श्री आर के होमियोपैथी हॉस्पिटल ,सागवाड़ा
डॉ रजनीश जैन BHMS, PGDHHM
Limca Book Recored Holder 2009
Heel pain usually develops gradually and gets worse over time. The pain is often severe and usually occurs when you put weight or pressure on the heel
Heel pain usually develops gradually and gets worse over time. The pain is often severe and usually occurs when you put weight or pressure on the heelWhat is heel pain?
Heel pain is a common foot problem. A person suffering from this problem usually feels sharp pain when using the affected heel.
Heel pain usually develops gradually and gets worse over time. The pain is often severe and usually occurs when you put weight or pressure on the heel.
In most cases only one heel is affected. However, according to statistics, about one third of people have pain in both heels.
The pain is usually worst in the morning, or when you take steps after sleeping or sitting for a long time. The pain usually subsides after walking, but often increases again after walking or standing for a long time.
Some people walk in an abnormal way or limp as they try to avoid putting more weight on the affected heel.
Heel pain is a common complaint that can significantly disrupt a person's daily life. It refers to sharp or dull pain and may sometimes be experienced while walking or running. Some of the common causes of heel pain include:
Plantar fasciitis: This is inflammation of the plantar fascia, a thick tissue band that affects the toes.
Achilles tendinitis: This is caused by inflammation in the Achilles tendon (the connection between the calf muscles and the heel bone).
Bursitis: This involves inflammation of the bursa, a fluid-filled sac located at the back of the heel. Ayurvedic procedures for heel pain treatment may include abhyanga (oil massage), swedana (sweating), virechan (digestion), basti (enema), raktamokshana (blood removal), lepa (applying poultices on the affected part) and agni karma (burning the affected part with metal)1. Apart from this, herbs and medicines like Chitrak, Rasna, Arandi, Yogaraj Guggul and Dashmularishta can also be used.
What causes heel pain?
Heel pain usually occurs when a band of tissue in the foot, called the plantar fascia, becomes damaged and thickened.
Plantar fasciitis is a medical term used for thickening of the plantar fascia.
Plantar fascia
The plantar fascia is a band of tough and flexible tissue located just below the foot. It connects the heel bone to the bones of the foot and acts as a kind of rubber for the foot.
Tears (microtears) can develop inside the tissue of the plantar fascia due to sudden damage, or damage over many months or years. This causes the plantar fascia to thicken and heel pain begins.
Apart from this, the surrounding tissue and the heel bone may also sometimes become swollen.
DiagnosisIn most cases, your doctor or podiatrist (a specialist in foot problems and foot care) diagnoses the cause of heel pain. During this, they do tests in the following way:
Asking about your symptoms and medical historyExamining the heel and footRead more about how heel pain is diagnosed.
Treating heel painThere are many treatments available that can relieve heel pain and help you recover faster. This includes:
resting the heel - try to avoid walking long distances and standing for long periods of timeregular stretching - stretch your calf muscle and plantar fasciapain relief - use an icepack on the affected heel and take painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs)wearing well-fitting shoes that support and cushion your foot - running shoes are especially usefulusing assistive devices such as orthoses or strappingfour out of five cases of heel pain resolve within a year. However, it is quite painful and miserable to suffer heel pain for such a long time.
In one in 20 cases, the above treatments are not enough and surgery may be recommended to get rid of the plantar fascia.
Preventing heel painIncreased body weight can put extra pressure and strain on your feet, especially your heels. Regular exercise along with a healthy balanced diet helps to keep body weight under control. This is beneficial for your feet.
Apart from this, it is also important to wear proper footwear. You should wear shoes with low or medium heels that can support and cushion your heel. Avoid wearing shoes without heels.
Causes of heel painPlantar fasciitis is the most common cause of heel pain. Four out of five cases of heel pain are caused by it.
Plantar fasciitis occurs when the thick band of tissue that connects the heel bone to the rest of the foot (plantar fascia) becomes damaged and thickened.
The plantar fascia is damaged due to:
Sudden damage - for example, damaging the heel while jogging, running or dancing; This type of damage usually affects physically active young people. Gradual wear and tear in the tissue that makes up the plantar fascia – this usually affects adults 40 years of age or older. Risk factors Wear and tear can gradually increase your risk of developing plantar fasciitis.
