Dr Mary McCarthy: One step forward in treating painful heel
The patients you see in a morning's surgery vary enormously. Some have serious disease which needs constant monitoring in order to make life liveable.
Some seem like very minor problems but even small things can affect your normal life to a surprising degree. Your feet seem to be a less important part of your anatomy but when something is wrong it can dominate your waking life.
A patient came into the surgery complaining that his feet hurt. In fact the pain was so bad that he limped in from the waiting room, unwilling to put any weight on one foot. He said he had noticed some discomfort for the last few months but it had been noticeably worse over the last week or so, so much that he found it painful to put his heel to the floor. There was no pain in the leg or hip on that side and he had never had back problems.
He told me that he'd never had any problem with painful feet before and replied to further questions by revealing that his current job was as a security guard. He usually did the night shift and spent most of his time patrolling the large premises. He was eager to take off his shoes and socks and to demonstrate where his foot hurt.
When his foot was examined it was clear that the pain was located in his heel. His foot was not hot or swollen and there was no evidence of infection. His heel was tender and the pain could be triggered by pressing on the heel pad.
Plantar Fasciitis used to be known as Policeman's Heel because those patrolling a beat on foot, as the police used to do, were liable to develop the condition. Ill fitting shoes can exacerbate the problem and it can be very uncomfortable. It is an inflammation of the layer of fascia under the heel and occasionally a bony spur on the heel bone can start the problem.
Most cases will settle down in time but simple measures can help. Ibuprofen gel can be used on the painful area and wearing well cushioned shoes makes walking easier. Trainers with thick soles may be enough but proper insoles are even better.
Stretching the heel tendon, called the Achilles tendon, eases the pain and although some cases, which don't settle, may be referred to the foot clinic, surgery or steroid injections are only rarely used. Patients in general practice consult with a large range of complex problems.
Sometimes it's good to deal with something simple.
* Dr Mary McCarthy has worked at Belvidere Surgery in Shrewsbury for more than 20 years. She is chairman of the local medical committee and represents Shropshire, North Staffordshire and South Staffordshire on the General Practitioners Committee of the BMA.
