Heel pain the agony of "de feet"

By Robert Chelin D.P.M (podiatrist) Heel pain affects people of all ages and all sizes. It should be treated as a signal to seek medical attention. Because of the many afflictions that can contribute to heel pain, your best bet is to consult a podiatrist to help you deal with the agony of “de feet”. Heel pain is generally a result of abnormal bio-mechanics (gait patterns) placing excessive stress on the heal bone and the soft tissue attached to it. This stress may result from injury or be incurred while walking, doing sports, or just working on hard surfaces. Poorly constructed footwear or being overweight can aggravate the problem. The heel bone is the largest of the 26 bones of the human foot. Like all bones it is subject to external factors that can affect its integrity and ability to keep us on our feet. Heel pain, sometime disabling, can occur on the front, back or the bottom of the heel. Heel spurs, a common cause of heel pain, are bony growths on the front side of the bottom of the heel bone (calcaneus). The spur can be seen on an x-ray. When there is pain, but no bone enlargement, the condition is sometimes called “heel spur syndrome”. Heel spurs result from excessive strain on the long, thick band of tissue that connects the heel to the ball of the foot. This band consists of three parts — the medial, the middle and the lateral. The medial is the thickest and strongest band and takes most of the strain. Repetitive strain and stress on the soft tissue band may result in a bony protrusion. This condition usually results from improperly fitted shoes, being overweight, excessive standing or bio-mechanical imbalance. Both heel pain and heel spurs are frequently associated with an inflammation of the band of tissue (fascia) running along the bottom of the foot. This inflammation is called Planter Fascitis and can be quite painful. It occurs when the planter fascia elongates beyond normal causing the soft tissue to tear or stretch at various points along its length, especially at the front of the heel bone. This stretch can cause inflammation resulting in pain and possibly a heel spur. Causes may include a lack of foot support, inappropriate shoes or bio-mechanical imbalances. Resting provides some relief but when you get out of bed in the morning or resume activity from a resting position, this sudden stretch of the fascia will pull on the heel. As you continue walking the pain will disappear, for a while. Excessive pronation is the most common cause of heel pain. In pronation the longitudinal arch will lower and the foot and ankle will roll inwards putting an excessive strain on the medial band of the planter fascia. Excessive pronation may also contribute to injury, hip, knee and/or back pain. This condition could be due to a flexible or flat foot, a muscle weakness, or as a result of compensation. Prescription orthotics will provide long-term correction. Some health conditions such as rheumatoid arthritis and other forms of arthritis, including gout, can cause heel discomfort in some cases. A thorough medical examination by a physician may rule them out. Heel pain may also be a result of soft tissue inflammation (bursa) or a nerve growth (neuroma). Such pain may be associated with or may mimic the pain of a heel spur. Haglund’s Deformity (pump bump) is a bony enlargement on the back of the heel, in the area of the achilles tendon, resulting in inflammation and a painful bump. A prime suspect is excessive friction from ill-fitting shoes, skates or boots. Stress fractures or bone tumours are less frequent causes. Children’s heel pain occurs most commonly between the ages of eight and 13, as they become increasingly active. Increased physical activity, particularly jumping, irritates the heel bone’s growth centre and delays closure and maturation. Pain will cease if the activity is stopped for a while and footwear with heel cups or heel cushions are worn. Children do not often develop heel spurs. Prevention is the best cure • Wear comfortable shoes that fit. • If overweight, try to shed some pounds. • Do not walk around barefoot. • Do arch strengthening exercises, such as picking up a towel with your toes, or rolling your foot on a ball. Treatment may be necessary • Physical therapy is soothing and may be helpful (anti-inflammatories or cortisone injections) • Prescription orthotics are very effective • Finally, if none of this helps, you may be a candidate for surgery.        Put your best foot forward June is National Foot Health Month in Canada. Podiatrists are recognized by their DPM designation which stands for Doctor of Podiatric Medicine. All podiatrists are graduates of a four-year post graduate doctorate degree program followed by a one-to-three-year hospital residency. Robert Chelin, a Toronto podiatrist, is one of the Canadian pioneers in Endoscopic Plantar Fasciotomy, a new surgical treatment for chronic heel pain.