Treatments for a common cause of heel pain
DEAR DR. DONOHUE: I started a running program about two months ago, but I have had to put an end to it. My right heel has become so painful that I can’t walk, let alone run. It hurts most in the morning when I get out of bed and take some steps. The pain lessens but comes back later in the day. What might this be, and how can I treat it? — W.D.
ANSWER: My bet is that you have plantar fasciitis, a common heel problem. I can give you a few tips, but, if the pain persists, see a doctor. Many other things cause similar pain.
The plantar fascia is a sheet of tough tissue that runs from the front of the heel to the bottom of the toes on the sole side of the foot. One of its functions is to support the foot arch. Your pain fits the description of plantar fasciitis. It’s at its worst upon taking steps after a long rest. The pain eases but comes back later in the day.
Rest is essential. Nonsteroidal anti-inflammatory drugs like Aleve and Advil reduce pain and inflammation. Wear well-cushioned shoes, and put a heel insert into the shoe. Stretching the fascia gradually lessens pain and prevents recurrence. Sit in a chair with your right foot on your left knee. Grab hold of the toes and bend the foot toward the shin to stretch the fascia. Hold the stretched position for 10 seconds and then repeat the stretch 10 times. Do this exercise three times a day.
Wearing a splint at night promotes fascia healing. The splint is applied to the bottom of the foot so that it holds the foot at a right angle to the ankle. If you can’t find a splint, you can make one of your own easily.
If, after these measures, the pain persists, a doctor can inject cortisone into the area of pain so it bathes the fascia. Sound-wave treatments also are available. And an Italian doctor has devised a novel treatment. Guided by ultrasound, he pokes a needle in the area of pain to provoke bleeding. The area is first anesthetized. The small amount of blood that leaks from the poking furnishes enzymes that spur fascia repair. Then he injects a small amount of cortisone for immediate relief. I don’t know if this treatment will catch on in North America.
DEAR DR. DONOHUE: Do you know any exercise to relieve heel-spur pain? — M.D.
ANSWER: Heel spurs aren’t usually the source of pain. They’re a sign of plantar fasciitis. The tips I gave to W.D. should work for you, too.
Have you tried Tylenol for your pain? It doesn’t relieve inflammation, but it provides pain relief without a lot of side effects.
DEAR DR. DONOHUE: I work out in a place that has both free weights and weight machines. Which is better? The guys with the biggest muscles gravitate to the free weights. — B.K.
ANSWER: Free weights are barbells and dumbbells. Weight machines are stations where a person sits, lies or stands and lifts weight from a rack of weights that can be changed by inserting a pin in the stack.
Weight machines allow a rapid change of weights. They’re quite safe. Recently a California college football player lost his grip on a barbell while he was bench pressing. The barbell came crashing down on his neck, and he required emergency surgery. This can’t happen with machines.
Free weights are harder to handle, and you have to interrupt your exercise if you want to change the amount of weight. However, free weights provide total workout. Even when doing arm exercises, the lifter is also exercising the back, abdominal and leg muscles. Free weights improve balance. They permit greater versatility in exercise by changing the grip position and location of the hands on the barbell.
Both methods work well. Unless you’re a dedicated bodybuilder, you can benefit from either. Bodybuilders tend to favor free weights, but they use weight machines, too.
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.