Ram's Rehab

Plantar fasciitis

A few days back, I felt a needle-pricking kind of pain in my heel when I got up in the morning and kept my leg on the floor, It was very difficult to walk, so I took the support of the wall for walking. After walking for some time I felt this pain was reducing. Later in the afternoon, I was sitting in the chair and when I got up I felt a needle-picking pain on my heel again.

 

This continued for a few days, everyday morning I was feeling the same pain, and also when I sat for some time and got up.

When this pain continued for a few days I thought of seeing a doctor, and I went also. The doctor asked me what happened?, I said I was feeling a needle-pricking pain in my heel. He suggested me to take an x-ray of my foot.  I took an x-ray and went, after looking at the X-ray doctor said he could see a bone growth. Because of the bone growth, this will rub on the plantar fascia and this generates a swelling in that area.

 

The doctor said this inflammation is the reason for heel pain,

so do one thing buy an MCR chappal and wear that, also I am giving tablets for two weeks.

If the pain is not reduced after two weeks I will give you an injection

So I got medicines for two weeks and came home. okay, now let me start from here, a bone is growing in the heel. Because of this growth, swelling can be seen in the heel, This is the reason for the pain.

For years we have believed this theory. 

 

 In this video, I am talking about five concepts of heel pain. The first one is calcaneus spur or” bone growth in the heel” which is the cause of heel pain.

The second point is whether the inflammation or swelling on the heel is responsible for heel pain. Third is the treatment for heel pain, and Fourth is how it can be reduced within weeks

And fifth one is which chappal is okay to wear for heel pain

Chapter1:

Is the calcaneus spur seen in the x-ray is the cause of heel pain.? 

The bone seen in the heel is called the calcaneum. This has two attachments, one is the tendon of calf muscles seen above the calcaneum(the place where the tendon attaches). Second is our foot where plantar fascia attaches. For years we have believed that this growth in calcaneum bone causes an inflammation in fascia and this is the cause of heel pain.

 

The first study about this was conducted in 1900, around 123 years ago. A German scientist known as Dr Plantnar did studies on cadavers. When he was dissecting the dead bodies he saw a bone growth in the heel. He called this bone growth a calcaneus spur. This bone growth may cause inflammation of the plantar fascia of the heel. This is the cause of the heel pain, and he published in his paper in(1900)

 

For many years we have believing the same that this calcaneus spur is causing inflammation in the heel in turn causes heel pain. But in 2018 Dr. Henson, from his fifteen years of studies reported that people believe that the bone growth in the heel is the cause of the heel pain, but his team found that it creates pain in the heel and increases the pain in heel bone growth (calcaneus spur) in the heel is not the cause for the pain.

 

According to his reports If you consider a person who doesn’t have heel pain even for the same person also you will see bone growth.

Chapter:2

Now let us see whether the inflammation in heel is the cause of heel pain.

From more than a decade people were believing that the inflammation in the heel is the cause for heel pain. But in 2003 Dr Harvey Lemont from his studies reported that,From years of his studies he could not detect inflammation in the heel and he also got lots of proof that the changes observed in the heel are just normal day to day life activity changes. So the reason for heel pain is not the inflammation of the heel is what he reported in 2003 , in his papers.

            Hence, the belief from more than a decade was correct, the reason for the heel pain is not the calcaneus spur/ bone growth we could see in the X-ray or neither the inflammation caused by that was proved.

                 So the treatment which we are practising from years to reduce inflammation like Rest, Ice and anti-inflammatory medications. If this is not working then steroids,If steroids are not much effective for pain, then surgery. All these cannot reduce heel pain permanently.

                  So, Is there any treatment to cure heel pain permanently? Before talking about the effective treatment for heel pain, we should know the major reason for heel pain.

                To explain this, there are two possible theories , one is work capacity theory.

                Heel pain is normally seen in active and young children/ old people who are leading a sedentary life style. According to this theory the work load of our body and the capacity of our body should be balanced always. If it is not balanced and it is moving to an unbalanced state, there are changes that you may feel pain anywhere in your body.

         Here is an example, of a highly active dancing girl , imagine she practices every day for three hours and one day she started getting pain in her heels without any injuries.But the pain was a sudden one.What could be the possible reason here?

               In this case the load of her activities is not able to cope up with her body capacity while practicing dance

            So in this case what treatment can be given to reduce the heel pain. One best choice is modified rest, means, if this girl is practising dance for three hours it would be better, if she reduced it to one hour or one and a half hour. So If she is able to afford the pain, when the time is reduced then gradually this duration can be increased

          Now the second group who are leading a sedentary lifestyle (aged - individuals).

 when they get’s a  heel pain without any injuries. 

Here the work load is the not the problem but the problem is reduced capacity of their body due to aging.

            So what treatment can be given for them. If I say a complete rest, that is not at all an effective treatment. Because eventually, the capacity of your body will reduce in this case when you are in always rest.

         so while taking rest you might feel differences in the pain.

             But once you come back to your activities you will definitely experience a full fledge pain.

          So in this case rather than reducing the load the best treatment is to increase the capacity of your body.

        So let’s see what can be done to increase the capacity of the body.

       The best choice is to do some exercise. Many exercises can be done to increase the capacity of your body and then to reduce heel pain.

           From our clinical experience, we are mainly focusing on three exercises for this case.

First one is plantar fascia stretch

Second one is eccentric calf

Third one is towel gripping exercise. 

These three exercise exercises would definitely increase the capacity /the strength of your heel.

        Now the second theory is referred pain theory. According to this theory the major reason for heel pain is the soleus muscle which is seen below the knee( calf muscle). So the deposition of lactic acid in soleus muscle and the trigger activation might refer / radiate to the heel.

          Many studies from years couldn’t find any inflammation in the heel region , so this theory is a worth believing theory.

             From our  clinical experience, by releasing the trigger activation in the soleus muscle within few days, this pain will be completely cured.

              Next is which chappal/ sandal to wear when you get heel pain.

                       Generally three changes was used to observe in heel pain patients. First one was those who has flat foot a medial arch support was given.

                           Secondly for those who are using shoes , an insole support is provided, and for those who are wearing chappals, MCR chappal the one with soft pad were provided.

                     

         But in our clinical experience we got a mixed response. Why because for few populations, when these alternatives for the foot are provided some changes are observed but for the other group I have seen the pain is increasing/ no change in pain, when the changes in chappals are provided.

       so those who are suffering from heel pain should strictly use MCR Chappel is totally meaningless.

        But if you can observe changes in your pain when you use these chappals then you can make some changes in your chappal, and if you are not noticing any improvement, it’s not a mandatory thing. 

        Without making any changes in the chappal, within few days this heel pain can be cured. so because of heel pain if you want to make any changes in chappal, the choice is yours its not mine. when you are making changes, if you are finding it effective, you can make changes , and in the other case its not necessary.

        Let’s conclude this, by saying the calcaneus spur/ bone growth or the belief that the inflammation caused by this is not reason for heel pain . Majority (95%) the reason is imbalance in work capacity or the referred pain

This can be definitely cured permanently within few days. Rams Rehab is the Physiotherapy clinic in Kerala. Complete physiotherapy for plantar fascitis, stroke, all neuro and ortho treatments are available here.