Tortured sole
THE largest bone of the foot is the heel bone, or the calcaneus.
It is directly at the end of lower extremity and it can transmit a tremendous amount of energy. Witness, for example, the spectacular ushiro-gerior back-kick of a seasoned karateka and realize that it is the heel that strikes the opponent. A woman’s heel buried deep in an attacker’s groin may be enough to save her from rape.
Unfortunately, the heel can give problems, too. This article is about what can go wrong with the heel bone or the sole and what can be done about it.
Plantar Fasciitis.
Topping the list is an overuse injury of the sole called plantar fasciitis. The fascia of the foot is a strong, fibrous tissue that attaches from the heel bone to the toes. Too much walking, running, or jumping can damage the fascia and over time micro-tears appear. Pain is localized under the heel or midway between the heel and toes. Pain is usually worst in the morning. Taking those first few steps to the bathroom can be an ordeal. As the day wears on, heel pain may diminish. However, if you sit most of the day, pain may reappear the moment you stand up and put weight on the foot.
The medical expert to see is the family medicine practitioner, or the podiatrist (foot specialist), or the rheumatologist, or the rehabilitation medicine doctor, or the orthopedic surgeon. Any one of them may suggest stretching exercises for the foot and ankle and medication such as NSAIDs (non-steroidal anti-inflammatory drugs) or COX-2 inhibitors (etoricoxib, celecoxib). Rest can do wonders. Orthoses or special footwear to cushion the heel can be custom-made or just bought in medical supply stores. A steroid injection may do the job. In recalcitrant cases, surgery is an option.
Stone Bruise.
Even if the skin of the sole is thick, injury to the fat pad under it can still happen. Usually, the person steps on a protruding rock or hard object and the fat pad is damaged. The condition is worse in older people because the fat may no longer be thick and its supporting structure not as elastic. Treatment consists of rest, ice, elevation, and compression either with tape or bandage.
Retrocalcaneal Bursitis.
If plantar fasciitis is sole pain, retrocalcaneal bursitis presents as pain behind the heel. Remember that the largest and strongest tendon of the human body, the Achilles tendon inserts into the heel bone. As the ankle and foot move, this thick, cord-like tendon mercilessly tugs on the calcaneus. You can easily inflame this area by running too much (without pre-activity stretching), or by simply wearing shoes that rub or dig behind the heel. The doctor will prescribe medication and heel inserts. Stretching for the Achilles consists of leaning forward against a wall. With the foot flat, the Achilles elongates slowly. Medication for pain and swelling is in order. Instead of wearing shoes, sandals or slippers will decompress the back of the heel.
Prevention.
Warming up before a sports activity minimizes injury. For heel conditions, this means stretching the foot and ankle. All kinds of footwear should fit properly. Replace worn out shoes. Finally, rest and investigate any foot or ankle pain. Tolerating the pain will only worsen things.
Heel pain is annoying, disabling, but preventable. Should it happen, you know what to do.