Dr Sachin Tapasvi: Painful heel syndrome

How often have you wondered that you have woken up in the morning and couldn’t walk properly because of a lot of pain in the heel. The first few steps are always painful and then as the day progresses, things slowly ease down a bit. You visit a doctor and he says: “You have got a bone spur!” This sets off a panic reaction, since the presence of a bone spur is thought to be a big problem, leading to serious repercussions.

Painful heel syndrome or heel spur or Plantar Fasciitis is quite a common problem amongst middle-aged people. What exactly happens in this problem? What can we do to prevent it as well as cure it?- is what we will discuss in today’s blog.

The foot is a fantastic structure, composed of 25 bones arranged in a framework so that it allows perfect weight bearing as well as walking, jumping, turning and twisting. These bones are arranged so that there is an arch that is formed on the inner side of our foot and flattening on the other side of our foot. These bones are connected to each other with a series of ligaments. These ligaments are quite strong and they have to support our whole body weight. These ligaments are also assisted by muscles from the leg, which will cross the ankle on the inner, outer as well as on the front and back of the ankle, and they will go ahead and attach to the various bones within the foot. They act like the tie-ropes and help control the foot and ankle movements very effectively.

As is usually the case, the arc of the inner side of the foot starts falling progressively in some people. This usually occurs if there is a sudden increase in the body weight, or if the person sustains an injury to the foot, which results in the reflex inhibition of the small muscles of the foot, or if there is a pre-existing deformity of flat foot since childhood, which slowly progresses. Once the flat foot sets in, what happens later are a series of events, which lead to the formation of a heel spur. The structure of the foot is such that when we take weight, the heel will take 60% of the body load and 40% of the body load is shared between the 5 toes. The 1st toe takes on 20% of this 40% load and the 2nd, 3rd, 4th and 5th toes take 5% of the weight each. With progressive collapse in the arch, the ligament, which is there on the inner side of the foot, starts getting stretched out. As it starts getting stretched out, there is an increase in strain on the areas or the insertion sites on those bones to which it is attached. As this ligament or Plantar Fascia is attached to five toes in front of the foot,there is relatively more sharing of this excessive stress. But since the heel shares 60% of the weight and this Plantar Fascia or ligament is attached only to the heel, there is a lot of strain on the point of the heel. Progressive stretching of the ligament at this area then gradually causes a small bone spur to develop along its course. The bone spur  in itself is not the only cause of pain. There is inflammation associated with this spur and there is a thin nerve that runs along side it which gets reflexively inflamed which will than lead to the exact cause of pain. Also, the pad of fat that lies between the skin and the spur is also inflamed, which then causes that area to ache and hurt more.

The diagnosis is usually confirmed by doing clinical examination, and on an X-ray as well. Once the whole problem sets it, it is necessary to then do a series of physical measures which will help alleviate the pain as well as prevent the problem from progressing. Any form of flat foot can be corrected with the help of corrective insoles and footwear, any tightness in the calf or in the foot muscles can be sorted out with the help of any form of appropriate stretching programme. Any weakness in the dynamic muscles in the foot needs to be corrected with an appropriate strengthening programme and any tightness of the ligaments is released by doing a stretching programme. Along with this, one needs to do some ice packs as well as hot water fomentation. A course of anti-inflammatory medicines may be prescribed to help achieve a faster recovery. Shedding of excess weight would be extremely beneficial for long-term alleviation of symptoms.

In extreme cases, one would choose to inject the painful spur area with either Cortisone or Platelet Rich Plasma. Cortisone injections were the norm previously. These cortisone injections help get rid of the painful cells, however, they do not help in any regeneration of tissue. Platelet Rich Plasma (which is harvested from the patient’s own blood) seems to be a much better procedure in this aspect as it allows the cells to regenerate and will help in recreation of a normal strong plantar fascia ligament.

To prevent this problem, make sure that you don’t put on excessive weight-which is easier said than done, make sure that you use good footwear which have correction of the foot bio-mechanics and kindly ensure that you keep on stretching tight muscles and prevent any contractures from happening.

Dr Sachin Tapasvi

Dr Sachin Tapasvi

Dr Sachin Tapasvi is one of India’s leading joint replacement surgeons. He practises in Pune and has been awarded several fellowships with experience garnered internationally as well as in India. Dr Tapasvi writes every Wednesday on Pune365.
Dr Sachin Tapasvi