Several non-drug approaches can relieve pressure on the heel, including:

* Sturdy Shoes and Insoles. It is important to wear comfortable but sturdy shoes that have thick soles, rubber heels, and a sole insole to relieve pressure. (An insole with an arch support might also be helpful.) Cutting a round hole about the size of a quarter in the sole cushion under the painful area may help support the rest of the heel while relieving pressure on the painful spot. Heel cups are not very useful. When combined with exercises that stretch the arch and heel cord, over-the-counter insoles may offer the same relief as prescribed orthotics.
* Night Splints. Some evidence suggests that splints worn at night may be helpful for some people. One device, for example, uses an Ace bandage and an L-shaped fiberglass splint to keep the foot stretched while the patient is sleeping. This allows the muscle to heal. One study reported that nearly any splint, regardless of cost, is equally effective in about three-quarters of patients. Although patient compliance may be better with custom-made prescribed orthotics than with tension night splints, one study found they are equally effective in improving pain.
* Elevated Heels. Some people report relief from mild symptoms with the use of shoes or cowboy boots that have elevated heels. This approach, however, may not work in some people and is not recommended for anyone with a moderate-to-severe condition.
* Orthotics. For severe conditions, such as fallen arches or structural problems that cause imbalance, insoles, called orthotics, molded from a plaster cast of the patient’s foot may be needed.
* Extracorporeal Shock Wave Therapy (ESWT). ESWT may be used as an alternative to surgery for patients who have not responded to other treatments. The therapy uses low-dose sound waves to injure the surrounding tissues in the heel, which is believed to trigger healing of the tissues that are causing the pain. Studies show that the treatment provides a very small reduction in heel pain without side effects. It can be considered as an option for patients who haven’t responded well to extensive conservative treatment.
* Surgery. Surgery may be needed for some patients, typically those who have disabling heel pain that does not respond to other treatments for at least a year. A typical surgery is called instep plantar fasciotomy. It relieves pressure on the nerves that are causing pain by removing and therefore releasing part of the plantar fascia. A less invasive method uses a procedure called endoscopy, which requires smaller incisions. Wearing a below-the-knee walking cast after surgery for 2 weeks may reduce the need for pain relief and speed recovery time compared to the use of crutches.
* Botox. Small studies show that injections of botulinum toxin (Botox), a protein used to temporarily paralyze certain muscles, reduces pain and improves patients’ future ability to walk.

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The heel is the largest bone in the foot. Heel pain is the most common foot problem and affects 2 million Americans every year. It can occur in the front, back, or bottom of the heel. Types of heel pain include:

* Achilles tendinitis
* Bursitis of the heel
* Excess pronation
* Haglund’s deformity
* Heel spur syndrome
* Plantar fasciitis

Each type of heal pain is described in more detail below. General treatment guidelines are as follows:

* The American Orthopaedic Foot and Ankle Society (AOFAS) suggests shoe inserts, medications, and stretching as a first line of therapy for heel pain. One study found that 95% of women who used an insert and did simple stretching exercises for the Achilles tendon and plantar fascia experienced improvement after 8 weeks.
* If these treatments fail, the patient may need prescription heel orthotics and extended physical therapy. Surgery may be an option if other methods have failed.

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Normal” flexibility varies among each individual. Younger people and females tend to be more flexible than others.  But everyone can stretch to better prepare the body for an activity and also facilitate recovery from that activity.  Flexibility is generally defined as the range of motion around a joint. The goal of stretching is to improve your flexibility to enable you to perform an activity without compromising joint stability.

Improved flexibility has many benefits:

·        Increased range of motion of your joints- requires less energy and provides a safer and more efficient movement.

·        Injury prevention- although there is insufficient evidence to prove, by improving your range of motion, the soft tissue’s resistance to stretch is decreased. Soft tissue damage may not occur as this elastic limit of the tissue is not exceeded.

·        Decreased muscle soreness- stretching after exercise can prevent or reduce delayed muscle soreness and enhance recovery.
·        Increased blood supply, nutrients and joint synovial fluid- regular stretching and proper warm-up increases the deep muscle and tissue temperature which decreases the synovial fluid thickness. This enables nutrients to be transported more easily to the joint articular and hyaline cartilage, possibly decreasing degenerative joint changes and allowing increased joint range of motion.

·        Better posture- by improving your flexibility, better postural alignment and muscular balance can occur. Studies show that by improving pelvic mobility and strength, decreased low back pain is noted.

·        Stress reduction- stretching encourages muscular and mental relaxation. These positive adaptations should lead to healthy, supple muscles that are more resistant to fatigue and injury.

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Pregnancy and early parenting can be stressful times both physically and emotionally. Therefore it is not uncommon for depression and anxiety to resurface, even if it has been well-controlled previously. Depending on what works best for you, having strategies in place to help manage episodes if they arise will help immensely. These may include:

* Seeking support by sharing your thoughts with your partner, a friend or family member. This allows them ‘in’ so they can understand how you are feeling and can help you not to feel isolated. Try to do things with or be around others who make you feel better. If the episode is severe, you may need professional counselling.

* Looking after yourself with a good diet, some exercise and relaxation. Rest as much as possible and try and do something for yourself every day. This may involve creating a quiet space, going for a walk, having a massage, a facial or a long bath, reading or expressing yourself creatively by painting or writing. It may be that you need to stop work or study commitments earlier in the pregnancy .

* Making plans for when the baby comes and how you will facilitate support and help if you experience postnatal depression or anxiety. Many women set up emergency contacts with professional help at the hospital just in case and put in place things like family help, their partner taking time off work, pre-cooking meals, a nappy service or other domestic services to help with the demands of early parenting. The majority of women (up to 70 percent) who experience depression after the birth will do so before their baby is three months old.

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This is the VOA Special English Health Report.

Hand washing is a powerful way to prevent the spread of disease.

Medicine did a study to urge hand washing around the world. They found that one million lives could be saved each year if people washed their hands with soap often. They said that programs to increase hand washing with soap could be among the most effective ways to reduce infectious disease.

Doctors say many diseases can be prevented from spreading by hand washing. These include pinworms, influenza, the common cold, hepatitis A, meningitis and infectious diarrhea.

Hand washing destroys germs from other people, animals or objects a person has touched. When people get bacteria on their hands, they can infect themselves by touching their eyes, nose or mouth. Then these people can infect other people.

The experts say the easiest way to catch a cold is to touch your nose or eyes after someone nearby has sneezed or coughed. Another way to become sick is to eat food prepared by someone whose hands were not clean.

The experts say that hand washing is especially important before and after preparing food, before eating and after using the toilet. People should wash their hands after handling animals or animal waste, and after cleaning a baby. The experts say it is also a good idea to wash your hands after handling money and after sneezing or coughing. And it is important to wash your hands often when someone in your home is sick.

The experts say the most effective way to wash your hands is to rub them together while using soap and warm water. They say you do not have to use special antibacterial soap. Be sure to rub all areas of the hands for about ten to fifteen seconds. The rubbing action helps remove germs. Then rinse the hands with water and dry them.

Alcohol-based hand sanitizers are rubbed into the hands and do not require soap and water. Experts say these products must contain at least sixty percent alcohol to be effective in killing most bacteria and viruses.

Experts also say that people who use public bathrooms and dry their hands with a paper towel should use the towel to turn off the water. Then, before throwing it away, use the same paper to open the bathroom door.

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