Q: I am a male 82 years of age, height 5’8”, weigh 172 pounds and am in relatively good health. My problem is that all at once I started getting a sharp pain on the bottom of my right heel. I haven’t been to a podiatrist but purchased a recommended insert. It might have helped a little. As long as I’m moving, the pain is tolerable but standing or if I’m off my feet for a short time and then start walking, the sharp pain returns but gradually lessens after walking for a short time. Hopefully you can help me like you have in the past.
A: There are a several possibilities for heel pain, including a heel spur, plantar fasciitis, or even a problem with the Achilles tendon, to name a few. Because you refer to the bottom of your heel, you may have plantar fasciitis, inflammation of a thick tissue band. Some individuals tend to have pain along the bottom of the foot; however, there could be inflammation at the insertion of the fascia near the heel. This condition generally causes a stabbing pain when a person first begins to walk, after which the pain may decrease when the foot muscles stretch some. The condition commonly affects one foot, although it can occur in both and can act up following long periods of standing. It is rather common in individuals who wear shoes without adequate support, in those who are overweight, and in runners. Risk factors for developing plantar fasciitis include doing specific types of exercise, having an occupation that keeps you on your feet for extended periods, having high arches, or being flat footed.
Diagnosis can be made by your primary care physician who will check your balance, muscle strength, reflexes, and more. He or she may order an X-ray to rule out such things as a bone spur, or an MRI if there is a suspicion of a stress fracture or pinched nerve.
Treatment might begin with an over-the-counter NSAID and physical therapy to stretch the plantar fascia, Achilles tendon and lower leg muscles. A custom-fit arch support or splint worn while sleeping might also help. When these conservative measures fail to provide relief, prescription corticosteroids that can be administered topically through iontophoresis or via injection would be the next step.
A heel spur is a calcium deposit on the underside of the heel that will not improve with walking. . It occurs because of a buildup of calcium and is often caused by a ligament strain or stretching of the plantar fascia. Risk factors include poorly fitting shoes, obesity, running on hard surfaces, and having a gait abnormality. It is diagnosed through X-ray. Treatment includes exercise, anti-inflammatory drugs, cortisone injections, and custom orthotics.
Achilles tendonitis is a possibility. The Achilles is one of the longest tendons in the body, stretching from the heel bones to the calf muscles. It is what allows you to extend your foot and point your toes. When this tendon is injured, pain and inflammation occur. With a major injury, the tendon can tear or partially rupture. Injuries result from failing to stretch sufficiently prior to exercise, overuse, having flat feet, or having leg muscle tendons and muscles that are too tight. The condition is seen in athletes, dancers, and gymnasts. My guess is that at 83, you aren’t on a football field too often!
Whatever your condition, you should be seen by a health care professional. If your physician questions what is wrong, ask for a referral to an orthopedic specialist and be sure to keep the appointment because to ignore your pain may lead to further complications including back problems, and issues with your feet, knees, and hips because you are likely modifying your style of walking.
Readers who are interested in learning more can order Dr. Gott’s Health Report “Managing Chronic Pain” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.
