Thursday 19 July 2018

Ask the GP: Don't grin and bear it - your doctor can help

High heels can cause pain. Photo: Getty Images
High heels can cause pain. Photo: Getty Images

Nina Byrnes

Advice from our GP on foot pain and on why it is important to seek medical advice when you notice blood in your stool.

Question: My foot is aching lately. It hurts most when I try and put my foot to the ground first thing in the morning. I feel the pain mainly under my heel and it really burns.

Dr Nina replies: The foot contains 33 bones surrounded by muscles, ligaments and tendons. A problem with any of these can cause pain. The calcaneus is the large bone in the heel area of the foot. Pain that occurs under this area is most likely plantar fasciitis. Pain at the back of the heel is most likely related to the Achilles tendon.  Pain may also occur due to injury, ill-fitting shoes or obesity.

Plantar fasciitis occurs when the fibrous band that runs along the sole of the foot from the heel bone becomes inflamed with chronic stretching or straining of the bottom of the foot.

This may occur in those wearing shoes that provide little support, in those with flat arches, or in those with especially active lifestyles such as running frequently.

Obesity is also a risk. Plantar fasciitis is more common in men aged 40 to 70, but it can occur in either sex. 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. Prolonged bursitis of the heel joint is sometimes associated with enlargement of the bone at the back of the heel. This is commonly associated with chronic irritation from the heel of shoes also.

Inflammation of the Achilles tendon occurs when the tendon becomes stretched or strained causing tearing of small fibres leading to inflammation and pain. The area over the Achilles tendon may become red, thickened or swollen.

Pain here usually gets worse when you exercise after periods of rest. 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.

For simple heel pain, applying ice or taking anti-inflammatory medication such as ibuprofen may help. Steroid injections to the area can provide great relief in more severe cases.

Wear proper-fitting shoes that are suitable to the activity undertaken. They should fit well all around the foot. Moulded orthotic inserts may help to support the structures of the foot. Replace or repair shoes that show excessive wear on the heel or soles - very flat shoes and flip-flops should be avoided.

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 regimen, pace yourself and build up activity gradually. Consider talking to an exercise or health professional to assist you with planning an exercise program.

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 program. Eating well and aiming for a healthy weight will also help.

Lastly, if pain is going on several weeks, don't grin and bear it. See your doctor or chiropodist for prescription medicine or custom fit insoles.

Question: I have noticed that there is blood in my stool a few times lately. I feel otherwise fine. Someone said it might be haemorrhoids. How can I tell? Do I need to see my doctor or can I manage this at home?

Dr Nina replies: If you pass bright red fresh blood separate to stool, it hasn’t travelled very far and the bleeding is likely towards the end of the bowel, namely the rectum or anal area.

Red blood mixed with the stool has likely come from the large bowel. Blood from the stomach or higher in the gut becomes partially digested. This may result in dark tarry stool.

Your doctor will ask if you have had abdominal pain. It is also relevant whether you suffer with constipation or have experienced diarrhoea or loose stool. If the bleeding started suddenly, and is associated with fever and pain, it may imply an infection in the gastrointestinal tract.

Bleeding occurring over a period of days to weeks is more likely associated with other problems. Other associated symptoms, such as anal itching, weight loss or a family history of bowel disorders, are also important to note.

Bright red blood with the stool is usually due to haemorrhoids or a small anal tear. Prescription suppositories and ointment and ensuring soft regular motions will help these settle down. Bright red blood mixed with stool or dark tarry stool may be due to polyps, inflammation, diverticular disease or bleeding higher in the gut. If your doctor suspects any of these causes, you will be referred for a colonoscopy.

Treatment varies from simple lifestyle management to ensure regular bowel motions to prescription medicine or surgery. Most causes of blood in the stool are fairly easily treated. However, more serious causes do exist. It’s important not to try and diagnose and treat this yourself. A medical opinion is worth seeking whenever this occurs.

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