Healing the heel

Pain in the heel is one of the most common ailments of the foot. The most common form of heel pain is pain at the bottom of the heel. It tends to occur for no apparent reason and is often worse when first placing weight on the foot.

Patients often complain of pain in the morning, or after getting up to stand after sitting for a while. The pain can be a sharp, shooting pain or present as a tearing feeling at the bottom of the heel.

As the condition progresses, there may be a throbbing pain or there may be soreness that radiates up the back of the leg. Pain may also radiate into the arch of the foot.

To understand the cause of the pain one must understand the anatomy of the foot and some basic mechanics in the functioning of the foot. A thick ligament, called the plantar fascia, is attached to the bottom of the heel and spread out into the ball of the foot, attaching to the base of the toes. The plantar fascia is made of dense, fibrous connective tissue that will stretch very little. It acts like a shock absorber.

As the foot presses the ground with each step, it flattens out, lengthening the foot, making the plantar fascia stretch slightly. When the heel comes off the ground, the tension on the ligament is released. Force from above tends to make the foot elongate, making flat the foot. Pain can result when these tissues become irritated or inflamed, or when small spurs grow on the heel bone. Adults, regardless of occupation or activity level, develop heel pain most frequently. 

Causes: The main causes for pain in the heel are repeated stress, falling arches, being overweight, fractures, cysts, infections, wearing shoes with poor foot beds, arthritis, collagen diseases, overuse trauma and nerve entrapments. However, the majority of heel pain can be due to abnormal walking position with corns, high heels and arthritis. Abnormal posture in rest and sleep - locking the ankle one with another - also causes heel pain. The ankle position of long-drive drivers may also become a cause. It may be due to infection, reaction to infection, rheumatoid, rheumatic, porous bone or thinning of bones which are very common in ageing due to hormonal deficiency.

Calcium depletion and taking drugs like steroids and thyroid hormones will also induce thinning of the bones. Changes in joints caused by osteoarthritis are thinning of cartilages, thickening of joint surfaces, new bone formation, loose bodies inside the joint, weakening of the muscles, swelling and fluid collection. All these lead to pain, swelling and restricted movement of joints. They may also cause heel pain.

Types of pain in the heel

Plantar fascitis – Plantar fascitis, also known as heel pain syndrome, is an inflammation in the plantar fascia at the bottom of the foot. The inflammation of plantar fascia at its origin at the heel bone causes the classic symptom of pain at the bottom and side of the heel. In course of infection and inflammation, the plantar fascia gets tightened as a course of natural protection mechanism to avoid movement and thus pain. When it is stretched against natural tightness, it pains. The plantar fascia resists this force. If there is more force on the plantar fascia than it can handle, one of two things that can happen is either tiny plantar fascia fibres tear, or it pulls too strongly on the heel bone.

The injury of the plantar fascia begins a process of heel inflammation. Inflammation is characterised by swelling but this is not so visible in plantar fascitis. Some of the inflammatory fluids brought to an injured area stimulate pain nerves. This is nature’s way of slowing down after an injury to allow the tissues to heal. Heel pain syndrome can be caused by shoes with heels that are too low, a thinned out fat pad in the heel area, or from a sudden increase in activity. Some of the factors to plantar fascitis include flat foot, pronated feet; high-arched rigid feet; inappropriate shoes; running on the toe or hill-running, running on sand, and ageing.

Calcaneal spurs (Calcium spurs) – The abnormal stress placed on the attachment of the plantar fascia to the heel usually causes pain, inflammation and swelling. If this process continues, the plantar fascia partially tears away from the heel. The body will fill this torn area with calcium, developing it as a bone, resulting in a heel spur. Constant abnormal pulling of the plantar fascia irritates the heel bone and the body lays down a bone spur as a protective mechanism. The projection or growth of bone may be called a spur and it grows where the muscles of the foot attach to the bone. While some heel spurs are painless, others that are determined are the cause of chronic heel pain and may require medical treatment or surgical removal.

When small tears occur, a very small amount of bleeding may occur. Pain experienced in the bottom of the heel is not produced by the presence of the spur. The pain is due to excessive tension of the plantar fascia as it tears from its attachment into the heel bone and not from the spur. Heel spur formation is secondary to the excessive pull of the plantar fascia. Many people have heel spurs at the attachment of the plantar fascia without having any symptoms or pain. The spurs may not appear on the X-rays of patients with acute heel pain. Conversely, heel spurs of all sizes are often seen on X-rays of patients who do not have any heel pain. If a spur exist, it is only a shelf of bone rather than a small, sharp protrusion. Therefore, initial treatment is directed at decreasing the pulling and tightness of the plantar fascia and supporting the fascia during weight-bearing to decrease inflammation. If a nerve is initiated by the spur or inflamed due to swollen fascia the pain may radiate into the arch of the ankle.

