Q: I am a 42 years old man who had a biopsy of my transplanted kidney done 11 months back, which confirmed the recurrence of IgA nephropathy and my serum creatinine level was 3.7 at that time. Now, I am on a heavy dose of immunosuppressive medicines – Cyclosporine 50 mg OD, Mycept 500 mg, Siropan 2 mg/1mg on alternate days along with high blood pressure and cholesterol medicines. My recent report showed creatinine - 2.9, blood urea - 65, haemoglobin - 8.8, potassium - 4.5, uric acid - 5.9, red blood cell - 90, urine albumin - traces. For the last 15 days I am having pain in and around the heel of my right leg. I have tried applying pain reducing ointments, warm water therapy, etc. but of no use. The pain gets aggravated while walking. Last year, I had pain in my big toe while uric acid was 6.4, which subsided within 7 days after applying the above methods. Please advise.

A:Heel pain is often due to a condition called plantar fasciitis. 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).

Treatment is essentially treatment of the primary condition. In your case you have a combination of poor kidney function with poor excretion of uric acid as an underlying problem. In view of your kidney problem anti-inflammatory painkillers are also not safe on a longer term.

The simplest measure in your case would be to ensure that your uric acid levels remain low.

In addition you could take care of not being bare foot at any time. The best footwear for such condition is a microcellular rubber footwear. The cheapest form of this is 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.

As far as your kidney status is concerned I would recommend that you would get in touch with an experienced transplant Nephrologist for advice on this.