Healing Heel Pain

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Heal Your Heel

Your foot and ankle has 26 bones, 33 joints and over 100 tendons with your heel being the largest bone in your foot. Heel pain can naturally be a pain in the wrong place.

The heel forms a major part of the hind foot with the largest bone, calcaneum being at its epicenter. It has a generous soft tissue envelope at the base as well as at the back. The base is formed predominantly by fascia, fat and passing tendons while the back is supported by the Achilles tendon and its bursa. “If one overuses or injures your heel, you may experience heel pain. This can range from mild to disabling. It is possible you will need to have a doctor to diagnose the cause if simple home remedies don’t ease the pain,” says Dr. Aditya Khemka, Orthopaedic Surgeon, Hinduja Healthcare Surgical, Mumbai. Dr.Vikash Kapoor, Joint Replacement and Arthroscopic Surgeon and Group Director Orthopaedics, Medica Group of Hospitals, Kolkata adds, “heel pain commonly can occur below the heel or behind the heel. Pain is intense when a person is about to stand and walk but if it eases out after 5 minutes then it is a case of the pain below the heel. If the pain is not that intense then if it is behind the heel. Both these pains are usually caused by small bone spur or growth which digs into the muscles on walking/standing.”

Causes

If you overuse or injure your heel, you may experience heel pain that can range from mild to disabling. It is possible that you need to have a doctor or podiatrist diagnose the cause if simple home remedies do not ease the pain. Heel pain is most often caused by plantar fasciitis or achilles tendonitis. A condition that is sometimes also called heel spur syndrome. Pain in the heel normally happens under or back. The pain can occur if you injure or overuse your heel. Such a pain is infrequently a cause of concern. “The most common causes of heel pain are plantar fasciitis, sprain and strains, fracture, Achilles tendonitis, bursitis, ankylosing spondylitis, Osteochondroses, and reactive arthritis. People who have problems with their arches whether overly flat feet or high-arched feet are more prone to developing plantar fasciitis,” says Dr. Nadeem Shariff, Chief Physiotherapist and Sports Rehab Specialist, Primecare Hospital, Bengaluru. Obesity and overuse may also contribute to plantar fasciitis. Plantar fasciitis occurs when too much pressure on your feet damages the plantar fascia ligament, causing pain and stiffness, Sprains and strains are injuries to the body, often resulting from physical activity. Pain on the bottom of the heel, in the arch of the foot, pain that is usually worse upon arising and pain that increases over a period of months, swelling on the bottom of the heel are some common symptoms of heel pain. Dr. Aashish Chaudhry, Managing Director and Orthopedic Surgeon, Aakash Healthcare Super Speciality Hospital says, “bursitis is another condition in the heel that causes pain, it often occurs near joints that perform recurrent motion. An underlying infection or a cyst can be another reason for pain in the heels, we rarely see such cases.”

Medical Assistance

So the question of when to see a doctor is something that comes to mind as well. And here is the answer, persistent heel pain for two to three weeks means you should see a doctor. If your pain is severe, the pain starts suddenly, there is redness in your heel, swelling in your heel and face difficulty in walking due to the pain in your heel, you must visit the doctor immediately. Very often an X-Ray may be required to narrow down the cause of your heel pain. Physical therapy to strengthen the muscles and tendons of the foot to prevent further injury may be prescribed. If your pain is severe, anti-inflammatory medication may be required that can be injected into the foot or taken orally. Your doctor may also recommend foot support by either taping the foot or using special footwear devices. Surgery may be recommended at times, to correct the problem, but heel surgery often requires long recovery time and may not always help relieve foot pain,” says Khemka. If the pain in the heel region is not due to arthritis or gout, then it is best managed with proper evaluation by a physiotherapist, activity modification, footwear modification in form of use of appropriate shoes or insoles, simple exercises for the strength of the deep muscles of the foot, maintaining flexibility of the calf and the foot muscles and fascia can help. In case of Achille’s tendinitis activity modification is very important as there can be partial rupture of the tendon which may lead to a complete rupture if not managed properly. Dr. Ayan Roy, Consultant Orthopedic Surgeon, CK Birla Hospitals says, “a supreme and soft quality footwear is a must. Any persistent prolonged heel pain which can be a bony excrescence or a tight plantar fascia will cure but needs to be first ruled out.”

Home Remedies

Lifestyle changes and home remedies come in handy to ease the symptoms of heel pain. Applying ice to the heel in a cold compress is among the most used methods to relieve heel pain. The cold temperature has a numbing effect and helps both the pain and inflammation. “You can make a cold compress by putting some crushed ice in a plastic bag and wrapping it in a thin cotton towel. Apply this pack on the painful area for about 15 minutes. Repeat a few times a day or as needed. Another option is to freeze a bottle of water and roll it over the painful area for 10 to 15 minutes. Repeat as needed. Never apply ice directly on the skin, as it can cause frostbite,” says Shariff. Dr. Gagan Kapoor, head of physiotherapy, HealthCare atHOME, a home healthcare services adds, “for plantar fasciitis usually hot fomentation or contrast baths (alternate hot and cold) help relieve the pain and discomfort. The activities that lead to pain should be avoided and should consult a doctor in case the condition is not improving. Weight control, maintain good flexibility of the calf muscles, do regular simple exercises of the foot like toe curling exercises, use appropriate foot wear, proper warm up for runners, consult a physiotherapist in case you are planning to increase the running distance, pace or terrain, use insoles as advised by the physiotherapist or doctor.” Dr. Anuj Malhotra Sr. Consultant & HOD- Joint Replacement, Arthroscopy & Sports Injuries Saroj Super Speciality Hospital, Rohini elucidates a case. “A middle aged 45 years female with moderate obesity was having heel pain since one year and was put on conservative management mild physiotherapy patient did not respond to the treatment of two month of conservative management. Thus she was advised local infiltration of steroid twice and changing of footwear. This helped her a lot in reducing pain to get back to normal life.”

Tips

  • Exercises that stretch out the calf muscles help ease heel pain and assist with recovery.
  • When you walk without shoes, you put undue strain and stress on you plantar fascia. So make sure to always wear shoes when stepping outside.
  • Avoid wearing high heel shoes.
  • Use an ice pack on your heel for 20 minutes a day and repeat over the day to reduce inflammation but do not apply ice directly to the skin.
  • Oral nonsteroidal anti-inflammatory drugs like ibuprofen may be recommended to reduce pain and inflammation.

This story first appeared in the Sep 2018 issue of Smartlife magazine here:

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