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General Practice 2023

Heel pain: what it can be (and what to do)

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Heel pain: what it can be (and what to do)
Heel pain: what it can be (and what to do)

There are several causes of heel pain, from changes in the shape of the foot and the way of stepping, to being overweight, calcaneal spurs, blows or more serious inflammatory diseases such as plantar fasciitis, bursitis or gout, for example. These causes can either cause constant pain or only pain when stepping, as well as arise in one or both feet.

To relieve pain, it is recommended to consult an orthopedist and follow-up with a physical therapist, who can identify the cause and indicate the most appropriate treatments, which can be the use of anti-inflammatory drugs, orthotics for the feet, resting and physiotherapy techniques for postural correction, stretching and joint strengthening.

Some common causes of heel pain include:

1. Foot shape changes

Although they are rarely remembered, changes in the shape of the foot or the way of walking are one of the major causes of foot pain, especially in the heel. These types of alterations can be born with the person or be acquired throughout life by using inappropriate shoes or practicing some type of sport. Some examples of alterations include flat or flat foot, varus and hindfoot valgus, for example.

Heel pain from these alterations usually arises from poor foot support on the ground, which ends up overloading some joint or bone, when it shouldn't.

What to do: in some cases, postural correction exercises, use of orthotics and insoles or even surgery may be indicated. However, follow-up by an orthopedist and a physical therapist is necessary to assess the changes and plan the best treatment.

It should be remembered that women who wear heels often cause a kind of momentary "deformity" in the biomechanics of the feet, which can compromise the calf tendon and muscle, which is also a cause of heel pain.

2. Trauma and beatings

Another very common cause of heel pain is trauma, which occurs when there is a strong blow to the foot. But trauma can also appear from wearing heels for a long time, from doing an intense run for a long time or due to wear on the shoes.

What to do: it is recommended to rest for a period, which varies according to the intensity of the injury, but it can be between 2 days to 1 week. If the pain persists, an orthopedist evaluation is necessary to observe if there are more serious injuries, and the need to use anti-inflammatory drugs or immobilization of the site.

A good tip to recover faster is to use cold compresses to reduce inflammation and swelling, in addition to choosing comfortable shoes.

3. Plantar fasciitis

Plantar fasciitis is inflammation of the tissue that covers the entire sole of the foot and is usually caused by repetitive trauma or injuries to the plantar fascia, which is a firm, fibrous band that supports and maintains the plantar arch. standing, which leads to local inflammation.

Some of its main causes include having heel spurs, standing for long periods, being overweight, having flat feet and doing too much physical activity. This inflammation usually causes pain under the heel, which gets worse in the morning when starting to walk, but tends to improve after the first few steps. In addition, there may be local swelling and difficulty walking or wearing shoes.

What to do: It is recommended to do calf and sole stretches, strengthening exercises and deep rubbing massage. But more specialized treatments may also be indicated, such as infiltration with corticosteroids, radiofrequency at the site or use of a splint to sleep.Some exercises include scrunching up a towel on the floor and picking up a marble. Understand better what plantar fasciitis is and how to treat it.

4. Heel spur

The spur is a small fibrous projection that forms on the heel bone and results from intense pressure and overload on the sole of the foot for long periods of time, so it is more common in people over 40 years, people who are overweight, who use inappropriate shoes, who have some kind of deformity in their feet or who practice very intense running, for example.

Whoever has a spur may have pain when getting up or stepping on, being common in the morning. In addition, it is very common for the spur to be associated with the appearance of plantar fasciitis, as the heel inflammation can extend to nearby structures.

What to do: the treatment of spurs is usually done when there is local inflammation, especially when in conjunction with plantar fasciitis, being recommended the use of ice, rest and use of anti-inflammatories, guided by the doctor.These measures are usually sufficient, and surgery to remove the spur may be indicated, but it is rarely necessary. See some homemade strategies in this video:

5. Heel bursitis

The bursa is a small bag that serves as a shock absorber and is located between the heel bone and the Achilles tendon, when it inflames there is pain in the back of the heel, which worsens when moving the foot.

This inflammation usually appears in people who exercise or are athletes, after a sprain or bruise, but it can also happen due to Haglund's deformity, which occurs when there is a bony prominence at the top of the calcaneus, causing pain near to the Achilles tendon.

What to do: You may need to take anti-inflammatories, use ice packs, cut back on workouts, do physical therapy sessions, stretches, and exercises. Check out more details about bursitis treatment.

6. Sever's Disease

Sever's disease is pain in the region of the growth plate of the calcaneus bone that affects children who practice impact exercises such as running, jumping, artistic gymnastics and dancers who dance with the need to jump on tiptoe. Understand better what this disease is and why it happens.

What to do: you should reduce the intensity of the workouts and the jumps to avoid their aggravation, in addition it can also help to put some ice cubes wrapped in a napkin for 20 minutes on the spot and use a heel to support the heel inside the shoes. In addition, to avoid aggravating the pain, it is also advisable to always start training with 10 minutes of walking.

7. Drop

Gout, or gouty arthritis, is an inflammatory disease caused by excess uric acid in the blood, which can build up in the joint and cause inflammation and severe pain.Although it is most common in the big toe, gout can also appear in the heel, as the feet are the main sites for uric acid accumulation.

What to do: Treatment for gout attacks is guided by the doctor, and involves anti-inflammatory drugs such as ibuprofen or naproxen. Then, follow-up with the rheumatologist is necessary, who can also prescribe medication to control the levels of uric acid in the blood to prevent further attacks and prevent complications. Understand better what it is and how to identify the drop.

How to know the cause of my pain

The best way to know the cause of heel pain is to try to find the exact location of the pain and try to identify a cause such as having increased physical activity, starting a new sport, hitting that location or something like that. Placing a cold compress on the pain site can relieve symptoms, as can soaking your feet in a basin of hot water.

If the pain persists for more than 1 week, an orthopedic or physical therapist should be consulted so that the cause is identified and treatment begins.

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