My wife is an avid hiker but has not been able to walk for months due to heel pain. Her doctor and podiatrist both suggested plantar fasciitis, but it is not typically painful, and she has not responded to treatment. She is 67 years old.
Peter Goode, via email.
Heel pain, as your wife has discovered, can be a bothersome and debilitating condition.
The most common causes are plantar fasciitis – an inflammation of the ligament of tissue that runs across the bottom of the foot, causing pain in the heel and arch of the foot – and Achilles tendon pain caused by inflammation of the tendon at the back of the heel.
Diagnosing these conditions is usually straightforward because the pain tends to follow a specific pattern at a time. It appears from your longer letter that your wife’s pain is slightly outside of the typical range for plantar fasciitis.
Research, including ultrasound, has confirmed that your woman has a thickening of the Achilles tendon, which suggests that there is inflammation.
My suggestion is that the pain is due to a bruise of the fat pad caused by the breakdown of the protective fat pad under the heel that usually acts as a shock absorber
They say she received extracorporeal shock wave therapy, which uses a device to transmit sound waves through the skin of the foot to increase blood flow to the affected area.
The idea is that this will help reduce inflammation. Studies have shown that this can be effective for plantar fasciitis and Achilles tendonitis – but it wasn’t effective for your wife.
My suggestion is that the pain is due to a bruise of the fat pad caused by the breakdown of the protective fat pad under the heel that usually acts as a shock absorber.
This can be due to overuse or injury and can cause persistent pain, especially during long periods of stance or walking.
The periosteum (the membrane covering the bone that contains sensory nerves and blood vessels) may also be less protected, which can be causing your woman’s pain.
This is a less common diagnosis and has no definitive treatment, but in the few cases I’ve seen, it’s ultimately settled.
Sometimes a donut-shaped heel pad that you can get from your pharmacist is of more value than a full heel pad (you mention that your wife wears insoles). Two or three weeks of no stress can also help.
This is not an evidence-based suggestion, but it is worth making these diagnoses with your wife’s doctor.
I am concerned about high ferritin levels in my blood – 790 or higher compared to normal levels below 400. I had an ultrasound; What other tests do you recommend to rule out hidden diseases?
Joe Seet, Sidcup, Kent.
The good news is that the detailed tests you had – an abdominal ultrasound and special blood tests – would have ruled out any serious illnesses.
Ferritin is a protein in the blood that carries iron. Elevated levels (usually above 400 ng / ml in men and 300 ng / ml in women) may indicate iron overload, but it can also be due to, for example, inflammation.
This can be caused by a number of medical conditions including metabolic syndrome (a combination of diabetes, high blood pressure, and obesity) and kidney failure as they cause inflammatory responses. In rare cases, cancer can increase ferritin levels – but the numbers tend to be far higher than yours.
Increased iron absorption can be the result of hereditary hemochromatosis caused by a faulty gene. In your case, this is a possibility and can be checked with an additional blood test called the transferrin saturation test. This can be done with the help of your family doctor.
Liver disease can also lead to an increase in ferritin, as damage to liver cells releases stored iron into the circulation.
If your recent blood tests ruled out liver disease, it is likely that your increased levels were due to inflammation or infection. This can be confirmed by additional blood tests that look for a compound called C-reactive protein (CRP).
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Dr. Scurr cannot conduct personal correspondence. The answers should be given in a general context and should always consult your own general practitioner if you have any health concerns.
In my opinion … let science judge cannabis
The use of medical cannabis was legalized in the UK in 2018, but NHS prescribing is limited to well-defined conditions such as rare forms of epilepsy.
Patients can get private prescriptions for conditions such as pain and anxiety, but it can be costly and access is limited to a handful of clinics. As a result, many people use illegal supplies and risk arrest.
Now a patient who uses cannabis to treat her chronic pain has set up a program called Cancard where you pay £ 20 for a photo ID that says you are using cannabis for medical purposes only to avoid prosecution, if questioned by a police officer.
While the Federation of Police has been reported to have endorsed the program, what we really need is solid evidence of the wider use of medical cannabis, fueled by adequate science, not law and order concerns. I suspect myriad benefits are demonstrated, but the dog-tail wagging approach is not correct.
It is believed that around a million people in the UK regularly use cannabis to treat their disease