Heel Pain

Symptoms

A common foot problem that many people suffer is heel pain. This is a condition in the foot that can effect any individual from any walk of life. The chance of a person developing these symptoms depends on how much they use their feet during the week. For example in a job that requires long hours standing up, the pain can be more severe as more strain is put on the feet.  Another factor that can effect the severity of the pain is how well a person looks after their feet.

Heel pain usually occurs under the heel or just behind it. The most common symptom for a patient is that when they wake up in the morning and put their feet on the floor to make their first steps of the day, they will immediately feel a sharp pain in their heel. In order to not exert any more pressure on the area producing the pain, the patient will feel the need to tip-toe and avoid walking on their heels, as they move around the house. After a few minutes of walking, the heel pain will decrease as the process of walking stretches the fascia. However, after sitting down for a period of time, when walking is resumed the heel pain will return and will be as intense as previously felt.

This type of discomfort can be very frustrating and can leave a patient feeling as though they will never fully recover. In addition, as the symptoms develop, the pain will increase and will not subside as before. Furthermore, when taking a walk, or doing other exercises that exert pressure on their foot, the pain will continue to persist.

Causes

When the base of the foot (sole) muscle becomes so weak that the foot is unable to carry a person’s body weight during daily routines, this will result in heel pain. In this troublesome problem, muscle fiber tears off repeatedly at the same spot, producing a wound or fibrosis.

Heel pain appears to be more of an issue for people that work in the city, such as in office jobs. This is due to the fact that they usually wear smarter shoes with a harder sole. Furthermore, they will often walk on a harder, flatter floor for the majority of the day so the smaller muscles of the base of their feet will not be stretched as much; they will progressively become weaker day by day, until finally, during a period of heavy use, the muscles at the underside of the heel will tear off followed by inflammation. This incident will occur repeatedly in patients and, since the cause of these symptoms are the weak muscles under the feet, it can be very difficult for it to be cured unless the muscles on the underside of the feet are recovered beforehand. In contrast, people that work in other occupations or away from the city may not be exposing their feet to the same levels of intensity so their symptoms are usually much milder.

An x-ray picture of the heel bone with the calcite

An x-ray picture of the normal heel bone

Treatment

Taking painkillers does provide some relief, temporarily. However, after finishing a one or two week dose of pills, the pain will often return. Moreover, there is also potential for a stomach ulcer to develop as a side effect of taking painkillers for a prolonged period of time. Furthermore, some patients have also reported that they have felt the symptoms so often that painkillers are not having any effect. With this in mind, a viable option is to opt for treatment. If this is chosen, patients are injected with a medicine containing steroids into the most painful point of their heel. Some patients are reluctant to carry out this form of treatment and believe that steroid injections are dangerous. A common reason for this is because they have heard of the side effects of the steroids used in some painkiller pills and in the general medicinal balls. Needless to say, all medicines are dangerous if not used correctly or if not used with the guidance of experts. An injection differs from taking oral medicine for various reasons. Firstly, the oral medicine will be digested and absorbed into all parts of the body through the blood stream, however, an injection will only be effective in reducing the inflammation within the 2-3 centimeter area around the injected position; there is no effect on other parts of the body. Furthermore, as an injection is effective on a specific spot, it can be administered into the heel of a pregnant woman who may be suffering, without any complicated side effect, therefore the medicine itself is rather safe to use.

The effects of the injection will last for approximately three months. However, if the patient has weak muscles in the base of their foot, unfortunately the heel pain is likely to return. Also, if the problem is ignored and the issue is neglected for too long, there is a possibility that a calcite attached to the heel bone could develop. In this case, when taking a walk an individual will feel like there are thorns continually ‘pinching’ on their heel on each step that they exert pressure on the heel. The calcite will become so thick and long that the other treatments become inadequate and have little to no effect. In this situation, the only viable treatment option is to undergo surgery.

The surgeon takes out the calcite by using the special x-ray equipment, providing them with a crucial real-time picture.

If a patient does decide upon having surgery, this can be thought of as an effective method to cure heel pain. The surgeon will perform a small surgical procedure where a small incision is made into the heel area that harbours the wound. Next, the surgeon will trim out the fibrosis from the wound and take out the calcite, before also repairing the attached point at the underside of the foot muscle. This procedure is the cure of the root cause and prevents the heel muscle repeatedly tearing off. which is the main cause of the heel pain.

Who should take the surgery?

The following patient groups should seriously consider taking this surgery:

• Patients with chronic heel pain.
• Patients who have calcite in their heel.
• Those patients who have been continually injected with steroids, where symptoms persist.
• Patients who are unable to take anti inflammation medicine for a long duration.
• Patients who cannot walk for a long time.
• Those patients who walk in an unstable way or have back pain.

If patients are not comfortable with undergoing surgery to prevent heel pain as described above, they can make some small alterations to their day that will help ease their pain. One option is that they can take off hard sole shoes from time to time during the day. Another solution is to avoid walking on hard surfaces, by walking on grassy patches or smoother surfaces, where the option is available. This will give the muscles in the underside of the foot the exercise needed and will allow the inflamed muscle to rest, recover and get back to normal.