DEAR DR. DONOHUE: I am 50, and I am experiencing pain in my right heel. The pain has become severe. About 15 years ago, I started walking for exercise and to stay healthy. The first doctor I saw said the fat tissue beneath my heel had disappeared. The second doctor gave me a shot of cortisone, which helped wonderfully for about five weeks. Then the pain started coming back. I really need to exercise. What can I do? – M.M.

ANSWER: For your heel pain, there are two possibilities: atrophy of the heel’s fat pad, as suggested by doctor No. 1; and plantar fasciitis, as treated by doctor No. 2. I vote for doctor No. 2.

The plantar fascia is a wide band of tough tissue that attaches to the front of the heel and fans out to the ball of the foot. It supports the foot bones and the foot arches. Inflammation of the plantar fascia – plantar fasciitis – is the leading cause of heel pain. The pain is worst when taking the first steps out of bed after a night’s sleep. It lessens a bit during the day. It gets bad if you stand for any length of time or if you have to climb stairs.

If you need to, lose weight. Soaking the heel in cold water after walking reduces pain and inflammation. Shoes with flat heels are best for you. Never go barefoot. Heel inserts or cushions will help you. Drugs like Aleve, if tolerated, can reduce pain and inflammation. A shot of cortisone almost always brings relief. You have to rest the heel after the shot for a couple of weeks. If you don’t, the pain will come back quickly. The shot can be repeated three or four times a year.

An exercise designed for plantar fasciitis goes like this. (Do it only when the heel doesn’t hurt.) While seated, rest the foot with the painful heel on the other leg’s knee. One hand’s fingers are wrapped over the toes of the foot and the other hand holds the heel. Pull the front of the foot toward the shins until you feel a stretch, and hold that position for 10 seconds. Repeat the exercise 10 times, and do it three times a day.

The heel’s fat pad, under the heel, serves as a cushion. Age can make it thin. The resulting pain is in the center of the bottom of the heel. Heel pads can be used as a replacement for it.

DEAR DR. DONOHUE: When figuring one’s obesity with the body mass index formula, how does one take into account the loss of height that happens over the years? I was 5 feet 6 inches tall, but now I am 5 feet 4 inches. Which height should I use? – E.B.

ANSWER: That’s a good question. I don’t have a good answer for it.

Body mass index is obtained by multiplying weight in pounds by 703 and then dividing that number by height in inches squared, or weight in kilograms divided by height in meters squared. It gives a better indication of how much of body weight is fat and how much is muscle and bone. Normals lie between 18.4 to 24.9.

Everyone loses height with age. We shrink because our backbones shrink. Women lose more height than men, due to osteoporosis.

I would take your current height as the height to use in the formula.

DEAR DR. DONOHUE: I have the same problem as P.I., who experiences irregular heartbeats after running 2 miles. After walking, I take my blood pressure. My machine also displays an irregular heartbeat. I discussed this with my cardiologist and was given a scan, an EKG and a treadmill test. The doctor kept me on the treadmill only for five minutes. It takes 15 to 30 minutes for the irregular heartbeat to occur. What should I do? – A.R.

ANSWER: P.I. had episodes of fast, irregular heartbeats during exercise, which sounded like atrial fibrillation. He had not seen a doctor.

Your heartbeats sound like premature ventricular beats – quite often, innocent beats. However, tell the doctor that you need to stay on the treadmill longer or wear a heart monitor during exercise. The monitor will record those irregular beats.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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