by Dr. S. Liam
Pruritus Calcaneus is a condition where a certain point of the heel is itching.
Following Symptoms are being associated with Deep Heel Itching (Pruritus Calcaneus):
- Irresistible itch on the heel, mostly on one foot, sometimes both heels
- Anti-Inflammatory creams, anti-fungal creams and anti-itching don’t help or provide only a temporary relief
- Itching feels like it comes from inside the heel rather than on the surface
- Doesn’t disappear and stays with the patient for 5, 10, 30 years and longer — sometimes rests for years and comes back
- Patients feel the need to use callus remover or foot scrubber to peel off the callus round the heel to get closer to the itch
- Often appears before sleep or during the night — sometimes causing sleep disorders due to pain or heavy itching
- Feeling pulse sensation around the heel
- Feeling heat sensation and sometimes pain on the surface of the heel
- Rubbing the heel to a surface (warming it up) causes a temporary relief
If you associate yourself with one or more of these symptoms, you might have one of the rare but harmless conditions called Pruritus Calcaneus — a bacterial infection of the Calcaneus (heel bone), which is often described as to be impossible to detect since it is neither based on the surface of the skin, nor it’s neurologically related.
Pruritus Calcaneus is a harmless infection and causes no dangerous side effects, it’s not contagious, but it can be very annoying for those who have to endure it.
Since it’s hard to detect, it is also misdiagnosed. Below are some common misdiagnoses:
Deep Heel Itching is mistaken for other diseases since dermatologists can’t find any inflammation or other irritations on the surface or inside the skin of the heel. Due to no findings, the patient is sometimes being sent to a neurologist who mistakenly can diagnose a nerve damage or point the source to back issues. Below are typical diagnoses that are not associated and are the source of Deep Heel Itching:
- Back Pain
Patients suffering from back pain can mistakenly associate the deep heel itching with their back problems, because itching of the foot are often associated with nerve issues on the back.
- Sciatic Nerve and Spine-Health related problems
A very common mistake to make, because the nerve roots in the spine can lead to numbness, tingling, burning, and prickling sensation in the legs and the feet, known as Sciatica Symptoms.
A variety of lower back problems can lead to pain that radiates along the sciatic nerve. Most often, sciatica pain is caused when the L5 or S1 nerve root in the lower spine is irritated by a herniated disc. The nerve roots that exit the spine to form the sciatic nerve are extremely sensitive, and the inner portion of the disc that may herniate or extrude contains proteins that are inflammatory and easily irritate the nerve.
- Plantar Fasciitis
Plantar Fasciitis is a band issue that connects the heel bone with the toes. It has nothing to do with patients who have itching problems on their heel or heels.
- Athlete’s Foot
Not only the heel is rarely infected by tinea pedis, patients with deep heel itching do not show any signs of a fungal infection, also antifungal medications provide no help or relief.
- Tarsal Tunnel Syndrome
Both, Tarsal Tunnel Syndrome (TTS) and Carpal Tunnel Syndrome are wrongly associated with Deep Heel Itching. Especially TTS (also known as posterior tibial neuralgia) since it’s foot related.
- Bone Spur (Osteophyte)
Osteophyte is the formation of the bone causing many problems, but very seldom the symptoms described above.
- Multiple Sclerosis
This is a very scary diagnosis; however deep heel itching has nothing to do with MS.
- Neuropathic or Chronic Itch
Since many patience experience the same symptoms on the exact same location, the source of the problem can’t be a chronic itch caused by a dysfunction of the itch-sending neurons causing a sensory hallucination of pruritogenic stimuli.
The deep heel itching is caused by a developed type of the bacteria Actinomyces. Since Actinomyces are not being expected to nest in the heel, it makes the diagnosis extremely difficult and almost impossible. Actinomyces are known to cause problems in ENT areas, and especially intestines, which explains why doctors are hesitant to associate deep heel itching with it, or do not see a connection.
Actinomyces species are anaerobic bacteria and they can flourish deep under body tissues such as under the heel, where even oxygen levels are very low. In case of deep heel itching, the bacteria rests on the Calcaneus (heel bone), close to the Subcalcaneal Bursa, which also makes it very difficult to detect.
Once infected and nested, the bacteria usually don’t spread to other parts of the foot or body, as it seems that the heel provides exactly what the bacteria needs to settle down and live for even decades. Other than severe itching and sometimes pain, the infection is harmless.
Due to its strong persistence to short-time antibiotic treatments, Pruritus Calcaneus is hard to get rid of with antibiotics. A recent study in 2016 researched the resistance patterns of the Actinomyces species as former studies could not provide enough information on the antimicrobial resistance of the Actinomyces bacteria. However, these kinds of treatments are recommended for severe infections with Actinomyces such as in the intestines, face and mouth. It’s not recommended to treat Pruritus Calcaneus with antibiotics for 5 to 12 months as it seems unnecessary and excessive to expose oneself to the side effects of a long-term antibiotic treatment because of a harmless, nonetheless annoying itching sensation.
The way to get rid of the Actinomyces is in fact Melaleuca Alternifolia — I’ll explain why: Actinomyces is in fact a tropical bacterium and was often classified as fungus due to its very similar behavior and conduct on the human body. In my research could find a very close connection between Melaleuca Alternifolia and Actinomyces. Especially in tropical areas such as Australia, Melaleuca Alternifolia was used by indigenous people to treat many diseases long before bacterial research was conducted in modern societies. Melaleuca alternifolia is known for its very strong antimicrobial properties as it is composed of terpene hydrocarbons, sesquiterpenes, and alcohols which penetrates skin — and it can find its way into the blood stream and bone tissue where it can unfold its healing and antimicrobial properties.
The following treatment will get rid of the deep heel itching
The patient must use callus remover on the heel to get closer to the source of the bacteria. Melaleuca Alternifolia (known as Tea Tree Oil or TTO) must be applied 2 hours before sleep time around the itching area.
This is how it’s done:
Use silicon heel cups before going to bed, and apply 10 drops of TTO inside the cup (products displayed further down).
Repeat for 6 consecutive weeks.
What it does
The heel cup conserves the tea tree oil on the surface of the heel and helps to penetrate the skin or callus. Once in contact with the infected area, TTO will slowly kill the Actinomyces over the next weeks since Actinomyces is extremely sensitive to Monoterpenes which is the ingredient of TTO . It’s important that the treatment is not stopped and continued for 6 weeks, even when the patient feels relief, and it seems that symptoms such as pain, heat and itching on the heel have disappeared within days.
Below are the products tested:
Silcon based cup heels that keep the tree tea oil inside (Amazon Link)
When it comes to Tee Tree Oil, you want to make sure they have the highest amount of monoterpenes and alcohol. Not all Tree Tea Oils provide that, like the ones from Walmart, CVS. They come very cheap, but are not as effective (some have low concentration of progesterone — but you need a high concentration of progesterone to get rid of the cause of deep heel itching which are Actinomyces). Below are the products that have been tested: