It is common on the underside or back of the heel.
It is a very common foot problem as the heel is designed to provide a rigid support for the weight of the body. It is one of the prices we humans have to pay for our upright posture. So activities like walking and running place lot of stress on the foot ultimately damaging the heel which is the major pressure point.
Pain is usually mild and bearable. However, if early signs are ignored and strenuous activities are continued without precautions, it can get worse, turning into a chronic condition.
Common conditions causing heel pain
- Plantar fascitis
- The plantar fascia is a tough fascia connecting the heel bone with the foot bone and acting as a shock absorber to the foot.
- Activities like running or jumping as seen in athletes can cause repetitive stress and micro tears in this band leading to pain.
- Achilles tendinitis
- This is a long term condition associated with progressive degeneration of the Achilles tendon.
- It may become painful when intense physical activity, such as running and jumping causes Inflammation.
- Eventually the tendon thickens, weakens and becomes painful chronically.
- Heel bursitis
- Inflammation of the back of heel/bursa.
- Can be caused by pressure from footwear or awkward landing.
- Heel spur
– It occurs due to calcium deposition when plantar fascitis continues for a long time. Although having a bone growth over the heel seems to be painful, it is the result and not the cause of the pain. It has a thin papery consistency, even though it is vbisualised like a bone on Xray. Thus excision of heel spur is umlikely to relieve the pain.
- Stress fractures and sprain
– Repetitive stress, as seen in runners can cause fractures in the metatarsal bones of the foot. Even ligament strain and sprain can cause pain.
- Rare causes like bone cysts , neuromas, osteomyelitis, peripheral neuropathy, ankylosing spondylitis etc. can lead to heel pain if affected.
Diagnosis of Heel Pain
- Patients medical history and clinical examination of foot is a must to reach to a specific diagnosis.
- Some modalities like x-ray, ultrasonography , MRl may be helpful to find out the exact problem in more difficult cases.
Heel Pain Management
- Stretching exercises to ease the pain and strengthen the heel are always helpful in the initial management.
- Limiting physical activities which are strenuous to the heel (jumping, walking) to provide rest and time for healing the injured tissue is important.
- Applying ice packs help reduce the inflammation.
- Shoe modification for good arch support helps to reduce stress on the heel.
- Orthotic devices may be advised to correct the underlying structural abnormalities, if present.
- Exercises and physical therapy measures provide some relief
- Medications – NSAIDS or appropriate pain killers can be prescribed for limited duration.
- Rarely surgical treatment is needed for resectable causes.
- Newer treatment modalities: PRP (Platelet Rich plasma) Therapy :This is a very novel treatment option for conditions like plantar fasciitis or Achilles tendinitis, as it works by the principle of healing with regeneration. In this treatment, we draw the patient’s own blood in a small quantity, process it in specialised equipment and separate the platelet rich component from it. This concentrated platelet solution when injected in injured and damaged tissue, help in healing by natural process and also reduces the pain. This treatment can be done on day care basis and without patient undergoing any preparation. Thus it is a very convenient, safe and evidence based option if used optimally in select group of patients.
Treatment Options available at Painex for Heel Pain:
- Trigger point injections
- PRP therapy
- Yoga therapy
- Dietary advice on weight reduction
- Ergonomic advice
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