Ask The Doctor

Healing for Heel Pain

Now that we’ve been having nice weather, I have been doing a lot of walking lately, and I have noticed pain in my heel that I have never before had. My friend tells me it might be caused by something called “plantar fasciitis.” 
The interesting thing is that it hurts most in the morning and actually begins to feel a little better after I have walked for a while. There is no sign of bruising or redness on my heel.
I made an appointment with a podiatrist, which is a couple of weeks away. Could you please tell me more about plantar fasciitis and what could be causing this?
Heel Pain in Howard Beach
 
Dear Heel Pain,
Heel pain is one of the most common forms of foot pain in adults. It often occurs as a result of daily activities and natural aging.
Let’s first review some of the symptoms and causes, and then we can address your specific case.
Heel pain is most often caused by the condition called “plantar fasciitis” (pronounced plan-tar fa-seye-tis). These are fancy words describing an irritation and swelling of the tissue that runs from the heel to the toes, on the bottom side of the foot, basically the arch of the foot. The tissue or tendon attaches to each one of the bones that form the ball of your foot.
A pad of fat in your heel covers the plantar fascia to help absorb the shock of walking. Damage to this fascia can cause heel pain.
As a person gets older, the plantar fascia becomes stiffer and doesn’t stretch very well. The fat pad on the heel becomes thinner and can’t absorb as much of the shock from walking. There may be damage to the plantar fascia, which may, as a result,  tear or bruise. You may even notice an area of swelling on your heel.
A heel spur, or tiny piece of bone extending from the bottom of the heel, may develop and further irritate the tissues of the heel.
The pain is on the bottom of the heel and increases over a period of months. It is usually worse upon arising from sleep. After a few minutes of walking, the pain decreases, as the walking stretches out the tissues on the bottom of your foot and helps ease the pain. After spending long periods of time walking, the pain gradually worsens.
The condition is prevalent in those spending long periods of time on their feet, in obese people and in those wearing non-supportive footwear, such as sandals.
It is time to see your podiatrist when you cannot walk comfortably, the pain occurs at night and keeps you awake, if it persists for more than a few days or if there is swelling or discoloration of the back of the foot.
If there are any signs of infection, such as fever, redness or warmth, then it is imperative to see your physician immediately.
The podiatrist can usually arrive at the diagnosis with a good history and medical exam. He or she may call for X-rays of the feet, plus an MRI or bone scan.
Treatment Options
There are many non-surgical treatments available that include the following:
• Try stretching exercises.
• Avoid going barefoot.
• Put ice packs on your heel for 10 minutes several times a day to reduce inflammation.
• Wear supportive shoes. Orthotics may be prescribed by your podiatrist.
• Drugs such as Motrin may help to reduce pain and inflammation.
• Rest. Stop jogging or prolonged standing for a while. This allows for the inflammation to cool down.
If the pain does not respond to the above measures, your podiatrist may inject the heel area with steroids to relieve pain.
There are splints that can be worn at night to keep the tissue of the bottom of the foot stretched, to help relieve morning pain. Very few patients will require surgery. 
I hope this helps you and other readers who may be experiencing heel pain. It is definitely treatable, and hopefully, if caught in time, you will not need surgery.

 

Dr. Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on The NET, Tuesdays at 8 p.m. on Channel 97 Time Warner and Channel 30 Cablevision.
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