The human foot is a delicately architected part of the body. It is made up of 26 bones, with the calcaneus or heel-bone being the largest, 33 joints, over 100 tendons, and ligaments. All these elements give the feet required flexibility, strength and various movements. The Achilles is a tendon, in fact the longest and strongest tendon in the body, which stretches from the calf muscle in the leg to the heel of the foot, and helps you lift the foot off the ground. The Plantar fascia is a ligament that lies on the underside of the foot just above the skin. It’s a flexible band that connects the heel bone to the base of the toes and sides of the feet, through various branches.
Causes of Heel Pain
There are various feet conditions and ailments that can cause heel pain, either behind or below the heel.
1. Behind the heel
- Achilles tendinitis: The Achilles tendon has been described before. Achilles tendinitis is an overuse injury that inflames this tendon, and causes pain, swelling and stiffness behind the heel. Runners and basketballers who frequently lift their feet off the ground are more at risk from this.
- Bursitis: Bursae are fluid-filled sacs present at the joints, in different parts of the body and help in cushioning any movement. When the bursae in the feet get inflamed or swollen up, there can be a tender or bruise-like feeling behind the heel. This typically occurs when one has spent a long time on their feet.
- Haglund’s deformity: When there is constant rubbing and irritation to the heel bone from tight footwear and shoes with high heels, such as pumps, the back of the heel can get inflamed and a develop an enlarged bony bump (called ‘pump bump’).
- Calcaneal apophysitis or Sever’s disease: This affects children in the age-group of 8 to 14 years. Children who do a lot of running, jumping and other athletic activities are more prone to this condition where the growth plate in the back of the heel gets irritated.
2. Below the heel
- Bone bruise or contusion: While walking, if the person steps on a hard or sharp object, that can bruise the fat padding underneath the heel. This results in discoloration sometimes as well as tenderness or pain while walking.
- Stress fracture in the foot can cause pain all along the back and underside of the heel as well as sides of the feet. Such fractures are caused by repetitive stress from strenuous exercise, heavy manual work or certain sports. Runners are at high risk of stress fracture in the metatarsal bones in the feet. Osteoporosis can also cause stress fractures.
- Plantar fasciitis: Plantar fasciitis is the most prominent cause of heel pain. Covered in detail below.
- Heel spurs: When Plantar fasciitis becomes chronic, it can cause a bony growth on the heel called a heel spur. While to most people, this is not painful, to some, heel spurs can cause pain.
3. Others
- Tarsal tunnel syndrome or TTS: The tibial nerve is present in the ankle, and passes through a ‘tarsal tunnel’ made up bones and ligaments. People who have flat feet, or who exercise frequently or strenuously develop swelling in the tissues surrounding the ankle. This swelling compresses the tibial nerve and causes what is called compression neuropathy. TTS causes pain, burning or tingling sensation in the heel, underside of the feet and toes.
- Ankylosing spondylitis: A kind of arthritis that primarily affects the spine. Among its various symptoms and consequences is heel pain.
- Osteochondroses: A disorder that affects bone growth in children and adolescents, one of the consequences of which is heel pain.
- Reactive arthritis: A type of arthritis that is caused by an infection in the body, one of the consequences being heel pain.
- A rupture in the Achilles tendon
- A tear in the Plantar fascia
- Baxter’s nerve entrapment
- Stress fracture of the heel bone
- Bone cyst that is filled with fluid, in the heel bone
- Systemic arthritis
- Bone injuries or bruises due to nasty falls, jumping from heights or objects falling on the feet
- Osteomyelitis which is an infection of the bone or bone marrow
- Vascular or circulation problems in the feet
- Poor, improper or unnatural posture while walking or running
- Short flexor tendon tear
- Gout caused by excessive uric acid in the body
- Neuroma, or Morton’s neuroma
Plantar Fasciitis
The structure and function of the Plantar fascia has been described earlier. People who run, jump or walk a lot, especially on hard surfaces or on treadmills develop this painful condition. It feels like a stabbing pain in the underside of the foot/feet closer to the heel. When the person has been standing for a long time, or immediately upon waking, or rising after sitting for a long time, the pain is sharp.
Causes & Risk factors
- Age: Plantar fasciitis is most common in people between the ages of 40 and 60.
- Certain exercises: Activities such as long-distance running, jumping, athletics, aerobic dance, ballet dancing etc, especially when done on a hard surface, can stress the heel and attached tissue, eventually triggering plantar fasciitis.
- Foot mechanics: Having flat feet, or a high arch in the feet, unusual posture or walking style affects how weight is distributed when the feet move. This can create stress in the feet which eventually triggers plantar fasciitis.
- Excess weight adds stress on the plantar fascia, thereby triggering this condition.
- Occupations that require standing: Teachers, salespersons, factory workers or anybody who is required to stand for long hours on hard surfaces are at higher risk of plantar fasciitis.
- Ill-fitting shoes that are tight, do not have the proper shape to complement the arch of the feet or do not have adequate cushioning, wearing worn-out shoes with thin soles.
- Tight calf muscles that make it difficult to flex the foot or toes
- Inadequate warm-up before exercise, especially when the calves are stretched during warm-up.
- Tight Achilles tendons, a condition called as ‘heel cords’.
- Gender: For no clear reason, women are more at risk than men.
Treatment options
1. Home Remedies
- Exercises to stretch the calf muscles.
- Wearing shoes that are sturdy, well-cushioned and shaped as to complement the natural arch of the feet. Avoid wearing sandals, flip flops and walking on bare feet.
- Using arch supports, shoe inserts and customized foot-orthotics, inside the footwear.
- Wearing a night splint to minimize tightness in calf muscles.
- Gently massaging the painful area.
- Using ice-pack on the painful area, 3-4 times a day for 10 to 15 minutes.
- Limiting physical activity, avoiding standing for long durations.
- Taking OTC medications: such as NSAIDs like ibuprofen or naproxen
- Losing and maintaining body-weight.
- Using crutches in case the pain is severe.
2. Outpatient Treatments
- Taking steroid (Cortisone) injections.
- Physiotherapy which includes stretching and exercises.
- ESWT or Extracorporeal shockwave therapy: In this, shockwaves are used to stimulate the healing process.
- Meeting a podiatrist or foot specialist. He/she will make recommendations regarding footwear and insoles.
3. Surgical Interventions
If the above solutions do not work out, even after 12 months, then surgery is performed.
- Gastronemius recession: Since tight calf muscles are known to increase stress on the Plantar fascia, this procedure is done to lengthen the calf muscles and reduce stress.
- Plantar fascia release: In this, the Plantar fascia is cut partially, to reduce some of the stress in it.
Outlook
Plantar fasciitis is a serious condition if left untreated can lead to various complications that will limit one’s mobility and quality of life. If you or any of your dear ones are showing the symptoms of this condition, do not panic. Consult an orthopedic specialist at a reputed hospital. He/she will diagnose your condition precisely and put you on a course of treatment for quick recovery and rehabilitation.
NOTE: Take medications only when prescribed by your doctors, self-medication must be avoided under any circumstances.
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem and Bengaluru, the hospital also renders adult and pediatric trauma care.
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