only if all non-surgical treatments fail would an operation be considered
Are injections needed?
• Steroid injections are one of the commonest treatment for the chronic pains. However,
one should avoid repeated steroid injections as it might do more harm than good.
• Lately, plasma rich proteins extracted from your own blood is injected into the painful site and has shown some benefits.