You can increase your risk if you're:
Overweight or obese - if your body mass index (BMI) is 30 or higher, you're obese
Working in a job that requires standing for long periods of time
Wearing flat-soled shoes, such as sandals or flip-flops
Less common causes
The following are less common causes of heel pain.
Stress fracture
A stress fracture can occur if your heel bone is damaged by an injury.
Fat pad atrophy
Fat pad atrophy occurs when the layer of fat underneath the heel bone, called the fat pad, begins to waste away because of too much strain on the pad.
Women who wear high-heeled shoes for many years have an increased risk of fat pad atrophy.
BursitisBursitis is inflammation of one or more bursae (fluid-filled sacs under the skin, usually above joints and between tendons and bones).
Bursitis can develop anywhere inside the body, not just in the foot.
Tarsal tunnel syndromeThe nerves in the sole of the foot pass through a small tunnel inside the ankle joint called the tarsal tunnel. If a cyst forms or the tunnel is damaged, the nerves can become compressed (squashed). This can cause pain anywhere along the nerve, including at the bottom of your heel.
Sever’s diseaseHeel pain is common in children due to Sever’s disease. It is caused by stretching and tightening of the hamstring and calf muscles and tendons in response to a growth spurt.
Stretching of the calf muscle stretches the Achilles tendon. This puts strain on the growing area of bone at the back of the heel (the growth plate), causing heel pain.
Activities such as football and gymnastics make the pain worse. The pain is usually on the side of the heel, but can also be felt underneath the heel.
Calf and hamstring stretches, as well as heel pads if necessary, are usually effective treatments for severe disease.
Diagnosing heel painYour doctor or podiatrist (foot care specialist) diagnoses the cause of heel pain by asking about your symptoms and examining your heel and foot.
You'll usually only need further investigations if you have other symptoms that suggest your heel pain isn't inflammation, such as:
tingling and tingling in your foot – this can be a sign of nerve damage in your foot and leg (peripheral neuropathy)
you feel warm in your foot and have a body temperature (fever) of 38 °C (100.4 °F) or higher – these can be signs of a bone infection
stiffness and swelling in your heel – this can be a sign of arthritis
Further tests may include:
blood testsX-rays, which use radiation to look for problems in bones and tissuesMagnetic resonance imaging (MRI) scans or ultrasound scans, which give detailed scans of the bonesTreating heel painTreating heel pain usually involves techniques such as stretches and pain relief. These help relieve pain and speed recovery.
Most cases of heel pain resolve within 12 months. If your symptoms don't improve after 12 months, surgery is a last option. Only one in 20 people with heel pain will need surgery.
RestingAvoid walking long distances and standing for long periods if possible, and rest the affected foot. However, you should regularly stretch your feet and calves and do exercises as described below.
Pain reliefNon-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be used to help relieve pain.
Applying an ice pack to the affected heel for five to 10 minutes also helps some people relieve pain and swelling. However, don't apply an ice pack directly to your skin. Instead wrap it in a towel. If you don't have an ice pack, you can use a packet of frozen vegetables.
ExercisesStretching the calf muscle and plantar fascia (the tissue band on the bottom of the foot) helps relieve pain and improve flexibility in the affected foot.
A number of stretching exercises are described below. You are usually advised to do the exercises on both feet, even if only one of your heels is affected by pain. This improves the balance and stability of the heel and also helps relieve heel pain.
Towel stretchesKeep a long towel near your bed. Before you get out of bed in the morning, loop the towel around your foot and use it to pull your toes towards your body while keeping your knee straight. Repeat this three times on both legs.
Wall stretchesPlace both hands on a wall at shoulder height, with one of your feet in front of you. The front foot should be about 30 cm (12 inches) away from the wall.
Bend your front knee and keep your back leg straight. Now lean towards the wall until you feel a tightening in the calf muscle of your back leg. Then relax.
Repeat this exercise 10 times. You should do wall walks twice a day Stretches should be practiced.
Stair stretchesStand on the stairs with your feet against the railing and look up the stairs. Your feet should be slightly apart with your heels hanging off the back of the step.
