Question: I have severe pain at the back of my heel that flares up whenever I start running. I am young, and trying to keep fit, and this constantly prevents my running.
Running puts a great deal of stress on the attachment of the large Achilles tendon into the back of the heel bone. With the constant jarring and pushing on this point, th§ tendon may tear and separate slightly from the bone, leading to acute pain and tenderness at the site. Treatment is by rest, and anti-inflammatory tablets. Occasionally, an injection is given into the sore point to settle the inflammation, and very rarely surgery is required. If you do not rest for long enough, or start running too hard too soon, the problem rapidly recurs.
Running is not the best form of exercise to keep fit because of the excess stress it places on feet, ankles and knees. Swimming and cycling are far more effective, and it is probably better to keep fit with these for a season until the heel has completely healed rather than run.

Question: What can cause pain in the front half of the foot? I cannot recall injuring it in anyway.
Gout is a severe and obvious cause of foot pain, but there are several other common causes.
Metatarsalgia is a condition common in athletes. It is an inflammation of the bones that form the ball of the foot, and is due to prolonged running, jumping or walking, usually on hard surfaces. Soldiers on route marches may develop the condition. Severe pain may develop in the ball of the foot, and the treatment is primarily rest, and anti-inflammatory medications. A ‘march fracture’ of the fore foot bones, due to the stress of continued walking or running on the foot may be another cause. There are minimal changes on x-ray, but excruciating pain on attempting to walk. Six weeks rest heals these fractures. In the elderly, foot pain may be the first sign of poor circulation, diabetes, rheumatoid arthritis or neuralgia.
Because these conditions can be serious, the cause of the pain must be investigated by a doctor and the correct treatment started.

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.