Give foot pain the boot

February 21st, 2010

DEAR DR. GOTT: My 63-year-old mother has complained every day for three months about a sore heel. It feels better when I massage it for her, and it also helps if she stays off her feet. She believes it’s only the sole that hurts but refuses to see her doctor, so we would appreciate your thoughts on the matter.
DEAR READER: There are a number of reasons for a person to complain of foot pain, whether it presents in the heel or in the sole. Unfortunately, I didn’t get a full history from you, such as whether your mother is still employed and stands on her feet all day, whether she is dedicated to fitness and jogs to stay in shape, whether she is somewhat sedentary and has recently gained or carries excessive weight, or whether she simply prefers to wear shoes that don’t support her feet properly. Therefore, I will discuss several of the more common conditions that might provide some answers.
A condition known as plantar fasciitis occurs when a ligament known as the plantar fascia, which runs the full length of the bottom of the foot, is stressed, causing the tissue to tear. Irritation and inflammation of the fascia can result in bruising and extreme pain. Causes for the tear are sudden weight gain, repetitive or excessive stress, or wearing shoes without adequate support.
Achilles tendonitis is similar to plantar fasciitis, yet differs because of the location of pain, because it affects the tendon that runs down the calf, along the back of the foot and connects to the heel bone. Severe pain can result when the Achilles tendon or a calf muscle is stressed. Often seen in middle-aged recreational athletes, the condition is common when people fail to stretch and bend prior to strenuous physical activity. Other causes are repetitive movements and excessive physical stress.
Heel spurs are bony projections that occur along the edge of the heel bone. They typically develop on the front of the heel bone and point toward the arch of the foot. They often irritate the plantar fascia and cause inflammation but don’t always cause pain.
Morton’s neuroma is a benign growth of fibrous tissue around a nerve, commonly between the third and fourth metatarsal heads. The pain experienced is commonly the result of wearing high-heeled shoes.
Metatarsals are the long bones at the base of each toe. Excessive pressure on the ends of the toe bones can cause pain and symptoms in the ball of the foot. The medical term for this is metatarsalgia and is primarily the result of tight shoes and from wearing shoes with high heels. People suffering from this condition should forgo shoes that are narrow or have pointed toes or high heels and opt for wider shoes that will allow the foot ample room to stretch appropriately.
Without knowing the true cause of your mother’s pain, I recommend you begin simply. Purchase a nonsteroidal anti-inflammatory over-the-counter pain medication. If you have any questions about the numerous brands available, speak with your pharmacist for his or her recommendation. If shoes are the issue, depending on her general activity, have your mother purchase a pair of relatively flat or athletic shoes designed to cushion and provide extra support. She may wish to purchase cushioned shoe inserts and/or arch supports that can relieve stress. She can likely benefit from using a whirlpool-type foot bath at home and might relax in the evening with her feet propped up on a foot stool or pillow. An ice pack, either the real thing or one made from a frozen bag of vegetables placed against the foot, might also lessen the pain.
If all my recommendations fail to provide relief, attempt to convince her to see her physician or a podiatrist. A noninvasive X-ray, CT scan or MRI can be performed that will likely provide the answers her doctor needs to determine the correct diagnosis. While her doctor can make recommendations, your mother (perhaps accompanied by you) should be in complete control and call all the shots. She should be the one, with the guidance and knowledge of a healthcare professional, to decide what should or should not be done. Good luck.
To provide related information, I am sending you a copy of my newly revised Health Report “Managing Chronic Pain.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.