Achilles tendonitis – Another heel problem faced mainly by athletes is Achilles tendonitis. Over stretching the Achilles tendon causes a burning sensation behind the heel. The Achilles tendons are the very largest, tough tissue found in lower legs and connect the calf muscles to the heel. The calf muscles are responsible for strengthening the feet at the ankles when walking. When the calf muscle is tight, it limits the movement of the ankle joint. When ankle joint motion is limited by the tightness of the calf muscle, it forces the subtalar joint to pronate excessively. Excessive subtalar joint pronation can cause several different problems to occur in the foot. Exercise, such as walking or jogging will cause the calf muscle to tighten. Inactivity or prolonged rest will also cause the calf muscle to tighten. Women who wear high heels and men who wear western style cowboy boots will, over time, develop tightness in the calf muscles. Support beneath the heel providing proper shock absorption and anatomical balance helps alleviate this pain.

Pronation and supination - Pronation can cause the plantar fascia to be excessively stretched and inflamed. While pronated the foot rolls inward, causing a break down of the inner side of the shoe, the arch falls excessively, and this causes an abnormal stretching of the relatively inflexible plantar fascia, which in turn pulls abnormally hard on the heel. In pronation, the foot collapses and becomes very flexible. This flexibility allows the foot to adapt to changes in terrain. As the opposite foot swings by the planted foot, the foot begins to supinate into a foot rigid enough to support push-off. A supinated foot is very stable and not prone to plantar fascitis. The pathology occurs with “supination” is the rolling of the foot outward, causing a breakdown of the outer side of the shoe. Supinated feet are relatively inflexible, usually have a high arch, and a short or tight plantar fascia. Thus, as weight is transferred from the heel to the remainder of the foot, the tight plantar fascia does not stretch at all, and pulls with great force on its attachment to the heel. 

Treatment - Treatment should not only relieve the pain but it should also prevent it from recurrences. Treatment may include self-care, medications, therapy. 

Self-care - Self-care includes cushion and lubrication. Treatment must be directed towards realigning the foot as it goes through the gait cycle, and reversing the abnormal effects of pronation and supination on the plantar fascia and heel. In doing this, the abnormal pull of the plantar fascia on the heel will be made to disappear. This, in turn, alleviates the pain and inflammation at the heel. Realignment or proper positioning of the foot by cushioning the heel provides an immediate decrease in pain. 

Preventive measures - Avoid sports and other vigorous activities while healing. Avoid uneven walking surfaces or stepping on rocks as much as possible Relax and walk; relax and stand, Begin exercise programmes slowly; don’t go too far or too fast. Avoid going barefoot on hard surfaces.

Stand on your toes at full stretch with supports on hands. Do this type of exercise up to 10 times. Try gentle calf stretches for 20 to 30 seconds on each leg. This is best done barefoot, leaning forward towards a wall with one foot forward and one foot back. All exercise should be done slowly and the posture should be maintained for some time for efficacy

Before stepping down after sleeping or resting, make movements of toes and ankle in all the way to warm up and relax the foot. If the pain becomes intense, applying ice will reduce it. Place the ice directly on the heel and arch for at least 10-20 minutes. Elevating the heel will reduce the pull of the plantar fascia, thus reducing the pain.

Weight Reduction - Decreasing pressure on the heel by reducing body weight can often be quite beneficial when it is appropriate and indicated

Diet - In case of arthritis and bone disorders, treatment can be supplemented with calcium vitamin-D, vitamin-C, iron, hormonal replacement and exercises Balanced diet with plenty of greens, dates, cereals, vegetables, dairy products, meat, egg and fruits ensure adequate supply of calcium and minerals. For vitamin-C – fruits like orange, lemon, gooseberry, tomatoes, potatoes and vegetables. It is also necessary to absorb iron from meat.

Shoes: Wear shoes with heels made from soft rubber instead of leather and replace them regularly. Footwear selection is also an important criteria when treating heel pain. The right shoes can play a major role in relieving discomfort. 

Heel cushions . These are usually of very little value unless the heel pain was caused by a bruise. In heel pain, the heel cushions treat only a small portion of the symptoms. Physio-therapy-Stretching exercises are most effective. Night splints also give some relief. 

Medication - In Allopathy: Heel pain is treated with anti-inflammatory drugs. These medications cannot be taken by patients who are allergic to aspirin or suffering from ulcers.

Injections of a mixture of local anaesthetic and cortisone: Although relief of pain and inflammation is usually very good with injections, this treatment does not treat the cause of the problem. Multiple injections in the same location can weaken the tissue and cause atrophy of the tissue and fat in the heel area.

Instantly killing pain with pain killer tablet and injection is like putting off the light when you don’t want to see the things; surely the day will come to light up where you cannot switch off the pain.

Surgery: Surgery is used when conservative measures have not been successful or as a last resort.

Homoeopathic approach to heel pain

Homoeopathy is the finger-post on the cross-roads of healing which directs the way to safe and permanent cure. Homoeopathy works towards nature. All Homoeopathy medicines are proved in human beings. It is very much refined. Homoeopathy has no side-effects. It comforts modern living. It is very safe, effective and easy way to attain cure. The most common medicines are Antim-crud, Rhus tox, Thuja, Bryonia, Pulsatilla, Ruta, Ledum, Kalmia, Lycopodium and Apis mel. The medicines should be taken under the advice and diagnosis of a Homoeopath. The Homoeopathy medicines not only relieve the pain but also treat the condition permanently. In case of deformed foot it comforts the living by alleviating the pain.

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Published on 26^th July, 2004