Heel Pain

Weight is transferred from ankle to ground by heel bone known as calcaneum. Major weight bearing bone in our  body is calcaneum. Plantaris , gastrocnemius, soleus are the three major muscles related to calcaneus. Many times heel pain is disabling specially when we walk after rest or prolong sitting. 

  
  Pain can be due to:

1.      Plantar Fascitis – pain under the heel.

2.      Achilles Tendinitis - Behind the heel

Generally heel pains are temporary but if it persists for a long time and becomes chronic then it needs treatment. Disabling pain is another indication for treatment.

CAUSES –HEEL PAIN

We  will discuss major two causes of heel pain:

1 .Plantar Fascitis:

Plantar Fascia - Plantar fascia is a band like structure attached to heel on one side and to the toes on the other side at the bottom of the foot. If pain and inflammation occurs in plantar fascia , it is known as Plantar Fasciitis. Major cause of this condition is microtrauma ( repetitive injuries).

2.  Achilles Tendinitis

Calf muscles are connected to the calcaneus by a tendon called as Achilles tendon. Inflammation of this tendon causes Achilles tendinitis. Patient experiences pain behind the heel where this tendon is attached to the heel. Common in runners and  sportspersons.

SYMPTOMS

1 .Plantar Fascitis :

Stabbing pain at the bottom of foot near heel. Getting up from sitting position or after rest is very difficult and painful, especially first few steps. Prolong standing also aggravates the pain.

2. Achilles Tendinitis:

Common symptoms:

·         Pain

·         Tenderness

·         Swelling and

·         Stiffness

Generally, morning stiffness occurs. Initially pain is mild but as the stress and stretch increases on the tendon pain also increases. Sometimes a popping sound can be heard .

TREATMENT:

1 .Plantar Fascitis:

Medical treatment

To relieve pain and inflammation anti inflammatory and analgesic drugs are given, like ibuprofen , naproxen etc.

Steroid  Injections on the area having tenderness and pain

.

Physical therapy

• Strengthening exercises –strengthening of muscles responsible for stabilization of heel ,ankle and foot should be taught to the patient.
•  Stretching exercises- Stretching of plantar fascia and Achilles tendon forms the major part of treatment.
•  Night splints and Orthotics like heel cups.
• .Taping-Athletic taping will also help the patient. Taping  at the bottom of foot will support the plantar fascia.

Surgical treatment

First conservative treatment is given. Surgery is an indication when pain is disabling and severe. Detachment or partial release of plantar fascia is done .In the cases, where calcaneal spur is developed it is also removed.

2.Achilles Tendinitis:

Medical treatment

To relieve pain and inflammation anti inflammatory and analgesic drugs are given, like ibuprofen , naproxen etc.

Physical therapy

1.   Taping – relieves pain by supporting the tendon.  Stress and load on the tendon decreases.

2.   Ultrasound –Its micro massaging effect   helps in reducing  pain and inflammation.

3.  Sports massage and cryotherapy- It should be given on the affected area to decreases the pain and swelling .

4   Strengthening exercises – in acute cases rest is advised and eccentric exercises are indicated in chronic cases .

5.  Stretching exercises- Stretching of calf muscles  is  an important part of the treatment.

Surgical treatment

Depending on the severity of the condition the surgeon selects a procedure.One of the procedures is Gastrocnemius recession. Calf muscles are lengthened surgically.

Other causes of heel pain are:

      

• Bursitis
• Rheumatoid arthritis
• Osteomyelitis
• Tarsal tunnel syndrome
• Bone tumor
• Stress fracture
• Sarcoidosis

By : Pooja Dhamija PT