Foot healed. Heel hurts. Help heel heal?
April 17, 2013 8:17 AM   Subscribe

I broke a metatarsal in my foot last September, and (without a follow-up X-ray, which I really should do at some point), it seems better. My heel, however, hurts like the dickens. What's up, foot?

The break was near the top of the little-toe metatarsal on my left foot, and seemed very reluctant to heal -- I spent a few months on crutches with little result, more time with a cane with little result, and finally when I got referred to an orthopedic specialist he said "drop the cane and the crutches and the post-op shoe and just act normally, I want to encourage your foot to heal on its own."

That was at the end of last November. I haven't felt much pain in the broken part of the foot since then. I went for a test run of 3 km this morning, and the front-of-foot feels more or less fine.

But when I spend any amount of time walking, and especially after my run today, putting pressure on my heel is painful. Not screaming agony, but wince-with-every step, limp-slowly painful. It lessens if I walk consistently for a few minutes, and becomes more acute if I rest for a while and then get up (getting coffee at work, for instance).

I figure that this is due to the muscles in my heel atrophying or something. I know that I've lost all the running/walking callous on my left foot -- all the dead skin just sloughed off after a few months of non-use when I was on crutches -- and my foot is now remarkably smooth and soft compared to my right foot. But I'd like some reassurance (or dire warnings, if appropriate) about why my heel hurts so darn much when it seems like the rest of the foot is healing up more or less fine.
posted by Shepherd to Health & Fitness (18 answers total) 2 users marked this as a favorite
I am not a doctor, nor your doctor, but this sounds like the symptoms of plantar fasciitis.
posted by BusyBusyBusy at 8:35 AM on April 17, 2013 [1 favorite]

Have you seen a Physical Therapist aka physio? Your gait might have been affected. I'd schedule a few sessions with someone so they can analyze or tweak your gait.
posted by barnone at 8:35 AM on April 17, 2013

Can you clarify how much heel pain you were experiencing between end of November when you got rid of the crutches etc. and today (it sounds like some?) and when you first started experiencing it? It could be plantar fasciitis, which is really obnoxious to deal with. You perhaps had a mild case over the past few months that you really aggravated by running on it.
posted by drlith at 8:38 AM on April 17, 2013

My first thought was also plantar fasciitis, but I'm not sure if that comes about after injury and rest the way whatever is going on with your foot has.

See a doctor.
posted by ablazingsaddle at 8:41 AM on April 17, 2013

I had a similar metatarsal fracture, and although I was only on crutches for days, it did take a couple of months to get back to walking properly. You've just been wearing normal shoes for a couple of months, not the boot thing? Is it possible that you've worn down the padding given the increased pressure on the heel, or are these different shoes? If these are sneakers you haven't worn in a while, are they at all old and worn out anyway? It does kind of sound like PF, and if so, there are some basic stretches and amelioration techniques that you could try. I would say see your orthopedic specialist or a physical therapist.
posted by jetlagaddict at 8:43 AM on April 17, 2013

Sometimes walking awkwardly to protect one injury can cause a compensatory injury in another spot. I'd say plantar fasciitis is a good guess.
posted by cecic at 8:50 AM on April 17, 2013

sounds like it could be a heel spur, which can be caused by plantar fasciitis. A podiatrist or orthopod can evaluate - an xray is diagnostic - and can inject the heel for pain control and to reduce the inflammation. If you do have plantar fasciitis, it is typically much worse in the morning, when the fascia has has contracted. Stretching - like hanging by the ball of your foot off a step - will stretch the fascia and reduce the fascia symptoms.

I'm afraid I can't comment on routes to permanant correction if that's the cause. I've lived with both conditions for upward of 5 years. Others tell me physical therapy or just time can heal plantar fasciitis, but not for me.
posted by citygirl at 8:52 AM on April 17, 2013

Nthing possible plantar fascitis. I also broke my fifth metatarsal, and after a couple months in the cast and then going back to regular shoes, I developed it a few weeks later. Better arch supports in my shoes for a while took care of it.
posted by EmpressCallipygos at 9:00 AM on April 17, 2013 [1 favorite]

I agree that this could be plantar fasciitis if the soreness starts first thing in the morning or after you get up from sitting for a while. If it creeps up when you run, it could be something else. Do you have a sports medicine clinic near you? They deal with these things better than the average GP, the clinic gives you access to physio, and you wouldn't need to escalate to an orthopedic surgeon right away.

If it is PF, it's probably arising from changes in your gait and tightening of your calves and achilles tendons. Massage from a physiotherapist, stretching and working out the "knots" in the sole of my foot at home helped me recover from months of severe PF in 2005-2006. See. See also.

