Middle-age spread appears as the pounds creep up on the scales, first 10, then 20. You undertake a rigid exercise program only to be stopped by extreme heel pain--a condition affecting up to 3 million Americans each year.
Painful heel syndrome primarily affects overweight people in their 40s and 50s. Excruciating pain occurs when first putting weight on the heel in the morning. The pain eases after 30 minutes but recurs once the person stands after sitting for any length of time.
Sufferers often are told the pain is caused by a "bone spur" and surgery is recommended, at times unnecessarily.
The trouble may involve a bone spur, but the cause of the pain more often than not is from tiny stress fractures in the bones of the foot, according to Dallas surgeon Charles Graham. "If someone recommends surgery for a heel spur, be cautious and seek a second, even a third opinion," said Graham, clinical associate professor of surgery at the University of Texas Health Science Center in Dallas. "There is a lot of unnecessary surgery going on in this respect."
In a study of 400 patients with heel pain, Graham found that 80% of them had a stress fracture--a weakened area in the bone or muscle. Although heel spurs were found in many patients, their presence or size had no relationship to the patient's pain, he said. "The formation of the spur is a result of the trauma. The natural healing process is to form a spur."
But of those patients with stress fractures, 95% recovered without surgery with mild stretching exercises and over-the-counter, anti-inflammatory medication. Most of the patients were middle-aged and had a fairly rapid weight gain over the previous six months, he said. Then suddenly they decided to change their sedentary life style with walking, jogging or aerobic exercises.
"They're carrying more poundage, then decide to get fit," Graham said. "They get a little gung-ho and double the amount of exercise."
Others had undergone coronary bypass surgery and after recovering were placed on exercise programs by their physicians.
"They tried to do too much too soon," Graham said. "They had been inactive several weeks. Their bones weren't strong enough to take that extra stress that soon."
That sudden and prolonged stress causes the flexor brevis--the muscle extending from the bottom of the heel bone to the underside of the toes--to pull loose from the heel, he said.
The muscle pulls on the bone, causing a hairline stress fracture, Graham said. "It's a fatigue fracture or stress line that develops from multiple small injuries.
10 Minutes of Exercise
To avoid painful heel syndrome, middle-aged persons should start with a 10-minute daily exercise program and increase it only about 10% a week, he advised.
For those with the syndrome, Graham recommends mild stretching exercises. Place your hands on the wall in front of you with your good foot flat on the floor in front and the injured foot behind. Stretch the foot and leg, without touching the injured heel to the floor.
The exercises should be done for 5 to 10 minutes in the morning and again at bedtime. Stretching the muscles in the foot and calf promotes healing and prevents further injury when weight is applied to the heel.
Graham also recommends a mild exercise program of walking or swimming for chronic heel-pain sufferers.
"Rarely does the bone spur have to be removed to get rid of the pain," he said. "Only one out of 1,000 heel spurs needs to be surgically removed."