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HEEL PAIN

Heel pain is one of the most common foot complaints. During walking a pressure equivalant to body weight and during running a pressure  twice of body weight is exerted on heel. Considering the time that we stand and walk on heels, heel pain can be very annoying. It is a commonly believed that epin calcanei causes the heel pain, yet it is responsible only 10 % of cases. A heel spur can be observed in most of the elder persons and in middle age overweight patients. However, most of those heel spurs do not cause pain and can be diagnosed incidentally.

First, the area pain felt is evaluated thoroughly.

Pain at the bottom of the heel is usually due to plantar fasciitis, epin calcanei, hypoplasia of heel pad fat, nerve entrapment.

Plantar fascia is band shape fibrous tissue starting from heel bone to the front part of the sole. Recuurent traumas, walking overtime, sportive activities, using unproperly fitted shoes may cause inflammation of plantar fascia. The pain in plantar fascia is felt in the morning and standing up after prolonged rest position. During the day pain increases when the patient gets tired. Patients feel better in high heel shoes.

In epin calcanei disease pain at the bottom is felt sticking type as if they walk on a nail tip.

Nerve innervating foot splint in two parts around ankle and later it gives another brunch which innervates the muscle located an the lateral part of the sole. Entrapment of this nerve also causes pain mostly at the inner, medial side of the heel.

Pain felt behind the heel at the posterior ankle part is generally secondary to Achilles tendinosis,calcaneal spurs, and Haglund Disease. They may be developed due to long distance running, playing tennis and racketball, overtraining and constitutional.

Treatment

Stretching exercises, heel supports and anti-inflammatory medication are very effective in most cases. If symptoms are persistant, then further investigation is required for prompt diagnosis. Treatment alternatives are ESWT, Physical Theraphy, pain manegement drugs, and surgery according to underlying cause

Key Words: Heel Pain, plantar fasciitis, stretching exercises, sole pain, foot pain, calcaneal spurr, calcaneal spine.

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