Heel pain with or without Calcaneal spur and homeopathic management

Dr Saraswati

ABSTRACT
Heel pain is a common clinical condition and it is frequently associated with calcaneal spur(CS).It is abnormal bone growth at the inferior part of the calcaneus, which is the most common site of bony spur occurrence. Approximately 20% of calcaneal spur is asymptomatic and its pathology remains not fully understood. Homeopathic remedies are effective in relieving the pain in heels and in dissolving the spurs.

Keywards: Calcaneal spur (CS),Heel pain, Exostosis.

INTRODUCTION
Heel pain is one of most common disorder of foot, which occurs in individual who do a great deal in standing or walking, causes pain and tenderness of the sole of the foot. Pain in heel not only restrict movements, but affects the daily activities. It believed to be caused by repeated minor trauma .Repeated attacks of this condition induce ossification in the posterior attachment of the aponeurosis, forming a calcaneal spur. Calcaneal spur usually revealed in x-ray and is a bony projection forwards from under surface of calcaneal tuberosity. It is nothing but ossification of the planter fascia at its calcaneal end.

Epidemiology
The incidence of calcaneal spur in Indian population is about 59% and most common age group affected was found to be 40-50 years.

RISK FACTOR

• Gait abnormalities that leads to pronation issues.
• Running and jogging especially on hard surfaces.
• Excess weight and obesity.
• Spending most of the day on ones’s feet.
• Increasing age,which decreases plantar fascia flexibility and thins the heeel’s protective pad.
• Poorly fitting shoes that lack arch support.
• Frequent short bursts of physical activity.
• Having either flat or high arches.
• And illness such as diabetes mellitus and osteoarthritis.

PATHOPHYSIOLOGY
When there is repeated microtear in the fascia at the calcaneal insertion. Tears leads to inflammation where subsequently calcium gets deposited and spur develops.

SIGNS AND SYMPTOMS

• Pain over ball of the heel.
• Tenderness on planter aspect of heel.
• When appears when patient stands on the foot for walking
• And pain disappear when patient walk some distance.
• Pain is worst in morning and exacerbates by walking on hard surface.

DIFFERENTIAL DIAGNOSIS

• Retrocalcaneal bursitis
• Planter fasciitis
• Achilles tendonitis
• Tarsal tunnel syndrome.

DIAGNOSIS

Sharp pain localised to the heel.

Lateral x-ray of the ankle showing bony growth.

               

       

GENEARAL MANAGEMENT

Prevented by wearing well fitting shoes and supportive heel counters.

Choosing appropriate shoes for each physical activity.

Warming up and doing stretching exercise before each activity.

If you are overweight, losing weight may help to prevent .

Avoid wearing shoes with excessive wear on the heels and soles.

HOMEOPATHIC APPROACH

Rubric selection

SYNTHESIS REPERTORY

EXTREMITIES – EXOSTOSIS

aur.aur-m.calc.CALC-F.dulc.heclamez.nat-sil.ph-ac.rhus-t.rutaSIL.staph.sulph.syph.

EXTREMITIES – PAIN – Foot – Heel

acon.agar.alum.am-c.Am-m.ambr.anag.aran.arg-met.arist-m.ars.ars-h.aur.aur-ar.bad.bamb-a.bapt.berb.borx.Calc.Calc-caust.calc-p.caps.Carb-an.Cassia-s.castor-eq.cedr.cham.Chel.cinnb.clem.Coloc.crot-h.cycl.dios.eup-per.euph.Ferr.Ferr-ar.fl-ac.gard-j.graph.hell.ign.jatr-c.kali-bi.kali-c.Kali-i.kali-p.lac-c.lac-d.lap-la.led.lyc.lyss.mang.Med.meph.merc-i-f.morg-p.Nat-c.nat-m.nat-s.osm.Petr.phos.phyt.PULS.ran-b.ran-s.raph.RHOD.Rhus-t.rhus-v.rutasabin.sang.sep.spong.sulph.symph.tart-ac.thuj.upa.Valer.verat.xan.Zinc.zinc-p.zing.

BOERICKE REPERTORY

LOCOMOTOR SYSTEM – Heels – Os calcis, Pain aran.

