Question: I have had a sharp pain in my foot for some years now. X-rays are normal, but the instep becomes very painful. No doctor can find anything wrong. I would be very pleased if you could give me an answer to this.
I recently read an entire medical journal devoted to the subject of foot pain, and there are several dozen different possibilities. The one that springs most readily to mind is a condition called plantar fasciitis.
The sole of your foot is kept hard and firm by a band of fibrous tissue just under the skin. This is called the plantar fascia. If this becomes stretched, strained or inflamed, it will become very painful. If the foot is rested, the pain settles, but recurs when any prolonged walking or a small amount of running is performed. The only treatments are very prolonged rest, anti-inflammatory medications, and sometimes injections of steroids into the tender part of the foot. Other causes of foot pain include arthritis, gout, corns, plantar warts, bunions, poor circulation, anemia, nerve inflammation, minor cracks in the bones and scores of others. If your GP is unable to find a cause and effective treatment, request referral to an orthopedic surgeon for further assessment.

Question: I have severe pain under my heel. It is making it very difficult to walk, and I spend a lot of time on my feet in my job. What could be the cause?
Pain under the heel is one of the most common problems seen by a GP. It can be caused by a spur on the bottom of the heel bone, by inflammation of the large fibrous band that maintains the arch of the foot, or from damage to the heel tissues from running on hard surfaces. Joggers are particularly susceptible to heel pain, and should ensure that they wear good running shoes, and run on grass rather than roads.
Rest is the most important part of treatment. Swimming and cycling can be substituted for exercise while the damaged tissue recovers. Anti-inflammatory medications prescribed by a doctor may ease the discomfort, but some patients require injections of steroids into the heel. These are very successful in curing what can become a chronic problem, although they may be rather painful to receive. Many doctors inject local anaesthetic with the steroid to minimize the discomfort.

Question: I have had plantar fasciitis for nine months, and have been treated with physiotherapy, arch supports, Orudis gel, cortisone injections and osteopathy. I still have foot pain with walking. Is there anything else that I can do?
The arch of the foot is maintained by a strong ligament along the outside of the foot and under the sole. If this ligament (the plantar fascia) becomes inflamed because of injury, the patient develops the painful condition of plantar fasciitis.
The most common place for the inflammation to occur is the point where the ligament attaches to the heel bone, and the ligament may actually tear away from the bone by a fraction of a millimeter, resulting in considerable pain that may persist for months. You have tried all the recognized treatments for the condition with the possible exception of taking anti-inflammatory tablets, but these may upset your stomach.
Many patients suffer for months with this problem, but most eventually settle with time. My advice at this stage would be to persist with the arch supports in good shoes, walk quietly and never run or jump, ride if you can avoid walking (even riding a bike or using roller skates is better!) and try using anti inflammatory tablets provided your stomach can tolerate them.

Question: I have plantar fasciitis that has been plaguing me with pain for years. What causes this problem? Can massage or other treatments help?
The problem may start after excessive exercise (eg. an unusually long run or walk), after a sudden sharp injury (eg. landing heavily after jumping), or it may start for no apparent reason.
The most important treatment is rest, and several weeks on crutches may be very beneficial. Other treatments include the anti-inflammatory tablets that you have already taken, pain-killers, physiotherapy and occasionally steroid injections into the foot. As a last resort, the foot may be put in plaster for a few weeks to ensure total rest. Massage would be more likely to irritate the problem than help.