SORE HEELS - Full extract 

Colin is a taxi driver who jogs to keep in shape. One day he came into the consulting room and kicked off his shoes. "Gee I've got sore heels," he said, "especially this right one."

There had been no specific injury; his heels had just gradually become more painful over a few months. They were particularly sore when he stood up after sitting for a while. I asked him to take off his socks so I could examine his feet.

When I pushed under his right heel he almost jumped out of his seat. "That's the bloody spot alright." he said. His left heel was also slightly tender, but the rest of the examination was normal. I was quite sure that he had a condition called plantar fasciitis.

He was so distressed that I started him on a course of anti-inflammatory medication and I recommended a pair of heel-inserts for his shoes. I suggested that he stop jogging for a while and do some swimming instead.

Some physiotherapy has been arranged and I will review him again shortly.

Sore heels are a fairly common complaint. I have seen many causes over the years, from plantar warts and bits of glass to a variety of injuries, including fractures in the heel bone. But the most common cause is plantar fasciitis, where the main attachment of the tendons to the undersurface of the heel becomes acutely inflamed.

In most cases, the inflammation is due to repetitive strain. The tendon attachment can become torn when the heel continually impacts on a hard surface. This is more likely with footwear that has inadequate support and cushioning. The whole process is very similar to tennis elbow, where the tendon attachment on the outer side of the elbow becomes inflamed with overuse.

Being overweight increases the amount of pressure on the undersurface of the heel and can pave the way for plantar fasciitis. The condition can occur in people of any age, not only those who play sport.

The main symptom of plantar fasciitis is a painful heel, usually worse after walking or exercising. Frequently the tenderness and pain is more marked on the inner side of the heel. The heel
may be sore for months.

Occasionally an X-ray will show a bony projection under the heel, called a calcaneal spur. Contrary to what was previously thought, it is not the sharpness of the spur that causes the pain; the spur is an incidental finding.

It is worthwhile trying a shock-absorbing heel-insert to reduce the impact on the heel. If the foot is very flat, it may be necessary to get an orthotic insert for proper support. A longitudinal arch support with an excavated heel pad may be recommended.

If the heel is very painful, a course of anti-flammatory medication may be advised. Care needs to be taken with these medications in case they cause gastric ulceration or bleeding. They should be taken after food and always under medical supervision. Any history of indigestion or peptic ulcers should be mentioned to the doctor, in case the medication has to be avoided or taken in combination with another drug to protect the stomach. A course of physiotherapy or advice about weight loss may be required.

A cortisone injection may be advised if the symptoms persist or are severe. After feeling around carefully to locate the exact tender spot, a combination of cortisone and local anaesthetic is injected. The injection may need to be repeated if the pain persists.

Conditions like plantar fasciitis are notoriously slow to respond to treatment. Sometimes several different types of treatment are needed before the condition settles.

Health Tip:
* If you do a lot of walking or jogging check that your footwear is suitable. Make sure that your feet are adequately cushioned and supported.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001