Ankle and heel pain

by Bill
(Wichita, Kansas)

My right ankle and heel hurts severely when I first get up from setting to the point that I can hardly walk. But after walking across the room and back the pain tends to lessen quite a bit. But when I set back down and get back up the pain returns. I have been walking since the first of the year and currently I average 3 miles a day. I'm 67 years old and in good health otherwise. I have gone a week before without walking but the pain remains the same. Most people complain of pain after walking but I tend to have pain until I begin walking. What do you think?

RESPONSE

Hi Bill,

Morning stiffness, or in your particular case, pain when first starting to ambulate is highly suggestive of osteoarthritis or the "wear and tear" arthritis that all of us suffer from to some extent.
As we age the joints of the body begin to wear out. Certainly at age 67 you would fall into this category. As the joints of the body, in this case your ankle joint, begin to wear down, the joint begins to narrow, the cartilage which is the end point of the bone, that articulates with the cartilage on the adjacent bone (thus forming a joint) begins to erode.
The combination of these events results in stiffness of the joint. so when you first get up in the morning basically the ankle joint is "creaky" and will hurt as it begins to move. However, once you get going, the joint loosens up and starts moving more freely and thus your pain diminishes or even disappears, only to return should you sit down for a prolonged period of time.
As far as the heel goes, I am assuming it is the bottom of the heel that hurts. In this instance, it sounds like you have a case of plantar fasciitis. The plantar fascial ligament is a long ligament that extends from the bottom of the heel to the ball of the foot. Basically this ligament serves to maintain the congruity of your arch.
During the night, once again, the ligament will tighten up. When you take your first steps in the morning, you stretch the ligament and will feel pain. However, as you continue to walk, the ligament loosens up and stops hurting. If this is what you are experiencing, then you have classic plantar fasciitis.
Assuming I am correct on both counts then what are you going to do about it?
My first recommendation obviously would be to see a foot specialist who can confirm the diagnosis as I am making a diagnosis on the other side of the internet and that is hardly scientific.
Anyway, assuming I am correct, my first concern would be your gait. If you exhibit a pronated gait which is a highly flexible gait, or, if your gait is more of a supinated nature where there is not much motion in the joints of the foot and ankle when you walk, then a device known as an orthotic might be very helpful.
In other words, if you can better balance the way the foot functions when you walk, you will dramatically reduce the stresses on the plantar fascial ligament and the ankle joint. The analogy I use in my practice is that wearing an orthotic is the equivalent of having the tires on your car balanced; the tires wear better and you get a better ride.
Now I am not saying an orthotic will correct all the destruction that has occurred over 67 years of walking, but it should reduce your pain dramatically and prevent further destruction.
The ankle joint is the ankle joint and the damage done is irreversible, but the plantar fasciitis is very capable of completely disappearing.
In addition, a short term of physical therapy can be very helpful in reducing your symptoms but without some sort of long term plan, your pain would probably return after the therapy.

Marc Mitnick DPM
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