Walking and Heel Pain

Q:  Since retiring, my favorite exercise is walking, often two or three miles every other day. It makes me feel great and keeps me trim. Since I live in Milwaukee I do all my walking on cement sidewalks, usually wearing Reeboks.

Two months ago I awakened with a painful left heel. I tried hot baths and rest, which helped to relieve the pain slightly, but the pain persists when I walk. I would appreciate any advice that you can give so that I can enjoy walking again.

A:  Heel pain occurs primarily in adults and is present in about 10% to 15% of the older population. In one study of 100 people with heel pain, the average age was 48, with a range from 20 to 85. Many people have the mistaken notion that bony spurs are the cause of heel pain, and that removing the spur will remedy the pain, but there probably is no single cause of heel pain. The spur is not actually "bone" but calcification at the point where the foot fibers insert on the heel bone. Partial tears in the foot fibers or inflammation because of repetitive impact may result in pain. Treatment can be divided into 3 types: mechanical, medications, or surgery.

Dr. Michael Shereff, an orthopedic surgeon who specializes in foot and ankle diseases, believes strongly that an operation should truly be a last resort. He recommends beginning with mechanical methods to reduce the pressure on the heel pad, such as getting sturdy shoes. Rubber-soled "wedgie" shoes will decrease the impact load of the heel on hard surfaces. Other devices, which may be helpful, include firm plastic heel cup and flexible arch supports. He also teaches patients to do exercises that stretch the heel cord and foot fibers several times a day. Obviously activities that promote the pain may need to be curtailed for some time.

If these measures do not provide relief, then anti-inflammatory medications such as ibuprofen should be tried. Injections into the heel pad are also an option.

With conservative treatment alone, there is a good chance for resolution of the symptoms. In the study of 100 patients mentioned above, 82% had complete resolution, 15% had fair results with continued symptoms but no limitation in activity, and only 3 patients had poor outcomes. Those 3 patients all had pain in both heels. Other risks for continued problems included being overweight or having pain for a long period before seeking medical attention.

Maybe you could try walking on other surfaces than concrete and see if it makes a difference, for instance in a mall, on a treadmill, or on an indoor track.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.