H like heel

H as in Heel

The heel is the portion of the human body that lies at the back of each foot.  Its exterior shape is formed by the bone calcaneus, also known as the heel bone.  The heel bone also rests at the very back portion of the foot and is the largest bone in the foot . It is found right beneath the ankle.  The rear half of the heel bone is known as the tuber calcanei.  It is responsible for the visible projection of the foot that constitutes the heel.  Two muscles of the foot, abductor hallucis and abductor digit minimi, extend from the heel bone's sides.  These muscles move and flex the first great toe and the fifth toe, respectively.  The heel bone also contains the beginning portion of the Achille's tendon, which attaches the calf and its muscles to the heel.  The placement of the ankle and heel right above and below each other helps shape the area of the foot known as the arch. The arch and heel together allow the foot to evenly distribute any forces exerted on it, especially on ground that is not completely flat.

Heel pain is a very common foot problem.  The sufferer usually feels pain either under the heel (planter fasciitis) or just behind it (Achille's tendinitis), where the Achille's tendon connects to the heel bone.  Even though heel pain can be severe and sometimes disabling, it is rarely a health threat.  Heel pain is typically mild and usually disappears on its own; however, in some cases the pain may persist and become chronic (long-term).

There are 26 bones in the human foot, of which the heel (calcaneus) is the largest.  The human heel is designed to provide a rigid support for the weight of the body.  When we are walking or running it absorbs the impact of the foot when it hits the ground, and springs us forward into our next stride.  Experts say that the stress placed on a foot when walking may be 1.25 times our body weight, and 2.75 times when running. Consequently, the heel is vulnerable to damage, and ultimately pain.

In the majority of cases heel pain has a mechanical cause.  It may also be caused by arthritis, infection, an autoimmune problem, trauma, a neurological problem, or some other systemic condition (condition that affects the whole body).

The most common causes of heel pain are:

·         Plantar fasciitis is an inflammation of the plantar fascia.  The plantar fascia is a strong bowstring-like ligament that runs from the heel bone to the tip of the foot.  When the plantar fasciitis is stretched too far, its soft tissue fibers become inflamed, usually where it attaches to the heel bone.  Sometimes the problem may occur in the middle of the foot. 

·         Heel bursitis - inflammation of the back of the heel, the bursa (a fibrous sac full of fluid).  It can be caused by landing awkwardly or hard on the heels.  It can also be caused by pressure from footwear. Pain is typically felt either deep inside the heel or at the back of the heel. Sometimes the Achille's tendon may swell.  As the day progresses the pain usually gets worse.

·         Heel bumps (pump bumps) - common in teenagers.  The heel bone is not yet fully mature and rubs excessively, resulting in the formation of too much bone.  This is often caused by having a flat foot. Among females, it can be caused by starting to wear high heels before the bone is fully mature.

·         Tarsal tunnel syndrome - a large nerve in the back of the foot becomes pinched, or entrapped (compressed).  This is a type of compression  can occur either in the ankle or foot.

·         Chronic inflammation of the heel pad - caused either by the heel pad becoming too thin, or heavy footsteps.

·         Stress fracture - this is a fracture caused by repetitive stress, commonly caused by strenuous exercise, sports, or heavy manual work.  Runners are particularly prone to stress fracture in the metatarsal bones of the foot.

Severs disease (calcaneal apophysitis) - the most common cause of heel pain in child/teenage athletes, caused by overuse and repetitive microtrauma of the growth plates of the calcaneus (heel bone).  Children from 7-15 years old are most commonly affected.

·         Achille's tendonosis (degenerative tendinopathy) -  a chronic (long-term) condition associated with the progressive degeneration of the Achille's tendon.

Preventing heel pain

Prevention of heel pain involves reducing the stress on that part of the body.  Tips include:

·         Barefeet - when on hard ground make sure you are wearing shoes.

·         Bodyweight - if you are overweight there is more stress on the heels when you walk or run.  Try to lose weight.

·         Footwear - footwear that has material which can absorb some of the stress placed on the heel may help protect it; for example, heel pads.  Make sure your shoes fit properly and do not have worn down heels or soles.  If you notice a link between a particular pair of shoes and heel pain, it would be best to stop wearing those shoes.

·         Rest - if you are especially susceptible to heel pain, try to spend more time resting and less time on your feet.  It is best to discuss this point with a specialized health care professional, such as a podiatrist (foot doctor).

·         Sports - warm up properly before engaging in activities which may place lots of stress on your heels.  Make sure you have proper sports shoes for your task.

The NIMBLE method focuses a lot on feet and offers a variety of specially designed exercises to keep our feet flexible, healthy and nimble.  Take advantage of them and your feet will thank you!