How Big Is The Heel Problem?

Dr. Abhishek Arun completed M.S. Orthopaedics, D.N.B. Orthopaedics, F. Sports Medicine and Arthroscopy - Germany, and F. Advanced Hip and Knee Joint Reconstruction (SICOT). He holds 7 years' experience in treating patients at Hinduja Healthcare Surgical.

Heel pain is one of the common problems the mankind is facing these days. The incidence of nagging heel pain has been on the rise in millennials. It is an extremely annoying and irritating condition, as it makes you wince every time you put your foot on the ground. `Plantar Fasciitis' is the cause of this heel pain more often than not!!

What is plantar fasciitis? Plan-tar fascia is a thick band like structure that extends from the toes to the bottom of our heel. Due to multiple reasons, there is increased traction of this plantar fascia, leading to irritation near the attachment of this fascia to the heel bone. The actual cause of this condition is unknown, but it is believed that the constant traction of the plantar fascia to maintain the arch of our foot leads to small tears in the tissue and repeated tearing in this area can lead to inflammation of this tissue. Constant traction may also lead to beak like enlargement of the heel bone, called as `calcaneal spur'.

Typically patients present with stabbing pain at the bottom of their heel. This pain is more in the morning hours, and it is usually worse at the first few steps after you're awake in morning. It can also be provoked after prolonged sitting or standing for long hours. It may also be exacerbated by high impact activities and sports.

In rare situations, the pain may still persist, and we may have to proceed with surgical options. The aim of the surgery is to detach the tight plantar fascia from the bottom of your heel bone. Removal of the bony spur may not be necessary to tackle the pain

Plantar fasciitis can occur in any age, however it is more common in middle age individuals. It is usually associated with weight gain, and it takes a longer course to heal in obese individuals. It can be a part of occupational problems, and people who need to stand for long hours in their job are more prone to heel pain. Individuals with foot deformities, flat foot, or any other functional problems of the foot will be more susceptible. Use of improper footwear may add to the problems. However, it doesn't always follow the above rules and practically anyone and everyone can get this condition in some point of life.

Even the course of the disease is unpredictable. Usually it is a self-limiting disease, and it may disappear on its own after few weeks to months, but sometimes it may persist as nagging pain and may cause immense agony to the patient in routine day to day activities. Diagnosis of plantar fasciitis is clinical, but your doctor may advice you for an X-ray if the pain doesn't relieve in a few weeks. X-ray may be completely normal in some individuals or may show a pointed bony enlargement at the bottom of heel, known as `spur'.

Majority of patients respond well to conservative treatment like rest, anti-inflammatory medications and ice application. Physiotherapy exercises comprising of stretches of the Plantar Fascia and Achilles tendon are helpful. In advanced cases, you may need devices for night bracing to keep the plantar fascia stretched at night, and to maintain it in lengthened position during sleeping hours. There are various orthotics available to redistribute the body weight while loading the heel surface, like silicone heel pads, custom fit arch supports, gel pads and even air cushion heals, and they can be used judiciously as per the requirement of the patient.

Sometimes even after the best of the efforts, the pain may persist and then your physician will have to proceed to the next line treatment. Local injection with steroid formulation at the site of pain is often helpful to reduce the inflammation and alleviate the pain. The duration for which the effect lasts is variable, and administration of multiple injections in heel area is not recommended. There are options like injections of PRP (platelet rich plasma) or stem cell injections, however the effects are still under re-search and results are outcomes can-not be guaranteed. Modalities like ultrasound therapy and extra corporeal shock wave therapy have been tried, but the results have not been consistent, and are not recommended. So steroid injections still remain the treatment of choice amongst the available options.

In rare situations, the pain may still persist, and we may have to proceed with surgical options. The aim of the surgery is to detach the tight plantar fascia from the bottom of your heel bone. Removal of the bony spur may not be necessary to tackle the pain.

Dr. Abhishek Nerurkar, Consultant Orthopaedic Surgeon, Hinduja Healthcare Surgical, mentions that with the advancing technology, this surgery can be done by minimally invasive techniques with an endoscope. As a result of the small incision, the tissue handling is minimal leading to faster recuperation of the patient. The fascia is seen under magnification and can be released precisely under vision. Patients can get back to their routine faster and improvement of quality of life is significant.

If you have heel pain, please consult your Orthopaedic Surgeon early to get better outcomes. Listen to what your body wants to communicate with you. Stop activities that are causing pain, rather than pushing hard and causing more damage. Do not ignore the pain till it becomes chronic and unbearable, as it may lead to a longer recovery time. Believe me, you will be back in the game once you start the right treatment!!