Do not lower your heels until you feel a tightening in your calves. Remain in this position for about 40 seconds before bringing your heels back to the starting position. Repeat this process six times, twice a day.
Chair stretchesSit on a chair and bend your knees at a right angle. Turn your legs sideways so that your heels are touching the feet and the toes are in opposite directions. Lift the affected toes up while keeping the heels firmly on the floor.
You will feel a tightening in your calf muscle and Achilles tendon (the tissue band that connects the calf muscle to the heel bone). Remain in this position for several seconds and then relax. Repeat this process 10 times, five to six times a day.
Dynamic stretchesWhile sitting, roll the arch of your foot (the bottom between the toes and heel) on a round object, such as a rolling pin, tennis ball or drink can. Some people use a cold can from the fridge to relieve pain.
Move your foot and ankle in all directions on the object for a few minutes. Repeat this exercise twice a day.
FootwearDepending on your usual choice of footwear, your doctor or podiatrist may advise you to change your footwear.
You should avoid wearing flat-soled shoes as these do not provide support to your heel and can make heel pain worse.
You should wear shoes that cushion your heel and support the arch of the foot well.
Women should wear high-heeled sandals and men should wear heeled boots or brogues. This can relieve heel pain. Because such shoes help reduce pressure on the heel.
However, these types of shoes are not suitable for long-term use and may worsen heel pain. Your doctor or podiatrist can advise you on footwear.
OrthosesOrthoses fit inside the soles of shoes to provide support to the foot and help the heel heal. You can buy them from sports shops and large pharmacies. Your podiatrist can also refer you to a supplier of such shoes.
If foot pain persists after treatment, or if you have an abnormal shape or structure of your foot, custom-made orthoses are available. These are made specifically to fit the shape of your feet.
However, there is no evidence that custom-made orthoses are more effective than those bought off the shelf.
Strapping and splintingWhen using orthoses, your heel is strapped with sports strapping (zinc oxide) tape. Strapping helps to reduce pressure on the heel. Your doctor or podiatrist can show you how to apply the tape yourself.
In some cases, a night splint may also be useful. Most people sleep with their toes pointing downwards, which causes the tissues inside the heel to become pinched together.
Night splints look like boots. They help keep your foot and toes elevated while you sleep. They stretch both the Achilles tendon and the plantar fascia, helping you to recover faster.
Night splints are usually only available from specialist shops and online retailers. Your podiatrist can also refer you to a supplier.
Corticosteroid injectionsIf your painful symptoms don't subside despite treatment, your doctor may ask you to have corticosteroid injections.
Corticosteroids are a type of medicine that has powerful anti-inflammatory effects. They should be used with caution because overuse can cause serious side effects such as weight gain and high blood pressure (hypertension).
That's why no more than three corticosteroid injections are given to any part of the body in a year.
Before giving a corticosteroid injection, a local anaesthetic (pain-relieving medicine) is used to numb your leg so that you don't feel any pain.
SurgeryIf treatment is not working and you still have severe symptoms after a year, your doctor may refer you to:
Orthopaedic surgeon – a surgeon who specialises in surgery of the bones, muscles and joints.
Podiatric surgeon – a podiatrist specialises in foot surgery
Surgery is sometimes recommended for professional athletes and other sportspeople whose heel pain is adversely affecting their careers.
Plantar release surgeryPlantar release surgery is the most widely used surgery to treat heel pain. Surgeons cut the fascia to free it from the heel bone, which reduces tension on the plantar fascia. This also reduces inflammation and gives you relief from painful symptoms.
Surgery can be done in several ways:
Open surgery – this involves removing the heel bone and opening the foot.
A section of the plantar fascia is released by making a cut in the injured heel Endoscopic or minimal incision surgery – a small incision is made and special instruments are inserted through the incision to access the plantar fascia Endoscopic or minimal incision surgery does not take long to heal. So you can walk normally much sooner (almost immediately) compared to two to three weeks in open surgery.
One disadvantage of endoscopic surgery is that it requires both a specially trained surgical team and special equipment. So you may have to wait longer for healing than if you choose to have open surgery.
Also, endoscopic surgery carries a higher risk of damaging nearby nerves. This can cause numbness or tingling in your feet or reduced mobility of the feet.
