Pain in the bottom of both heels

by Matt
(Orlando)

Hello, I'm currently 23, male, in good shape, 5'9", and weigh 160Ibs. I've been dealing with pain in the bottoms of BOTH of my heels for a long time. The pain is almost nonexistent when I'm barefoot but the pain comes on pretty quickly when I wear shoes. My heels will start to hurt after about 10 minutes of standing. My feet will also hurt if my heels are touching the ground when I sit. I can get relief by walking (only short distances, if I walk to far my heels will begin to hurt while walking as well) or taking my shoes off to let my feet breath. My heels aren't sore to the touch. I can use my fingers and touch my heels with no pain. The pain feels like an achy/burning feeling inside my heels. The pain gets worse the longer I stand. If I stand for more than an hour the pain in my heels is almost unbearable.

I've been to two podiatrist and they both said the same thing, "you have flat feet and need inserts/orthotics and motion control shoes". This did not make sense to me since I told them that I don't have pain when I'm barefoot. But I went out and got fitted for motion control shoes and went through about 10 different insoles. None of them helped to relieve my pain. I then went a different route and started wearing minimalist shoes. My feet actually hurt less in minimalist shoes (but my heels still hurt while in them). I went back to one of the podiatrist with this new found knowledge. He told me that I need custom made orthotics and to stay away from minimalist shoes and NEVER walk barefoot. This made no sense to me since I have little to no pain while barefoot. So needless to say, I did not get the orthotics but now I'm wondering what to do next. I don't know whether to go to a holistic doctor, acupuncture, chiropractor, etc. This is a huge deal to me because I'm trying to get into the Marine Corps and they won't take me as long as I'm having foot problems. Any help would be much appreciated.

Thanks,
Matt

RESPONSE

Hi Matt,

Let me start off by complimenting you on your narrative. It is very complete. Most people give me one or two lines and expect me to figure out what is going on.
After reading your narrative, I tend to agree more with you than the podiatrists you have seen. Most people with flatfeet will have more trouble being barefoot than in shoes and according to you, this is just the opposite.
Although I cannot speak on their behalf I think both podiatrists saw flat feet and just figured it is a structural problem like plantar fasciitis or something along those lines.
Although your flat feet are probably the basis for your pain, I think it goes a little bit beyond a structural problem.
When patients tell me their feet hurt the more they stand or the more they walk, the problems that initially come to mind are the following: heel neuroma, heel bursitis or a tarsal tunnel which is the foot equivalent of carpal tunnel as seen in the hands.
A heel bursitis is an inflamed bursal sac in the heel. The bursal sac forms initially, to cushion an area, but the more you "pound" it by walking on it, the more inflamed it becomes and thus the pain.
A heel neuroma is an inflamed nerve branch that happens to travel under the heel and again, the more you stand, the more it will hurt with such symptoms as burning, tingling and outright pain.
A tarsal tunnel is also a nerve condition, but this is a nerve entrapment on the inside of the ankle secondary to a foot flattening out too much. The resultant nerve entrapment, may send pain into the heels.
A more remote situation may include a fracture of your heel bone, but since your pain is occurring in both heels, I doubt that is the case.
What should you do? If you liked one of the podiatrists you have already seen, go back to he or she and mention these potential problems and let them rule them out. If you were not happy with either of them, then I would suggest you find another podiatrist in your area.
Sometimes an orthotic can be effective in treating all three conditions, but depending on the diagnosis, you might need an orthotic with certain characteristics built into it, so it is beyond the scope of this response to recommend a given type of orthotic.
Additionally, again, depending on the diagnosis, a cortisone injection may be indicated as well as physical therapy.
But first you must get an accurate diagnosis.

see related article....bursitis

see related article....heel neuroma

see related article....tarsal tunnel

Marc Mitnick DPM
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