Heel Pain
Heel Pain – what’s it got to do with Easter
Firstly because Podiatrists around the UK are promoting a campaign in the run up to easter called #PodsHealHeels – more about that later.
And secondly because you may not realise it but Heel pain is central to the Easter story.
For many Easter is a time that we think of chocolate eggs and bunnies and more chocolate eggs. Often spring flowers adorn the cards we give to loved ones and for some of us the cross of Jesus is central to the importance of the season. The cross of easter is empty just 2 pieces of wood forming the symbol central to the Christian faith. This is to remind us that although Jesus did die on the cross, he rose again.
As a Christian Easter is not just about worshipping the risen Jesus’ its also a time of personal reflection and a reminder of just what He did for you and me. Anyone who watched Mel Gibson’s Passion of the Christ can’t fail to appreciate all he suffered for us.
What has this got to do with Heel pain you are probably wondering.
Being medically trained as a Podiatrist I have always been struck by an image I found of an archaeological find back in 1968 of a 2000 year old heel bone. What is so special about it is not that it is an old bone but that running through it is a rough iron nail that once pinned its owner to a cross when he was crucified in a similar manner to Jesus.
You can see it here
JERUSALEM, HEEL BONE WITH IRON NAILS REPLICA, 1ST C AD
Please credit this photo to “A.D. Riddle/BiblePlaces.com.”
I cannot begin to imagine the extreme level of pain that would be experienced whilst the 7 inch spike was being driven through the feet one after another and then once on the cross whilst all their weight was pressing down on them.
Suddenly whatever heel pain you might have pales in comparison but that said it can still cause considerable discomfort and affect your ability to enjoy even the simplest of activities.
Whether you are a person of faith or not, may I ask you to spend a moment before reading on just appreciating what Jesus went through for you and me. The mind-boggling thing for me is that he died not knowing if millions of people would follow him or just you or me – his death was that personal. The Good news of Easter is that the cross is empty, and he rose again.
Now getting back to #PodsHealHeels
As I write Podiatry as a profession in the UK is embarking on its annual fortnight campaign entitled Pods heal heels which aims to raise awareness that you don’t have to live with heel pain and signpost you to getting appropriate help.
The purpose of this article is not for you to be able to self-diagnose , treat and fix your problem but to help you see it is often a complex problem that needs professional diagnosis and help. It may be that your treatment plan may involve you doing things yourself but its always best to get the professional guidance on what to do rather than chancing it to dodgy online report or Joe Blogs who fixed their problem which sounds like yours but is in fact a totally different problem. You could be doing more harm than good and cause more pain and set your recovery back by weeks.
Why Heel pain?
The Heel is an extremely complex structure and has to withstand incredibly strong forces as it performs its functions. These forces can be both causative of heel pain and mean that it is continually aggravated once the structure is injured.
Many people develop it at some point in their lives and it can be very debilitating
The final reason we chose heel pain is because there are over 40 different causes of heel pain and many different treatments appropriate for specific problems meaning a correct diagnosis and treatment plan are very important to minimise the risk of permanent damage.
What is heel pain?
You might imagine that there is just one type of heel pain despite there being more than 40 different causes but the presentation, intensity and other characteristics of the pain may well differ depending on the condition you have.
Hence the best answer to that question is any pain in the region of the heel. This can include the sole of the heel (plantar surface), the sides and back of the heel generally up to just below the malleoli ( the bony protrusions of the ankle joint) This of course includes the many deeper structures within the heel.
To give you an idea of just how many types of pain can be experienced here are some of the most common descriptions we hear: Burning; sharp; cutting; throbbing; dull ache; intense ache; shooting; electric shock; pins and needles, cramping; bruising; walking on a pebble and countless other variations.
Some problems may present with different types of pain at certain times or under certain conditions and might progress over time to cause pain in a new area either elsewhere in the heel or foot or more proximally as your posture is affected by you having to walk awkwardly to relieve the pain.
A bit about the heel
The heel is a remarkable design and when I stop and think about it I wonder at the way they are able to withstand the repeated hammering that they get each and every day.
Your feet are amazing- they deserve to be looked after. I’d like you just for 5 minutes to appreciate them – take off your shoes and socks (OK if you’re on the train maybe wait till you get home) and have a look at them. Bend your big toe up and down, raise and lower your arch, rotate your ankle and bend your foot backwards and forwards. Grab hold of it ( if you’re thinking right now “Yuck” then it’s a sure sign you need to look after them better but that’s another story) and feel around how flexible the toes are . You are alone just you and your feet and its probable that you’ve never really stopped to appreciate what they do for you every day, week, month and year of your life.
Can you remember what they looked like 10,20,30,40, 50 years ago or conversely do you know for sure what they will look like in 10, 20,30 years time. More importantly what could they do for you and what will they be able to do for you in the future.
In my 30 plus years experience more often than not the injuries that present are at least in part due to an abnormal foot structure which in turn leads to an abnormal foot function with resultant abnormal forces and pressure being placed through the foot and up the body. A very common issue we are presented with is Heel pain.
