Heel pain is a very common complaint in any Orthopaedic hospital. There are 26 bones in the human foot, of which the heel bone (calcaneus) is the largest. The human heel is designed to provide a rigid support for the weight of the body. When we are walking or running it absorbs the impact of the foot when it hits the ground, and springs us forward into our next stride. Experts say that the stress placed on a foot when walking may be 1.25 times our body weight, and 2.75 times when running.Consequently, the heel is vulnerable to damage, and ultimately pain.
Heel pain is not usually caused by a single injury, such as a twist or fall, but rather the result of repetitive stress and pounding of the heel.
Pain typically comes on gradually, with no injury to the affected area. It is frequently triggered by wearing a flat shoe, such as flip-flop sandals with a hard insole. Flat footwear may stretch the plantar fascia to such an extent that the area near the heel becomes swollen (inflamed).
In most cases the pain is under the foot, towards the front of the heel. Symptoms tend to be worse just after getting out of bed in the morning, and after a period of rest during the day.After a bit of activity symptoms often improve a bit. However, they may worsen again towards the end of the day.
Causes of heel pain
Common causes of heel pain include:
- Plantar fasciitis
- Heel pad wear and tear
- Pinched nerve
- Rheumatoid arthritis
- Stress fractures
- Tarsal tunnel syndrome
When to see a doctor:
- Severe pain accompanied by swelling near your heel
- There is numbness or tingling in the heel
- There is pain in your heel as well as fever
- You are unable to walk normally
Most cases are treated conservatively. Surgery is usually the last resort
Different modalities of treatment include rest, pain relief by anti-inflammatory medications, stretching exercises, modification of footwear depending on the problem and sometimes alteration of the insoles. Your doctor may also recommend cortisone injections in certain cases when indicated.
You may also be advised certain modalities of physical therapy like ultrasound therapy or extra corporeal shock wave therapy to help in controlling the inflammation.
Minor injuries recover quickly within a few weeks. More severe injuries and injuries in athletic individuals, may take a longer time to recover. Outcome is generally good and most patients heal from an ankle sprain and are able to get back to their normal lives, sports, and activities. Some people, however, who do not properly rehabilitate their ankle or have had a severe sprain, may go on to have ankle instability. Repeated episodes can be dangerous because they can lead to cartilage damage within the ankle and may require surgery.
Surgery is rarely indicated when in spite of appropriate conservative treatment and physical therapy, the ankle joint continues to feels unstable and frequently gives way. Here, the ligaments are either repaired or reconstructed (using tendon grafts which involves replacing damaged tendons by borrowing them from a different area in the body)