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Pain in the back area of the left heel

by Marjorie
(Austin, TX )

Started hurting about a month ago, especially after long walk or standing on feet for a long time. Friday worked at school (I am 75 year old), helping to set up for a clothes sale for the PTA, Friday afternoon, severe pain in the heel area. This started before Christmas, but just a mild hurt when putting weight (140) on it, then walked to park (about a mile there, each way) since then, the heel has hurt pretty constantly except when not on it for a period of time. Don't remember hurting it but might have stepped on a stone or bur since I am bad to go around in socks. Do I ask my primary dr, or see a foot dr.


RESPONSE

Hi Marjorie,

Well, if you want to get your foot problem solved as quickly as possible then I would certainly suggest you see a foot doctor.
Your primary care doctor more than likely will call it plantar fasciitis since that is the most common cause of heel pain and more than likely he or she is not familiar with the different types of heel pain other than plantar fasciitis.
Based on your narrative it does not sound like you have plantar fasciitis, and here is why.
Most cases of heel pain caused by plantar fasciitis, occur when you first get up on your feet such as when you wake up in the morning. Those initial steps will be very painful, but as the patient walks around, the pain begins to subside. This is because the plantar fascial ligament tightens up over night or after being seated for a long period of time and when you stand up on it and stretch it, it hurts. As you keep walking and keep strethcing (loosening) the ligament, it hurts less and less.
In your situation, the heel seems to hurt from the time you get up on it, throughout the period you are walking on it.
For people in your age range, without knowing anything else about your medical history, my first thought as to the cause of your heel pain would be lack of fat on the bottom of the heel.
The one part of the body where we actually want to be fat is the heel as the fat acts as a cushion, however, as we age, most people tend to lose fat on the bottom of the heel. If you press on the bottom of your heel and can actually feel the bone, and there is pain, then you have probably lost the fat and you are suffering from nothing more than a bone bruise.
Now, if you take your other hand and wrap it around the heel (inside, back and outside of heel) forcing whatever fat is still left back under the heel, and once again press on the bottom of the heel and feel less pain and less protrusion of the heel bone, then that is exactly what you are suffering from.
Now, this can be complicated by the possibility of a stress fracture to the heel bone which can happen from nothing more than just walking.
Further complicating the issue could be the possibility of a heel bursitis or even a heel neuroma, both of which will cause the heel to hurt, the more you walk on it.
Unfortunately, these are issues that the average family doctor will be unaware of and a good podiatrist should be aware of.
Since this problem has been going on for a month now, it does not appear as if it is going away on its own, so a visit to a podiatrist would be my recommendation.

Marc Mitnick DPM
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