Heel Pain

Achilles, the bravest and strongest of Greek warriors had only one weak point in his body…the tendon at the back of his heel…he could be defeated in battle only by a blow to this heel tendon. Closer home, our own Lord Krishna also had only one weak area…the heel…

Though these are only mythological stories, many of us do suffer from heel pain at some time or the other in our lives….

The cause can be an overall illness…eg. Arthritis /Gout, but in most cases it is a local condition that affects only the foot.

The common local conditions causing heel pain are:

1. Plantar Fasciitis:
   A  painful  inflammation  of the band of tissue on the sole of the foot, which helps to support the arch of the foot.
   
   This inflammation occurs when the tissue gets overloaded or overstretched because of
   
   
   • Increase in body weight due to obesity / pregnancy/or any other cause
     
   • Stress on the tissue due to over-training in sprinters / Athletes
     
   • Sudden increase in exercise
     
   • Using worn-out or poorly constructed shoes
     
   • People with flat feet
   
   
2. Spurs:
   This is an abnormal growth of bone at the area where the plantar fascia attaches to the heel bone. This is caused by long-term, repeated strain/trauma on the plantar tissue and the muscles of the foot, especially in obese people, runners, joggers, etc. Though a spur can contribute towards heel pain, it is not the only cause of it.
   


3. Bursitis:
   This is an inflammation of a bursa.. which is a sac with fluid, between the heel tendon and the bone to allow smooth gliding movement. Pain due to bursitis may come behind the heel or on the underside of the heel. It may be caused by footwear with poorly cushioned heels. Sometimes a long time bursitis caused by footwear, can lead to an abnormal bony growth at the back of the ankle joint.


4. Achilles Tendonitis:
   It is the inflammation of the Achilles Tendon which is the thick cord at the back of the heel…due to over-training in athletes, excessive jumping, poorly cushioned shoes, etc…
   
   Besides these common causes, pain from a nerve trapped in the low back region can also be referred to the heel area, a fracture or a sprain in the ankle may cause a nerve to be trapped locally and cause pain. A local bruising, like stepping on a stone in inadequately padded footwear can also cause long-standing pain.

Heel pain can be prevented by

• maintaining a healthy weight,
• warming up properly before participating in any sport
• wearing softer, padded shoes that support the arch and cushion the heel.
• If you are prone to plantar fasciitis, stretch the heel cord and the plantar fascia regularly.
• Ice massage to the sole of the foot after a stressful athletic activity should help.
  

The duration and treatment of heel pain will depend on the cause. For eg. If the cause is obesity, it should gradually improve as the weight decreases. If heel pain is related to over-training or bad footwear, it should reduce with proper amount of rest from activity, and correction of footwear.

Plantar Fasciitis will usually heal itself over a period of 6-8 weeks with a proper amount of rest from activity and change in footwear. Heel spurs may require heel pads or heel cushions. Treatment can be in the form of anti-inflammatory drugs, ice massage / hot fomentation to the sole of the foot, physiotherapy treatments like, ultrasound, Wax bath, taping, and stretching. Sometimes, a night splint can be given to stretch the heel cord. If none of these treatments help to relieve the pain, corticosteroid medication may be injected in the painful area. In very rare cases, surgery may be required.

Once the pain reduces, a few changes can be made in the training program and shoes, so that the pain does not recur.

Treatment in Prakruti: Most patients coming to us for treatment of heel pain have suffered the pain for a long time, and have already tried many alternative treatments. We educate the patient about the condition, and explain the treatment protocol, giving them various options. Often patients choose to come in for treatments everyday for 4-5 sessions, followed by alternate day treatments for 4-5 sessions more. The treatment in the clinic would be electro therapy (Ultrasound/LASER/SWD), exercises, and sometimes taping would be done to protect the plantar fascia by unloading it. The recommended home program should be carried out for 3-6 weeks. A diet may be prescribed for weight-loss, and sometimes special insoles are recommended.