Invariably a person will call up, often having already seen the Gp or Physiotherapist and then finally It’s our job to identify the cause of their problem and get them strong again and back doing the things they enjoy pain free.
The vast majority of us don’t pay much attention to our feet. We just expect them to do their job until the end of our lives. Yet often they are gradually deteriorating and having a knock on effect on the rest of our bodies as their abnormal function causes degeneration in our knees, hips and back.
Lets take a quick look at just how amazing your heels are. Lets keep things simple and say that a 70kg person takes an average 10,000 steps a day. That’s 350 tonnes through each heel.
In fact they strike the ground every step you take with on average a force equating to 1.5 times your body weight meaning your heels have to deal with more than a thousand tonnes every single day.
What might my Heel Pain be ?
The more information we can glean from a patient the better. History taking is vitally important for us to diagnose and prescribe a correct course of treatment.
When answering an enquiry or seeing someone for the first time either virtually or in clinic we ask various questions all of which help us build up a picture of your complaint, its cause and what treatment it might respond well to.
If you are suffering with heel pain or maybe just have an occasional tweak of discomfort I would encourage you to ask yourself the following questions prior to seeing your Podiatrist.
1) Can I see anything on the surface? ( get someone else to look especially around the back )
Some of the things you might expect to see could be a callus, a fissure (crack), a corn, a verruca; a lump or a foreign body- such as a piece of glass)
2) When did I first notice it?
3) Do I remember injuring it?
4) Have I changed anything in life? Weight change, pregnancy, increased or changed exercise, changed job or footwear.
5) How painful is it? Give it a score out of 10. O/10 being no pain and 10/10 being the worst pain ever
6) Is it getting worse?
7) When does it hurt? – for example is it constant, just weight bearing , just on hitting the ground, time of the day, increases the more I walk or worse first thing and then wears off
8) What type of pain is it? – see the list above
9) Can I do anything to relieve it?
10) Where on the heel is it? Underneath, Back, outside edge or inside edge
Some causes are obvious but here are some examples of conditions causing Heel pain where nothing obvious is visible :
Plantar fasciitis is probably the most common name given for heel pain – the ending -itis means inflammation of and as most of the time there is no inflammation this can be confusing and so we tend to refer to this condition as plantar fasciopathy only calling it fasciitis if there are signs of inflammation.
Plantar fasciopathy is damage to the band of soft tissue called fascia (similar to a ligament) which stretches from its attachment into the heel bone to the base of the toes.
It is usually caused by an increase in activity such as running, walking, starting a new sport or standing for long periods of time. Tight calf muscles may contribute also as they put considerable pull on the achilles tendon,
A simple thing such as a change of footwear giving poor support, a sudden stetch of the sole such as stepping off a kerb awkwardly, standing on a ladder in soft sole shoes, digging the garden, walking in wellies or on uneven surfaces when not used to it can all trigger an episode of heel pain which may often be diagnosed as Plantar fasciopathy.
Heel spur. These often-sharp bony growths usually occur under the middle of the heel and can aggravate the flesh causing pain. However their presence does not mean they are the cause as up to 70%of the population probably have them and yet experience no pain whatsoever.
Achilles tendinopathy. The Achilles tendon is the thick band of tissue attached to the back of your heel bone and the calf muscles. It is the strongest tendon in the human body and has to deal with huge forces every step we take. Either it can become damaged itself as it inserts into the heel (or higher up) or a bursa (protective sack of fluid like a deep blister) can become inflamed.
Bursitis This is where a bursa becomes inflamed for example as mentioned above where it would be called a retro calcaneal bursitis. Bursae can also form under the heel.
Tarsal tunnel Syndrome – This presents with a nerve type of pain typically starting with some pins and needles and numbness sensations and sharp shooting pains progressively getting worse around the inside of the ankle and under the heel. It happens when the Tibial nerve gets pressure on it where it passes through a tunnel made between the bone and other soft tissues in the area.
Calcaneal apophysitis (severs disease) This only happens in children as it is damage to the growth plate of the heel bone. Most usually it occurs between the ages of 10 and 14 and should be rested assessed by a Podiatrist. A diagnostic test is to see if the child experiences pain whilst gently squeezing the heel from side to side.
Fat pad atrophy
The heel pad is designed to shock absorb and generally does a good job. However sometimes it can deteriorate with age or other conditions and is unable to provide the same level of protection.
Fracture.
Despite being a very tough bone , excessive force such as a landing awkwardly or from a height can lead to a fracture.
It should also be pointed out that Heel pain can also be caused by lower back problems or inflammatory joint conditions and even rarely bone cancer. These are another good reason for seeing a Podiatrist as they can refer on if they suspect anything.
This article really only allows me to scratch the surface of this huge topic and I think really the message can be summed up by: Don’t leave the healing of your heel pain to chance, self-diagnosing and dabbling with online remedies.
If you have got heel pain see a Podiatrist because #PodsHealHeels
Why not pop along and get your feet checked. If you’re in London or Surrey then please do come along for an initial consultation at Circle Podiatry or go to the website www.circlepodiatry.co.uk
Lastly please do email with any feedback or questions.