Q: I am 55 years old and have severe pain in the soles of my feet. Also, I feel the soles are warm and I feel irritation. The pain increases towards the evenings. It reduces only after I sleep. There is no pain till I walk the next morning. I have consulted an orthopaedic who says that there is no cure for this problem. They have ruled out flat foot/any growth inside. One of the doctors said that there could be some inflammation in the sole and it may take a long time for it to heal. They have not prescribed any medicine or treatment. The only thing I have been advised is to use MCR footwear. Is there any permanent cue to this?

A:Heel pain is a common condition in adults and > 40 years old people that may cause significant discomfort and disability. A variety of soft tissue, osseous, and systemic disorders can cause heel pain. Narrowing the differential diagnosis begins with a history and physical examination of the lower extremity to pinpoint the anatomic origin of the heel pain. The most common cause of heel pain is plantar fascitis. Patients with plantar fascists report increased heel pain with their first steps in the morning or when they stand up after prolonged sitting. Patients with plantar heel pain accompanied by tingling, burning, or numbness may have tarsal tunnel syndrome. Heel pain rarely is a presenting symptom in patients with systemic illnesses, but the latter may be a factor in persons with bilateral heel pain, pain in other joints, or known inflammatory arthritis conditions. The heel pad is composed of columns of adipose tissue separated by fibrous septae. It is located directly beneath the calcaneus and acts as a hydraulic shock-absorbing layer. Elderly and obese patients who present with plantar heel pain may have symptoms caused by heel pad damage or atrophy. Although the symptoms of heel pad disorders overlap considerably with those of plantar fascitis, heel pad pain is typically more diffuse. Heel pad pain involves most of the weight-bearing portion of the calcaneus, whereas plantar fascitis pain is centred for the most part near the calcaneal tuberosity. In contrast to pain caused by plantar fascitis, heel pad pain tends not to radiate anteriorly, and dorsiflexion of the toes does not increase the pain. Patients with known systemic arthritis conditions, bilateral heel pain, or symptoms involving joints beyond the heel should undergo a thorough review of symptoms to assess for systemic illness as a possible cause of heel pain. You should also get a blood glucose level measurement done. If that is normal, you can have the course of 2 to 3 local injections. X-ray may be necessary. Most of the patients get better with these modalities of treatment. If the pain continues, more investigation and surgical procedure may be required.