is a very challenging problem as it can be local and/or referred. It has been more prevalent
recently due to the hard grounds on which people have to run. Commonly people will present with heel pain, thrusting an x-ray at you, and being adamant that the problem is a heel spur. This is
defined as a small bone that grows from the heel, directing forwards towards the toes. This may be as small as 1 mm to anything as large as 8 - 10 mm. Most of the time, this is an incidental finding,
as there many heels that are pain free that have heel spurs evident on x-rays. The spur is thought to be a result of traction of the plantar fascia on the heel. In some cases, the spur may contribute
to the symptoms, but is not the main cause. This should be explained very carefully to the patient, as the focus on the spur may limit the recovery, as the patient may believe that the only way to
eliminate the pain is to remove the spur.
Pain in the foot can be due to a problem in any part of the foot. Bones, ligaments, tendons, muscles, fascia, toenail beds, nerves, blood vessels, or skin can be the source of foot pain. The cause of
foot pain can be narrowed down by location and by considering some of the most common causes of foot pain. Plantar fasciitis is the most common cause of heel pain. The plantar fascia, a band of tough
tissue connecting the heel bone to the toes, becomes irritated or inflamed. Heel pain, worst in the morning when getting out of bed, is the most common symptom. Arch pain may also be present.
Usually when a patient comes in they?ll explain that they have severe pain in the heel. It?s usually worse during the first step in the morning when they get out of bed. Many people say if they walk
for a period of time, it gets a little bit better. But if they sit down and get back up, the pain will come back and it?s one of those intermittent come and go types of pain. Heel pain patients will
say it feels like a toothache in the heel area or even into the arch area. A lot of times it will get better with rest and then it will just come right back. So it?s one of those nuisance type things
that just never goes away. The following are common signs of heel pain and plantar fasciitis. Pain that is worse first thing in the morning. Pain that develops after heavy activity or exercise. Pain
that occurs when standing up after sitting for a long period of time. Severe, toothache type of pain in the bottom of the heel.
The diagnosis of heel pain and heel spurs is made by a through history of the course of the condition and by physical exam. Weight bearing x-rays are useful in determining if a heel spur is present
and to rule out rare causes of heel pain such as a stress fracture of the heel bone, the presence of bone tumors or evidence of soft tissue damage caused by certain connective tissue disorders.
Non Surgical Treatment
Essentially rest from aggravating activity, physiotherapy treatment to alleviate the inflammatory component, stretching the tight calf, strengthening up of the intrinsic muscles of the foot e.g.
tissue scrunch, picking up pens etc. and correction of biomechanical problems in the foot e.g. orthotics. Sometimes, a heel cup or pad to relieve pressure - a donut type pad may be helpful. Strapping
has been shown to be helpful, especially in circumstances where the patient can?t wear orthotics - the foot is strapped to help support the arch. There has been limited success with cortisone
injections or surgery and the latter is very rarely required.
Extracorporeal shockwave therapy (EST) is a fairly new type of non-invasive treatment. Non-invasive means it does not involve making cuts into your body. EST involves using a device to deliver
high-energy soundwaves into your heel. The soundwaves can sometimes cause pain, so a local anaesthetic may be used to numb your heel. It is claimed that EST works in two ways. It is thought to have a
"numbing" effect on the nerves that transmit pain signals to your brain, help stimulate and speed up the healing process. However, these claims have not yet been definitively proven. The National
Institute for Health and Care Excellence (NICE) has issued guidance about the use of EST for treating plantar fasciitis. NICE states there are no concerns over the safety of EST, but there are
uncertainties about how effective the procedure is for treating heel pain. Some studies have reported 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).
Maintaining flexible and strong muscles in your calves, ankles, and feet can help prevent some types of heel pain. Always stretch and warm-up before exercising. Wear comfortable, properly fitting
shoes with good arch support and cushioning. Make sure there is enough room for your toes.