Suffering from heel pain?
Find out the cause for relief
Ravinder Chadha

HEEL pain is a common symptom which is generally ignored until it becomes a serious problem. It mainly occurs due to "plantar fascitis" (inflammation of plantar fascia). Plantar fascia is a thin layer of tough tissue which supports the arch of foot and its inflammation is the root cause of heel pain. Repeated stress leads to tears in the plantar fascia causing pain.

Heel plays an important role of a shock absorber as and when the foot strikes the ground. While walking as the training leg begins to lift above the ground, tension on the fascia is around twice the body weight and this increases if there is associated lack of flexibility of calf muscles. Classic presentation of plantar fascitis is heel pain, which worsens in the morning or after a prolonged rest.

The main causes of heel pain are:

* Obesity: Being overweight increases the pressure on the heel which can stress the fascia.

* People who have high arch or flat feet are more prone for the heel pain as they are unable to absorb the stress of walking.

* Sudden increase in training, running on hard and irregular surface.

* Using worn-out shoes especially while running.

* Prolonged sitting job leads to the weakness of the calf muscles, which ultimately stresses the fascia.

i. Rest from the particular activity, which increases pain.

ii. Ice should be applied two to three times a day.

iii. Taping during an acute phase can give rest to the fascia.

iv. Patients with planter fascia should wear shoes with more cushions and raised heel. Heel lift by using silicon heel is very effective.

v. Ultrasound therapy twice a week helps in reducing the inflammation.

vi. Shock wave diathermy is an expensive treatment, and can be used in resistant cases of heel pain.

vii. Injection: Corticosteroid should be considered as the last treatment.

viii. Stretching the calf muscles two to three times a day when one has to sit for a long time.

Treating morning heel pain: In most cases there is pain in the heel with the first few steps in the morning. Apply the heating pad and then massage the bottom of the foot with the help of golf ball or can of Coke or Beans. In severe cases night splint can be used to reduce the early morning stiffness.

Toe curls: Place a wet towel on the floor and then curl toes to pull the towel towards heel.

Towel stretch: Sit on a hard surface with the injured leg stretched out in front. Loop a towel around the ball of foot and pull it towards the body, keeping the knee straight. Hold the position for 15 to 30 seconds and then relax. Repeat three times.

Standing calf stretch: Keep the injured leg back and the uninjured leg forward. Put hands against the wall. Lean forward towards the wall until you feel a stretch at the back of your calf. Hold for 15 to 20 seconds. Repeat three times. Do this exercise several times a day.

Plantar fascia stretch: Stand with the ball of your injured foot on a stair. Lower down your heel until you feel a stretch in the arch of your foot. Hold this position for 15 to 20 seconds and then relax. Repeat three times.

There are certain myths regarding heel pain, which should be ignored.

1. Heel spur that appears on X-ray is the main cause of heel pain; spur formation is related to the progression of age. Mostly, heel pain is due to the stress on the plantar fascia, which causes irritation and inflammation and leads to heel pain. Therefore, one should be cautious if somebody advises surgery of heel spur

2. Heel pain can be cured immediately. There are no short-cuts to treat the heel pain. Mostly, the patient can improve with non-surgical treatment plan for the symptoms of pain, stiffness, etc., but it takes a long time to treat the cause.

Deep message, firm heel pads and various surgeries can sometimes prove to be harmful treatments.

Although patients with heel pain do get temporary relief with medicines, rest, etc., the mainstay of treatment is increasing the overall resilience and strength of legs and feet which is possible only by regular exercise regimen.

Heel pain is a real headache for some doctors as it takes a lot of time to cure with medicines, injections, etc. A combined therapy consisting of medication, stretching, exercises, a change of shoes and removal of the cause can cure heel pain.

How winter brings scabies
Neelam Sharma
Tribune News Service

Chandigarh: If you thought that in winter infections have the least chance to play havoc with your body, then think again. The drastically reduced frequency of taking baths and the habit of wearing the same clothes for days together can invite the highly infectious skin disease called scabies or pediculosis.

Being highly contagious, scabies immediately spreads to all the members of a family even when only one person is infected with the disease. Caused by mite, the disease easily spreads through the sharing of clothes or by merely being in close contact with the infected person.

"There are a large of slum-dwellers in the city who are thronging the dispensaries with the complaint of acute itching during the nights. Generally, patients maintain a very poor personal hygiene during the winters and they skip bath for days together. Many a times they continue to wear the same clothes as well. This is a cradle for the mite to grow which causes scabies," said a city-based dermatologist. Such cases keep coming to the clinics till the end of March every year, he added.

The mite may not only infect the person’s clothes but can also enter the quilts and blankets, which too go without a frequent washing in the winters. This is how the infection quickly spreads in the entire house.

Not surprising then, the patients of scabies are not merely given medicines for themselves but also the persons staying close to them are asked for symptoms and given treatment likewise. The doctors too make sure that "complete treatment of the entire family" is given.

To disinfect the person with scabies, the patients are recommended to have a scrub bath daily and boil their clothes, especially the undergarments, so that the mite is killed. Cutting of nails so that they are not capable of accommodating dirt, and washing of hands with soap and water a number of times during the day are other recommendations that the patients are required to follow.

The doctors advise that the symptoms of scabies should never be taken lightly as the disease spreads fast. "We have also seen that that the patients stop the treatment on their own, which can aggravate the condition later on. Once they are given the medicines they must stick to the entire course, or the itching resurfaces in no time," cautions the doctors.

Sydney: According to researchers Paracetamol is just as effective in treating osteoarthritis as some of the more expensive and controversial anti-inflammatories.

Three in four patients with osteoarthritis suffered fewer side- effects when treated with paracetamol, which was as effective in reducing pain as Celebrex and Ibuprofen, a study revealed. Michael Yelland, a senior lecturer at the University of Queensland Centre for General Practice, said the study was prompted by concern that some people were unnecessarily taking medication that might cause serious side-effects.

"It’s widely known that the anti-inflammatories have a higher chance of causing stomach ulcers and bleeding," he said. Dr Yelland added the safety concerns about Vioxx and Celebrex had left many arthritis sufferers uncertain about the safety and effectiveness of their medication.

"With Celebrex and Vioxx running into problems, the findings suggest maybe it’s time for people to re-examine their osteoarthritis treatments," he told The Australian.

Washington: A new review of studies published by the British-based Cochrane Library has revealed that the common use of anti-inflammatory steroids for traumatic head injuries like those from car crashes may actually increase the risk of death.

The review draws heavily from a recent study of corticosteroid treatment for brain injury, including coma and concussion, that included 10,008 patients, more than all similar studies combined. Corticosteroids are anti-inflammatory hormones used to treat all kinds of inflammation, from joint injury to asthma.

The large study found that patients treated with corticosteroids were 18 per cent more likely to die from their brain injury than those who did not take the drugs. Among the patients who received steroid treatment, 1,052 of the 4,985 treated, died, compared to 18 per cent who received a placebo.

"The significant increase in death with steroids found in this trial suggests that steroids should no longer be routinely used in people with traumatic head injury," said Dr. Phil Alderson, lead author of the Cochrane study. — ANI