Bilateral flatfoot before Surgery and  Bilateral flatfoot after Surgery
Ankle Arthroscopy and Subtalar Arthroscopy
Ankle Arthritis in Rhuematoid patient and Ankle Replacement in Rhuematoid Arthritis
Diabetic foot before Surgery and Diabetic foot after Surgery
Claw toe deformity in Rhuematoid patient and Claw toe deformity in Rhuematoid patient after surgery
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Calcaneal Fracture in India


Every mile you walk - about 6000 kg of weight is passing through each foot. God made feet to carry a body of 70 to 120 kg. Your feet depending upon your built are indeed very strong and can handle a heavy load, but too much stress pushes them over their limits.

When you walk and run on hard surfaces or wear shoes that irritate sensitive tissues, you may develop heel pain, one of the most common problem affecting the foot and ankle. A sore heel will usually get better on its own without surgery if it does not consult Dr Bhargava. Surgery is rarely necessary.

Diagnosis

Heel pain can have many causes. If your heel hurts, see your doctor right away to determine why and get treatment. The commonest cause is plantar fasciitis (which will be discussed more in the next section). Other causes include: 

  • 1.  Constantly being on your feet, especially on a hard surface like concrete and wearing hard-soled footwear
  • 2.  Thinning or weakness of the fat pads of the heel
  • 3.  Arthritis in the ankle or heel (subtalar) joint
  • 4.  Fracture of the heel bone (calcaneum)
  • 5.  Achilles tendon problems

Treatment

Conditions that cause heel pain generally fall into two main categories: pain beneath the heel and pain behind the heel.

Pain Beneath the Heel

If it hurts under your heel, you may have one or more conditions that inflame the tissues on the bottom of your foot:

Stone bruise

When you step on a hard object such as a rock or stone, you can bruise the fat pad on the underside of your heel. It may or may not look discolored. The pain goes away gradually with rest.

Plantar fascitis (subcalcaneal pain)

The pain is under your heel and felt more on the inside of the feet. It may be mild at first but flares up when you take your first steps after resting overnight.

 
plantar fascitis picture showing plntar fascia tear and heel spur
 
 
Plantar Fascitis. Pain on the inside of rear sole. Heel spur can be seen on Xray
 

Exact cause is not known but it is often associated with tightness of calf and thigh muscles. It is also more common in people who have high-arched ("cavus") feet or flat feet. Sometimes it starts after an injury to the heel. It is also more common in people with rheumatoid arthritis or ankylosing spondylitis.  

Usually plantar fascitis gets better itself, but this can take months or even years. If you have it once you are more likely to get it again.

You may need to do special exercises (Achilles tendon stretching), take medication to reduce swelling and wear a heel pad in your shoe. Rarely patient with severe pains who have not benefitted from medication and exercises- a small day case surgery procedure is indicated.

Heel spur

When plantar fasciitis continues for a long time, a heel spur (calcium deposit) may form where the fascia tissue band connects to your heel bone. Your doctor may take an X-ray to see the bony protrusion, which can vary in size. Treatment is usually the same as for plantar fasciitis: rest until the pain subsides, do special stretching exercises and wear heel pad shoe inserts.

 
Plantar Fascitis x-ray showing heel spur
 
 
Heel Spur
 

I've been told my pain is caused by a bone spur. Is this likely?

"Heel spurs" are commoner in people with plantar fascitis, but they can be found in people with no heel pain. The heel spur is caused by the same process as the heel pain, but the spur is not itself the cause of the pain.

Can I do anything about the pain underneath the heel pain myself?

You can try to avoid the things that cause heel pain to start:

  • 1. avoid becoming overweight - easier said than done.
  • 2. minimise the shock to your feet by choosing footwear with some padding or shock-absorbing material or heel wedge in the heel
  • 3. if you have high-arched feet or flat feet a moulded insole in your shoe may reduce the stresses on your feet
  • 4. if you have an injury to your ankle or foot, make sure you exercise afterwards to get back as much movement as possible to reduce the stresses on your foot and your heel in particular

If you start to get heel pain, doing the above things may enable the natural healing process to get underway and the pain to improve.

When should I take advice from Foot specialist?

If your heel pain is affecting your normal activities and not getting better with simple self-treatment you may wish to consult Dr Bhargava.

Pain Behind the Heel

 
Picture showing causes of retrocalcaneal heel pain
 
 
Causes of Pain behind your heel
 

If you have pain behind your heel

  • 1.You may have inflamed the area where the Achilles tendon inserts into the heel bone (retrocalcaneal bursitis).  People often get this by running too much or wearing shoes that rub or cut into the back of the heel. Pain behind the heel may build slowly over time, causing the skin to thicken, get red and swell.
     
  • 2. Non insertional Achilles tendinitis - Pain in distal part of Achilles tendon just above the heel is usually because of inflammation in the substance of the tendon. This part of Tendo Achilles tendon which is about 5-8 cms from its insertion into the heel is the most avascular part of the tendon is therefore prone to inflammation. This gives rise to a diffuse swelling in this area which is usually the size of a date.
 
Noninsertional Achilles tendinitis
 
 

Noninsertional Achilles tendinitis

 
     
  • 3. Insertion tendinitis of Achilles tendon and Haglunds Deformity

    You might develop a bump on the back of your heel where Achilles tendon seems to be attaching to the heel. The bump feels tender and warm to the touch. The pain flares up when you first start an activity after resting. It often hurts too much to wear normal shoes as the bump rubs on the shoes giving rise to impingement pain. You may need an X-ray to see if you also have a bone spur at the back of the heel.
 
Picture showing Insertional Achilles Tendinitis
 
 
Insertional Achilles tendinitis
 

 

Treatment  all these above-mentioned problems includes resting from the activities that caused the problem, doing certain stretching exercises, using pain medication and wearing open back shoes.

  • 1. Your Podiatrist/ foot specialist can prescribe or you may want you to use a 3/8" or 1/2" heel insert(heel pad, heel wedge).
  • 2. Stretching exersises of Achilles tendon by leaning forward against a wall with your foot flat on the floor and heel elevated with the insert.
  • 3. Use nonsteroidal anti-inflammatory medications for pain and swelling.
  • 4. Consider placing ice on the back of the heel to reduce inflammation.

    If the above mentioned treatment fails to relieve your symptoms a small day case heel surgery is indicated.

    heel pain surgery
    Heel Pain Surgery