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Ankle & Heel Pain
Heel Pain
Causes Of Heel Pain
Conditions that cause heel pain generally fall into two main categories: pain beneath the heel and pain behind the heel.
Pain Beneath the Heel
If it hurts under your heel, you may have one or more conditions that inflame the tissues on the bottom of your foot:
Plantar fasciitis:
One of the most common causes of heel pain is plantar fascitiis. This is causes due to the inflamaation of the band of tissue connecting the heel bone to the toes. Pain due to plantar fasciitis can be gelt in the heel or the arch and is usually worst in the morning. The first step coming out of bed is usually the most painful one. Common causes of plantar fasciitis include high level of physical activity; standing for prolonged periods on concrete or hard surfaces; faulty foot mechanics like flat-feet; tight calf muscles; increased weight; and improper footwear. It is a condition commonly seen in distance runners, but is also extremely common in the general population.
- Heel spur: When plantar fasciitis continues for a long time, a heel spur (calcium deposit) may form where the fascia tissue band connects to your heel bone. Having a heel spur may not cause pain and should usually not be operated.
- Stone bruise: When you step on a hard object such as a rock or stone, you can bruise the fat pad on the underside of your heel. It may or may not look discolored. The pain goes away gradually with rest.
- Pain Behind the Heel: If you have pain behind your heel, this may be due to the inflammation of the area where the Achilles tendon meets the heel bone. This may happen due to too much running or wearing sheos that rub the heel too much. Such pain typically builds slowly over time, and the skin becomes thick, red and swollen, in this process.
Retrocalcaneal buritis:
The bursa acts as a lubricant when muscles/tendons slide over bones. Bursas exist around most large joints of the body, including the ankle.
The bursa located at the back of the ankle, by the heel, is called retrocalcaneal bursa. Repeated/excessive use of the ankle may cause the bursa to get inflamed, leading to this condition called retrocalcaneal bursitis.
The most common symptoms of retrocalcaneal bursitis include:
- Pain in the heel, especially with walking, running, or on touching the heel
- Increased pain when standing on tiptoes
- Red, warm skin over the back of the heel
Achilles Tendonitis:
Achilles tendon connects the calf muscle to the heel. This tendon is used for walking, running and jumping. Achilles tendonitis is a condition in which this tendon gets inflamed due to uveruse of the foot. This condition is most common in people below 35 years of age, and often occurs in runners and other athletes.
Symptoms include pain in the heel and along the length of the tendon when walking or running. The tendon may be painful to touch or move. The area may become swollen, and you may have trouble standing up on one toe.
Achilles tendonitis is more likely to occur in cases of:
- Sudden increase in activity
- Running on hard surfaces
- Excessive running
- Excessive jumping (for example, when playing basketball)
- Wearing improper shoes
Ankle Pain
Causes Of Ankle Pain
Conditions that cause heel pain generally fall into two main categories: pain beneath the heel and pain behind the heel.
Ankle Sprains:
An ankle sprain is an injury to the bands of ligaments that surround and connect the bones of the leg to the foot. The injury typically happens when you accidentally twist or turn your ankle in an awkward way. This can stretch or tear the ligaments that hold your ankle bones and joints together.
- Rheumatoid Arthritis (RA): RA is a chronic disease of the joints that occurs when the body’s immune system mistakenly attacks the synovium, the thin membrane that lines the joints. The result can be joint damage, pain, swelling, inflammation, loss of function and disability. In about 90% patients with rheumatoid arthritis, the joints of the feet are ankles are affected.
Gout:
Gout is a form of arthritis that occurs when excess uric acid, a bodily waste product circulating in the bloodstream, is deposited as needle-shaped monosodium urate crystals in tissues of the body, including the joints. For many people, the first symptom of gout is excruciating pain and swelling in the big toe often following a trauma, such as an illness or injury. Subsequent attacks may occur off and on in other joints, including the ankles. After years with the disease, lumps of uric acid, called tophi, may form beneath the skin around the ankles.
Prevention of Heel & Ankle Pain
To prevent ankle/heel pain, ensure the following:
- Perform proper warm-up before running, exercise, sports, or any other strenuous activity.
- Maintain ideal body weight
- Wear supportive footwear whenever bearing weight (for example, have supportive shoes placed near bedside to put on before taking initial steps)
Treatment
Treatment Of Heel & Ankle Pain
There are a number of treatment modalities that can help relieve heel and annkle pain and speeden up your recovery. These include:
Conservative Care
- Resting your heel: Try to avoid walking long distances and standing for long periods.
- Fomentation: Alternate hot and cold fomentation helps reduce pain and swelling.
- Regular stretching: Stretching your calf muscles and plantar fascia helps reduce pain.
- Correct shoes: Wearing good-fitting shoes that support and cushion your foot running shoes are particularly useful.
- Medication and Pharmacotherapy: One of the easiest techniques for pain control is using an icepack on the affected heel and taking painkillers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and adding a neuropathic agent in case of chronification of pain.
Braces and supportive devices
Using supportive devices such as orthoses (rigid supports you put inside your shoe) or strapping can help control pain in the ankle and heel.
Interventional techniques
Intralesional injections in the ankle & heel have been found to provide significant pain relief in cases where medicines haven’t worked. Such interventional techniques should be followed by regular stretching and exercises for better results.
- Platelet Rich Plasma (PRP) Therapy: A more recent technique used for heel and ankle pain, PRP has become one of the most preferred minimally invasive technique for treating pain in the heel and ankle. At Delhi Pain Management, PRP has been used in over 500 cases of heel and ankle pain, with very positive results.
PRP therapy involves injecting platelets from the patient’s own blood to rebuild a damaged tendon or cartilage. It has been successful in not only relieving the pain, but also in jumpstarting the healing process. The patient’s blood is drawn and placed in a centrifuge for 15 minutes to separate out the platelets. The platelet-rich plasma is then injected into the damaged portion of the tendon or cartilage.
Available Treatments
Heel & Ankle Pain Treatment Options Available At DPMC
At DPMC, we provide the best and latest non- surgical interventions to treat heel and ankle pain
- Medication/Supporting braces
- Injections in the Heel & Ankle
- Platelet Rich Plasma Therapy
- Physiotherapy
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