All types of plantar release surgery carry a risk of infection and nerve damage. Your symptoms may also be more likely to get worse after surgery (although this is rare).
You should discuss the advantages and disadvantages of both techniques with your surgical team.
Extracorporeal shockwave therapy (EST) Extracorporeal shockwave therapy (EST) is a newer type of non-invasive treatment. Non-invasive means that no incisions are made in your body.
EST uses a device to deliver high-energy sound waves to your heel. The sound waves can sometimes cause pain, so a local anaesthetic may be used to numb the heel.
EST is thought to work in two ways:
has a 'numbing' effect on the nerves that transmit pain signals to the brain
helps stimulate and speed up the healing process
however, these claims have not yet been proven
Some studies have shown that EST is more effective than surgery and other non-surgical treatments, while other studies found the procedure to be no better than a placebo (sham treatment).
PreventionIt's not always possible to avoid heel pain, but there are measures you can take to help avoid further episodes.
Healthy weightBeing overweight can put extra pressure and strain on your feet, especially your heels. This increases the risk of damage to your feet and heels.
If you are overweight, losing weight and exercising regularly along with a healthy balanced diet can reduce symptoms of foot pain.
You can calculate your body mass index (BMI) to find out if you are at a healthy weight for your height.
To calculate your BMI, divide your weight in kilograms by your height in metres squared. If your BMI is:
less than 18.5 means you are underweight18.5-24.9 means you are at a healthy weight25-29 means you are overweight30-40 means you are obeseOver 40 means you are morbidly obeseYou can also use the BMI Healthy Weight Calculator to measure your BMI. Read more about obesity.
Healthy feetYou should always wear footwear that is appropriate for your environment and day-to-day activities.
There is no harm in wearing high heels when you go out in the evening. However, wearing them all week at work can damage your feet, especially if you have a job that requires a lot of walking or standing.
You should wear shoes with laces and a low to medium heel that can cushion and support your arch and heel. Avoid wearing shoes without heels.
Do not walk barefoot on hard ground, especially when on holiday. Many cases of heel pain occur when a person protects his feet for 50 weeks of the year and then suddenly walks barefoot while on vacation. Their feet are not accustomed to the extra pressure, which leads to heel pain.
If you do physical activity like running or exercising and this puts extra strain on your feet, you should replace your sports shoes regularly. Most experts recommend that sports shoes should be replaced after traveling about 500 miles.
Always stretch after exercising. Also, making strength and flexibility training a part of your regular exercise routine is also a good option.
Homeopathic Medicines for Heel Pain
Homeopathic medicines for heel pain are very safe and do not have any negative effects. These medicines help in both acute and chronic heel pain. They affect the root cause of the disease in the body and completely relieve the pain. Here are some good homeopathic medicines that are recommended for heel pain:
Rhus Tox: This is the leading homeopathic medicine for heel pain. This medicine is indicated when the heel pain increases with every step when the person starts walking, but gradually the pain subsides as the person keeps walking. This pain increases even more in the morning when the person stands on his feet after sleeping. This pain feels as if one is walking on semolina or iron nails. Rhus Tox tends to over-strain and strain the heel, leading to heel pain. The more stressed, the more strained one is.
Inflamed tendons or plantar fascia can also be treated effectively. It is also an excellent remedy in case of heel pain arising from joint inflammation.
Ruta: When heel pain is caused by strain or overuse of tendons and ligaments, Ruta is recommended. It is especially effective for pain that is aggravated by walking or standing. People who need Ruta often describe the pain as if the heel hurts or hurts. It is also beneficial for relieving heel pain caused by joint inflammation or conditions such as plantar fasciitis.
Calcarea fluorica (Calc. Fluor.): Calcarea Fluor. is useful for chronic heel pain, especially when there is a sensation of tightness or stiffness in the heel. It is indicated when the ligaments and tissues surrounding the heel become less flexible. This remedy can help improve flexibility and reduce discomfort.
Symphytum: Symphytum is known for its healing properties related to bone injuries and fractures. If there is a history of trauma or injury to the heel, Symphytum can be beneficial. It helps promote bone healing and reduces pain associated with fractures or stress on the heel bone.
@Dr.Rajneesh Jain
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