COMPLETE REPERTORY

EXTREMITIES – PAIN – lower limbs – Feet

Heels: acon.act-sp.aeth.agar.agn.all-c.alum.am-c.AM-M.ambr.anac.anag.anan.andoc.ang.ant-c.aran.arg-met.arag-met.am.ars.ars-h.arund.aur.aur-ar.aur-m-n,bad.bamb-a.bapt.bar-c.bell.berb.bism.borx.bros-gau.bry.calc.calc-caust.calc-p. calc-sil.cann-s.caps.CARB-AN.carb-s.carl.castor-eq.caust.cedr.cham.CHEL.cinnb.cic.cimic.cina cinnb.clem.cocc.colch.COLOC.con.crot-h.cycl.cymbop-ci,dios.dros.eup-per.eup-pur.euph.euphr.eupi.fago.FERR.FERR-AR.ferr-ma.fl-ac.graph.haliae-lc.harp.hell.hep.hydrog.ign.indg.jatr-c. kali-ar.kali-bi.kali-c.KALI-I.kali-p.kali-sil.kreos.lac-c.lac-d.lap-la.laur.led.lilth-c.lob-c.lob-s.m-ambo.mag-c.mag-on.manc.mang.med.meph.merc-f.merl.mez.morg-p.mur-ac.myric.NAT-C.nat-m.nat-p.nat-s.nat-sil.nicc-met.nit-ac.nit-s-d.nux-m.nux-v.ol-an.olnd.osm.par.PETR.ph-ac.phos.phys.phyt.pitu-a.plat.plb.podo.polyg-h.ptel.PLUS.ran-b.ran-s.raph.RHOD.RHUS-T.rhus-v.rutasabin.sang.sapo-so.sars.sep.sil.spong.stann.staph.stram.strant-c.stry-xyz.sul-ac.sulph.tart-ac.tep.ter.teucr.thuj.trom.upa.Valer.verat.verb.viol-t.xan.Zinc.zinc-p.zing.

MURPHY’S REPERTORY

EXOSTOSES: (10) aur.aur-m.CALC-F.dulc.HELC.mez.ph-ac.rhus-t.SIL.sulph.

EXTREMITIES -EXOSTSES- PAIN – lower limbs

.feet: (1) staph.

Feet

PAIN, heels: (69) acon.agar.alum.am-c.Am-m.anag.aran.ars.ars-h.aur.bapt.berb.borx.Calc.calc-p.caps.Carb-an.castor-eq.cedr.cham.Chel.cinnb.clem.Coloc.crot-h.dios.eup-per.euph.Ferr.Ferr-ar.fl-ac.graph.hell.ign.iod.kali-c.Kali-i.led.lyc.lyss.mang.meph.merc-i-f.Nat-c.nat-m.nat-s.osm.Petr.phos.phyt.PULS.ran-b.ran-s.raph.RHOD.Rhus-t.rhus-v.ruta sang.sep.spong.sulph.thuj.upa.Valer.verat.xan.Zinc.zing.

THERAPEUTICS

Aranea diadema:
Boring and digging pain in calcareous bone when first moving foot after sitting,disappear from continued motion.feet feels heavy.

Calcarea flouricum:
Pain in heel region with exostosis.worse in damp weather ,but relieved by rubbing.

Rhus toxicodendendron:
Sharp stitching pain in heels ,pain in heels  worse in morning when first moving, at night,cold damp wheather and heat in bed.Better from continued motion,from change of position.

Ledum palustre:
Pain of soles of feet and heels,as if bruised when walking.Painful heel with hard nodes<step on them. Sweeling of feet ,heels <by motion,at night,bedcovering,>only holding feet in ice water.

Silicea:
Soreness in feet from instep through to the sole.Icy cold and sweaty feet.<left side uncovering,damp and >warmth,summer.

Pulsatilla pratensis:
Boring pain in heels towards evening,suffuring worse from letting the affected limb hang down.Feet red,inflamed,swollen.

Rhododendron ferrugineum:
Rheumatic tearing in all limbs,especially right side,worse when at rest.Pains in bones in spots,and reappear by change of weather.Cannot sleep unless legs are crossed.

Ruta graveolens:
History of mechanical injuries of bones of feet.Pain in back of left heel and right with swelling.

CONCLUSION
Homoeopathy has got a wide range of remedies in treating heel pain with or without calcaneal spur. Further evidence-based studies must be conducted to show the efficacy of Homoeopathic remedies.

REFERENCE

1. Snell RS. Clinical anatomy by regions. Lippincott Williams & Wilkins; 2011 Oct 28.
2. Das S. A Manual of Clinical Surgery. Dr. Das. 2000;36:396-403.
3. Lourdes RK, Ram GG. Incidence of calcaneal spur in Indian population with heel pain. International Journal of Research in Orthopaedics. 2016 Jul;2(3):173.
4. Boericke W. Pocket manual of homeopathic materia medica. Homeopathic; 1903.
5. Clarke JH. A dictionary of pratical materia medica. homoeopathic publishing Company; 1902.
6. Murphy Repertory, Synthesis Repertory, Boericke Repertory, Complete Repertory.

Dr Saraswati
PG Scholar, MD part-1, Department of Materia medica,
Government Homoeopathic medical college & hospital, Bengaluru.