I've made a real effort to improve my lifestyle habits in the last few months. I have started running and I am trying to lose weight. I'm getting really frustrated as several weeks after starting to exercise I developed pain in my foot. It is mainly in the heel area but I feel it further forwards in my foot at times. It can be particularly sore first thing in the mornings. It is ruining my efforts to get fit. What should I do?
Heel pain is not a symptom that sends most people running to the doctor but nonetheless can cause stress and discomfort. It has been said that every mile you walk can put up to 60 tonnes of stress on your foot.
If we abuse our feet by pounding on pavements or wearing shoes that don't protect or cushion them correctly problems may occur.
The foot contains 33 bones, surrounded by muscles, ligaments and tendons and a problem with any of these can cause pain. There are two more common causes of heel pain. The calcaneus is the large bone in the heel area. Pain that occurs under this area is most likely plantar fasciitis and pain at the back of the heel is most likely related to the Achilles tendon. Pain can also occur due to injury, ill-fitting shoes or obesity.
A bony growth called a spur can occur underneath the calcaneus. The bone spur can put pressure on a long band of fibrous tissue (fascia) that runs along the base of the foot. Although a spur may cause heel pain it is not always the case.
Plantar fasciitis occurs when the fibrous band becomes inflamed with chronic stretching or straining. This may occur in those wearing shoes that provide little support, in those with flat arches or in those, like you, with especially active lifestyles. Obesity is also a risk.
The pain occurs commonly under the heel and may be burning, dull or sharp in nature. Classically the pain is worst taking first steps in the morning or after periods of standing, sitting or intense activity. The bottom of the foot may feel tender to touch or the arch may be stiff or tight. Pain can also occur if the fluid sac around the heel joint becomes inflamed leading to a condition called bursitis. This condition can also occur in other joints. Prolonged bursitis of the heel joint is sometimes associated with enlargement of the bone at the back of the heel.
Inflammation of the Achilles tendon occurs when the tendon becomes stretched or strained causing tearing of small fibres leading to inflammation and pain. The pain may build up over time and the area over the Achilles tendon may become red, thickened or swollen. In rare cases the tendon ruptures, causing a sudden severe pain to occur directly over the heel area. This is most common in those with tight tendons who run or walk a lot.
When you have heel pain, taking anti-inflammatory medication such as ibuprofen may help. In severe, prolonged cases steroid injections can provide great relief. Applying ice to the area can also help.
However, the main treatment of heel pain brings us once again to lifestyle. Firstly wear proper fitting shoes that are suitable to the activity undertaken. Moulded orthotic inserts may help to support the structures of the foot.
Warming up and stretching the muscles of the foot and the Achilles tendon is important before and after all exercise. If undertaking a new exercise regime, pace yourself and build up activity gradually. Avoid walking on uneven surfaces and avoid walking barefoot for prolonged periods on hard surfaces. Rest days are also important. Don't give up on your exercise programme. Eating well and aiming for a healthy weight will also help.
Lastly, if the pain is going on several weeks, see your doctor or chiropodist. Prescription medicine or custom-fit insoles may help.