From experience, it's the wee breaks in the metatarsal that can take months or even over a year to feel 100% recovered from. I would suggest sticking with walking or even cycling for now until your forefoot feels completely OK, not just kind of OK. Running can put a lot of stress on the forefoot. And if you have to put a walking cast back on for any reason, you can still cycle effectively if you have decent platform pedals.
posted by maudlin at 9:22 AM on April 17, 2013

I used to get that kind of pain pretty frequently from wearing work boots and from generally poor posture. I recently learned to treat it by massaging the bottoms of my feet and my calves. I massage my feet by rolling the sole of my foot back and forth on a smallish rubber ball; I massage my calves using my knuckles while sitting on the ground, or by rubbing my calf on the opposite knee while sitting in a chair. The idea is to find the knots and iron them out, so to speak, using deep, stroking pressure.

I learned the techniques from reading The Trigger Point Therapy Workbook by Clair Davies. Trigger points are basically small, chronic muscle knots that cause pain, joint instability, and other problems. I've had a lot of success using that book to relieve a few different types of chronic pain and stiffness. One of the nice side effects of treating my heel pain by massaging my calves is that I can now touch my toes for the first time since elementary school.
posted by Commander Rachek at 9:47 AM on April 17, 2013

Response by poster: I'm going to see a GP tonight, actually -- I'll ask, and thanks.

If this is PF, can I walk on the foot without aggravating the condition? It's annoying, so far, but seemed to be gradually diminishing over time (until I went for a run this morning).
posted by Shepherd at 11:04 AM on April 17, 2013

If this is PF, can I walk on the foot without aggravating the condition? It's annoying, so far, but seemed to be gradually diminishing over time (until I went for a run this morning).

It's not gonna, like, kill you that you've been walking on it for a couple days, no. It's just painful. But for me, better arch support for a while took care of it and now it's gone.
posted by EmpressCallipygos at 11:11 AM on April 17, 2013

Shepherd, your choice of footwear can make a big difference in avoiding "adding insult to injury" if it is plantar fasciitis. Better arch support = more gooder. Standard running shoes are probably better than something flat-soled and floppy like Chuck Taylors. No flip-flops or anything like that. If you've got time, stop by a sporting goods store and pick up a pair of green Superfeet insoles (better) or even just the nearest drug store for some Dr. Scholls arch supports (better than nothing).
posted by drlith at 11:15 AM on April 17, 2013

...and also avoid walking barefoot around the house. Put your shoes on first thing in the morning and keep 'em on.
posted by drlith at 11:16 AM on April 17, 2013

Response by poster: This has been going on for months, to be honest -- I just assumed it was a normal part of the healing process and I'd eventually "walk it off". I only asked about it today because going for a short run exacerbated it considerably.

I walk to work and back every day, about 80 minutes all told, in an old pair of construction boots. Again, I've been seeing what I think is a slow diminishment over time, but running today really dialled it back up to 11.
posted by Shepherd at 1:02 PM on April 17, 2013

One thing they taught my husband, (who has similar pain) was to stretch his feet before his feet hit the floor in the morning. Gently grab your toes, and pull toward your body. If you can't reach use a towel to do it.

If he does this daily, and wears good shoes and Super Feet insoles, it helps a lot and he works on his feet. Also, icing the heel in the evening helps.

This is if it is plantar fascitis. He also has to wear something with support at home if he is on his feet.
posted by SuzySmith at 4:19 PM on April 17, 2013

Massage therapist here. There's a pad of fat under the skin of your heel, and as the name implies, provides padding to the calcaneus (heel bone) during walking and to some extent when running. This pad may have atrophied during your time on crutches. A physio or PT should be able to advise you on what to do; meanwhile, and without having seen your foot or knowing exactly where it hurts, a donut shaped pad for your heel might help.
posted by flutable at 11:11 PM on April 17, 2013

Hard to tell from your description; although it rings my plantar fasciitis bells it could be something else as well. The key thing with PF is that it's related to your fascia - the tissue which connects your heel to your toes (metatarsals) losing some of its flexibility. Thus, instead of stretching when you move, it tears slightly (the blood then has nowhere to go and calcifies, forming the heel spur). It's usually worst in the morning or when standing/walking again after long periods of sitting.

If I were you, I would see a doctor/podiatrist and get a diagnosis. You will probably need to get x-rays. If it is PF, the things that helped to fix my plantar fasciitis (and I tried a lot) were simple stretching in the morning, good shoes with proper support and custom-made orthotics. Your doctor/podiatrist may have other advice and I don't want to contradict them, but if it is PF I would start with the stretching (unlikely to hurt even if it doesn't help) and getting better shoes (will generally be a good thing).

The stretch is very easy: before you get out of bed in the morning, sit on the edge of your bed. Put the foot that hurts up on your opposite knee (eg left foot on right knee). Grab your toes and gently pull them back. This stretches the fascia. Hold the stretch for at least 30 seconds. If you think the other foot might be affected, do the other foot as well. Ideally you'd do about a minute on each foot. It has been many years since I found this technique, but it was in a scholarly physiotherapy journal and was amazing - it doesn't work immediately, but if you keep it up over time it will help. Have told others who display PF symptoms about the stretch with positive results - and like I said, it's not going to hurt anything.

Ironically, after my PF getting better I now have problems with my achilles, right at the bottom where it joins the heel. I still search for a solution since podiatrist offers nothing effective.
posted by Athanassiel at 12:55 AM on April 18, 2013

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