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Why do I have pain in my feet?

Q: I am a 32 years old woman who had a caesarean section 3 years ago. For the last 7-8 months I am suffering from pain in my feet. At night when I get out of my bed, I cannot walk due to pain. I cannot stand or work for long durations due to pain. I never used high heel footwear and just do walks in my house premises. Please advise.

A:Unfortunately you have not clarified where exactly your pain is. Pain in the foot can be: pain in the heel, pain in the forefoot, generalised pain in the sole of the foot, localised pain in the foot because of what or a corn, pain at the attachment of the achilles’ heel, pain because of flat foot, in addition there are several other sites and causes of foot pain. I presume you have pain in the heel extending to the sole of the foot. This is often due to a condition called plantar fascitis. In this there is inflammation (swelling) in the tissue of the heel. Quite often this is part of what is known as an enthesiopathy (inflammation occurring around the attachment of tendons and ligaments). This could occur in arthritic conditions or in patients without any arthritis also, occasionally can also be painful in patients with high uric acid levels or patients with hypothyroidism (low levels of thyroid hormone). At times it is also seen in the post-partum phase. The pain is severe in the morning and the first few steps are uncomfortable. The first few steps are uncomfortable also after any prolonged sitting. The condition is quite harmless but has a lot of nuisance value. It is good get a baseline investigation to locate your ESR (blood test), your uric acid. If there is a family history of diabetes get your blood sugar also done. Occasionally as mentioned earlier you may need to get thyroid functions also but do this only if the pain is intractable or your gaining weight, feel lethargic and have excessive sleep. Treatment is simple analgesics but it is more important to care for your feet. Take care not to be bare foot at any time. Always ensure that you have a soft sole foot wear. The best footwear for such a condition is a microcellular rubber foot wear. The cheapest form of this is the conventional hawai chappal. You could keep separate ones for the bathroom and for your regular use and make sure you never put your foot on the ground without any footwear. Protecting your heel from any hard impact will help healing faster. Earlier local steroid injections were recommended routinely but there is evidence to show that this causes damage to the fat pad of the heel, which is very important for walking. Therefore this is to be only used as a last resort for intractable pain.

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