What's Causing Your Heel Pain

When we walk, we put a lot of stress on each foot. Our feet can actually manage heavy loads but too much stress can push them to their limits. When you’re involved in sports like running, playing basketball or volleyball and even using the wrong shoes can irritate tissues in the foot that can lead to heel pain.

When the tissues around the heel get irritated, this will cause considerable amount pain on the affected area. This can heal itself without any medication if the foot is allowed to rest. However, a lot of people ignore the early signs of heel pain and go on with their usual activities. This can eventually lead to chronic heel pain that will need one or more treatment modalities to alleviate pain.

Diagnosing the cause of heel pain is best done by a podiatrist. Identifying the cause is crucial because there may be different or similar treatment options for each condition.

Generally, there are two categories in the diagnosis of heel pain. These are posterior heel pain or pain at the back of the heel and inferior heel pain or pain underneath the foot.

Posterior heel pain usual involves the insertion of the Achilles tendon to the calcaneus or heel bone. This is common among runners or in people who wear shoes that can apply pressure at the back of the foot. This initially starts are as tolerable pain and can get worse if ignored.

Inferior heel pain usually involves an irritated plantar fascia. The plantar fascia is a strong fibrous tissue found underneath the foot. Same as the Achilles tendon, the plantar fascia also inserts to the heel bone to the digits of the feet. The plantar fascia is constantly under pressure when walking, running, or lifting weights. It also plays a vital role in maintaining the arch of the foot. Plantar fasciitis is the term used for an inflamed or irritated plantar fascia. Irritation occurs at the insertion of the plantar fascia to the heel bone. In chronic plantar fasciitis, it is common to find a heel spur on radiologic findings.

Treatment involves the R.I.C.E method, which stands for rest, ice, compress, and elevate. This is very effective in the early course of heel pain. On the other hand, chronic heel pain is more difficult to manage especially when a spur has already formed. It is best to visit a podiatrist when dealing with chronic pain.

Common Causes of Heel Pain

Heel pain is a very common condition. About 70% of Americans are not able to do much activities or exercise simply because of heel pain.  There are two kinds of pain associated with the heel. Posterior heel pain or pain behind the heel, which involves the attachment of Achilles tendon to the heel bone. Inferior heel pain or pain underneath the foot is caused by an inflammation or irritation of the plantar fascia.

There are several causes of heel pain:

Achilles tendinitis

Bone bruise

Bone cyst

Bone fracture

Bone spurs

Bursitis

Gait problems

Gouty arthritis

Heel pad wear and tear

Neuroma

Osteomyelitis

Peripheral neuropathy

Pinched nerve

Plantar fasciitis

Rupture of the Achilles tendon

Rheumatoid arthritis

Stress fractures

Tarsal tunnel syndrome

Tendinitis

Of all the causes of heel pain, plantar fasciitis and Achilles tendinitis are the most common.

Plantar fasciitis is the inflammation or irritation of the plantar fascia. The plantar fascia is a strong fibrous tissue that inserts at the heel bone and to the toes of the foot. It plays an important role in the biomechanics of the foot because it is responsible for maintaining the arch of the foot.

The plantar fascia can get irritated because of overuse. Usually, patients involved in sports or those who are overweight are affected because of the increased amount of stress on the plantar fascia. It is also prone to degenerative process of aging. The older we get, the weaker the fascia.

The Achilles tendon is a strong fibrous tissue that also attaches to the heel bone. Unfortunately, this too is prone to irritation and inflammation because of overuse. This condition is called Achilles tendinitis. Achilles tendinitis is more of a sports injury seen in runners, basketball players, and volleyball players and people involved in any sports that would cause strain on the tendon and calf muscles.

Resting the foot and allowing it to heal is the best treatment for both conditions. But if foot pain is ignored, which most patients commonly do, it can lead to chronic heel pain, where more complicated treatment modalities are needed.

If you have any question about heel pain or any other foot and leg condition please visit the Family Foot and Leg Center in Naples, FL or contact Dr. Kevin Lam at (239) 430-3668 for more details.

Thiamine Deficiency and Treatments

Thiamine Deficiency, also called Beriberi, is a condition where the body does not meet the minimum requirement thiamine. This occurs due to insufficient consumption of thiamine or due to lack of absorption of thiamine especially for patients who underwent gastrectomy.

There are two types of thiamine deficiency. One that affects the cardiovascular system is called wet beriberi. While the type that affects the nervous system is called dry beriberi.

In the United States, thiamine deficiency is rare since foods are now vitamin enriched. Only those who are heavy drinkers may develop symptoms of beriberi. Increased alcohol intake makes it difficult for the body to properly absorb thiamine. In worst cases, permanent brain damage can occur called Wernicke-Korsakoff syndrome.

Patients who take diuretics or had undergone dialysis can develop beriberi. Infants with asymptomatic mothers who have beriberi can develop infantile beriberi since the milk produced by the mother does not contain or lack thiamine.

Signs and symptoms

Symptoms of dry beriberi are: loss of sensation on feet and hands, paralysis of the lower leg, difficulty walking, confusion, back and forth eye movement (nystagmus), lack of concentration and confusion, difficulty talking, pain, vomiting and tingling sensations.

Dry beriberi symptoms affect mostly the heart: shortness of breath at night that cause the patient to awaken suddenly, shortness of breath after mild activity, palpitations, edema of the lower extremities.

Treatment

Treating this type of deficiency isn’t difficult. By simply correcting the levels of thiamine and maintain it will relieve all symptoms. This could be done by oral supplements or injection of thiamine. After administration, a blood test is usually done to test how a patient responds to the medication.

Prevention

Eating foods rich in thiamine like oat meal, eggs, liver, potatoes, oranges, flax and sunflower seeds. Daily vitamin supplements are also an excellent source of thiamine.  Stop drinking alcohol. Raw meat from fresh water fish and shellfish contain thiaminase. Thiaminase is a enzyme that breakdown thiamine. It is advised to cook fish and shellfish thoroughly.