Heel pain, not a spur

by Denise
(Phoenix, AZ)

I drive for long periods of time and am very over-weight. A couple months ago my right heel (gas foot) began hurting around the back edge where I rest it on the floor of the bus as I drive...and in my car when I drive. The pain became unbearable so I saw my old foot doctor and she X-rayed both feet and compared to my old X-rays; but nothing had changed over 10 years. She didn't know what would be causing my heel to hurt so much. She gave me a shot of cortisone which had helped me years prior for a spur, but this only gave me relief on the left part of the heel and then only for about 10 days. Now the whole back edge of the heel hurts every bit as much as it did before. There's no discoloration or swelling, nothing appears wrong. Any thoughts on this, doctor? (and if I could--I'd kick myself for spending $174 for nothing, lol!)

RESPONSE

Hi Denise,

Well, the free advice you are about to receive from me should help mitigate some of the $174.00 you spent elsewhere. Just remember, you get what you pay for.... lol.

Anyway, a cortisone injection was not such a bad idea, but unfortunately with cortisone injections, as I tell my patients, you can get absolutely no relief, all the way to complete resolution of the problem, to anything in between. That is just the nature of cortisone injections.

I am not so sure your weight has much to do with this as much as the nature of your work. I assume your foot is leaning in virtually the same position for hours upon hours. If that is the case then you are getting a bruising in the back of the foot where the back of the heel meets the bottom of the heel. On x-ray, you may have seen some bone irregularity on the back-bottom portion of the heel which would exacerbate the problem.

So...in essence your problem is the result of your occupation. You could have cortisone injections until the cows come home, but if you do not do something about the source of the pain, your problem will continue.

It would seem to me, the best approach would be to try and cushion the area to cut down on the excess pressure on the back-bottom of your heel.

Lets do a little experiment. With your finger press into the area that generally hurts to get a "base line" of how painful the area is.

Next, take one hand and wrap it around the back of the heel. By doing this you are forcing all the fat in your heel to stay in place (as opposed to displacing away from the back of the heel, such as when you are driving).

Now with one hand cupping the heel, forcing all the heel fat inwards, with the other hand, once again, press into the sore spot.

Now if you notice there is less pain compared to when you initially pressed on the sore spot I think your solution may be reasonably simple.

What you need to do is purchase what is known as an egg shell heel cup. You can purchase them here.


By using an egg shell heel cup you are essentially keeping all the fat in your heel "stuffed" between the heel bone and the back of your shoe. What has been happening up to this point is that when your foot rests in the driving position continuously for long hours, the fat in the back of the heel gets displaced away from the bone and you are ending up with a bone bruise which is essentially the source of your problem.

Hopefully this has helped. I do see this type of problem from time to time particularly in people who spend many hours driving with their foot in one particular position.

Marc Mitnick DPM
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