DEAR DR. DONOHUE: I was recently told I have tarsal tunnel syndrome in my left foot and that an operation is the only thing that will cure it.

Is this true? I would prefer doing some sort of exercise rather than having an operation. I enjoy walking briskly as often as I can, and I don’t like the idea of being laid up and having my muscles atrophy. — S.R.

ANSWER: Tarsal tunnel syndrome is the ankle’s equivalent of carpal tunnel syndrome, the entrapment of a nerve passing through the wrist to the hand. Carpal tunnel syndrome is a more common problem. In the ankle’s version, a nerve to the foot becomes trapped in a tunnel of bones and ligaments. The pressure put on the nerve sends burning, sharp or electric shocklike pain into the sole of the foot, around the bottom of the heel. The nerve is located behind the ankle bump on the inside of the ankle. That bump is the end of the tibia, the larger of the two leg bones. Gently tapping on the nerve will bring on the pain, a diagnostic test for tarsal tunnel syndrome.

You have to stop any activity that causes pain — temporarily. How about riding a stationary bike or swimming. Both will keep your muscles from atrophying (shrinking). Tylenol can deaden your pain. If it doesn’t, try an anti-inflammatory like Aleve or Advil. An arch support in your shoes or a cushioning pad will provide some relief.

If the pain persists for six weeks, ask your doctor if you can have an injection of cortisone in the tunnel area of the nerve. That often gets rid of any swelling that’s pressing on the nerve.

In three months, if none of these things has put an end to the pain, then you can consider surgery.

DEAR DR. DONOHUE: I am having problems with spurs in my right heel. What can I do for them? It is painful for me to walk. — Anon.

ANSWER: A heel spur is a deposit of calcium jutting off the heel, usually the front of the heel. It looks a little like a horizontal icicle. Quite often, the spur isn’t the source of pain. Plantar fasciitis is. The plantar fascia is a broad band of tough tissue that arises from the front of the heel and travels all the way to the base of the toes. It provides support for the foot. Pain from the inflamed plantar fascia (and the spur it causes) is worst upon taking the first step after getting out of bed.

Tylenol is reliable for pain relief. Well-cushioned, shock-absorbing shoes, especially in the heel area, will ease pain. If you are reluctant to buy new shoes, get heel cushions, which are available in all drugstores. Ice the heel three times a day, for 15 minutes each time.

In bed, your feet should be in a position in which the toes point to the ceiling. If the feet flop downward toward the mattress, pain worsens because the fascia is being stretched. Prop your feet up by sandwiching pillows between them and the end of the bed. You can get a splint that holds them up or you can make one of your own.

If, in three weeks, you haven’t made any progress, see your doctor. An injection of cortisone ought to quiet the pain.

DEAR DR. DONOHUE: Patches of hair on my head have come out, leaving bald spots. Is this alopecia? What causes it, and how can one treat it? — W.B.

ANSWER: That’s alopecia areata, another example of the immune system attacking the body, an autoimmune illness. In this case, the attack is on hair follicles. It leaves round patches of baldness.

Around 50 percent of people afflicted with it will experience a spontaneous recovery within a year. You can begin treatment with creams or ointments of the cortisone family. Cortisone might coax hair to grow back. Injecting the bald spots with cortisone is another treatment. Substances that cause an allergic reaction on the bald scalp also stimulate the regrowth of hair. DPCP (diphenylcyclopropenone) is an example.

A dermatologist is the kind of doctor best equipped to treat this condition.

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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