Left heel

by Diane
(Secane,, PA)

When I wake up or get up from couch or chair I am stiff and heel hurts as I begin to walk. As I walk around ok. I wear 24/7 sneakers with heal pad inside and helps. End of the day hurts. I am 59. I work as a cook and on my feet over 6 hrs and lifting. Ive soaked in warm warm, sea salts, muscel cream and still there after 3 weeks. Also have below the ankel a clear swollen blister like papules and get pain at times around it. Did drop a bag along side of ankel when I opened freezer door a few weeks ago.Not sure if it is bruised, papules or plantar and what I can do.

RESPONSE

Hi Diane,

The scenario you describe of getting up (out of bed), stepping down and having a lot of pain is classic plantarfasciitis. The plantarfascial ligament is a strong, thick ligament that attaches from the heel into the ball of the foot, the purpose of which is to maintain your arch.
Sleeping, or sitting for a long period causes the ligament to tighten up. Then when you first stand of it, it stretches, but because it is stiff, it begins to hurt. As you walk around and keep stretching the ligament, it eventually loosens up enough so that the pain diminishes.
The problem for you is that after standing for six hours, the heel is very sore.
In many instances, the soreness found at the end of the day is more than just plantarfasciitis. The two common causes of this "end of day pain" is usually the result of a heel bursitis or even a heel neuroma which is a pinched nerve that gets caught up in the inflammation caused by standing on your feet all day.
Most restaurant kitchens are concrete floor and even though some people may have pallets to stand on, the long term standing on hard floors is what is causing the plantarfasciitis because this ligament has to over work. Additionally, it is contributing to either the heel neuroma or heel bursitis.
If you are overweight this too will contribute to the pain.
The good news is that you are wearing sneakers and assuming they have a good arch support and assuming there is cushioning in the heel area, that is a step in the right direction.
More often than not the support of the sneaker will not be enough, depending on your foot structure and your weight. In these cases it will require some type of orthotic, which is a device that goes into the sneaker to better support the foot, so that the plantarfascial ligament does not have to work so hard.
In my practice, orthotics are the central core of treament; unless the ligament is adequately supported, the foot will never get better on its own and even if it does improve through medication or injections, you will be doomed to recurrence without some type of support.
Another factor working in your favor is that you have only had the problem for about three weeks.
In my profession we make a distinction between acute plantarfasciitis and chronic plantarfasciitis. Fortunately you are still in the acute phase. Chronic plantarfasciitis, also known as plantarfasciosis is a much more difficult problem to correct especially in those who make their living standing on their feet.
The best advice I could give you is to see a podiatrist in your area before the problem becomes chronic; chronic being anything over 2-3 months in duration.
Soaking your feet, applying cream, taking Advil, etc. will help a little bit, but unless the plantarfascial ligament is adequately supported, more than likely you problems will continue.
As a final point, I have discussed the most common cause of your foot pain, but should you not respond to standard medical treatments, further investigation would be necessary.

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article....heel pain

see related
article....heel neuroma

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article....bursitis

Marc Mitnick DPM
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