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Since 1st March, 1999
 
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Bring pain to heel

We spend our life standing upright, balancing our body weight on both feet. The distribution is never absolutely equal, as each of us has a favoured foot (right or left) on which we tend to lean slightly more. The impact of a hard landing or that of walking on an uneven, difficult surface is also absorbed by the feet. In such situations, heel pain can appear suddenly.

Most people have no history of heel pain — they wake up one fine morning and find that they have such intense heel pain that they are unable to place the affected foot on the ground. (Both feet are rarely affected together). Each step is accompanied by stabbing, shooting, excruciating pain. Though it can occur in younger people if they are athletes or have flat feet, it is more likely to occur in middle-aged women with a BMI (body mass index) more than 30.

Traditionally, Indian women walk around the house barefoot. This was fine as long as houses had soft, mud floors. Now the flooring is usually of a hard material such as stone or tiles, which provide no cushion for the feet. The entire body weight rests on the heel all day, leading to sharp, shooting pain.

Most of the time, this pain responds to simple home remedies, which should be tried for 3-4 weeks.

Take a basin of hot water. Add a teaspoon of salt. Stand in the water and gently rock from heel to toe.

Wear soft-soled slippers in the house and outside. They should have a one-inch heel elevation. Avoid hard leather soles as well as closed footwear or one with a back strap.

While exercising wear appropriate footwear. Purchase sports shoes, which are flexible and “give” easily. If possible, wear shoes with padding or an air cushion in the heel. Always wear socks.

Try to keep the foot pressed firmly against the end of the bed while sleeping at night.

Before sleeping and before getting out of bed, apply an ice pack to the heel for 10 minutes.

Stretch the tendons attached to the heel. Stand with the feet six inches apart. Raise your hands up over the head. With the knees straight and eyes fixed ahead reach for the ceiling. Stand on the right leg. Place the left foot on the back of the ankle. Raise the right foot and stand on the toes. Repeat on the other side.

Try OTC painkillers such as paracetamol, ibuprufen or other non-steroidal anti-inflammatory drugs (NSAIDs).

If work involves prolonged standing, purchase a four-inch wooden or plastic stool. Always stand with one leg on the stool and alternate the weight-bearing leg every 10 minutes.

If there is no improvement with these simple measures, an expert opinion needs to be obtained from an orthopaedic surgeon. Some investigations may be done.

An X-ray may reveal a small bony spur at the back of the heel. This looks like a parrot’s beak. Ten per cent of normal people have a spur but no symptoms. It is therefore difficult to pinpoint it as the cause of the pain.

Ultrasound examination can reveal areas of thickening in the tissue.

Surgeons will usually prescribe a week or two of physiotherapy along with electrical shock wave therapy. They may prescribe special footwear, tape the heel or provide a splint to be used at night. If all these fail, cortisone injections can be given in the painful area. This needs to be done with ultrasound guidance even if it is more expensive. A “blind’ injection can inadvertently be given into the heel fat, worsening the pain.

Surgery can be done to correct the problem in long standing cases (six months or more) if the above treatment is not successful.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in