What’s the diagnosis?
For this man, years as a policeman on the beat, walking on unforgiving pavements, together with a diet of good food washed down with a few beers, had led to obesity and difficulty walking because of severe pain in his heel. A point of extreme tenderness on the underside of his heel was noted, at the point of insertion of the plantar fascia; this is the tight band of connective tissue that supports the arch of the foot and is attached to the calcaneum.
The answer: plantar fasciitis
Plantar fasciitis (also known as policeman’s heel) usually presents in middle age in about 10% of the population, particularly those who are overweight and walk a lot. The patient was advised to avoid walking as much as possible and reassured this usually resolves in time. Obesity compounds it, so advice on diet and activity (swimming and cycling rather than walking or running) should be given. Shoe inserts may help to relieve the pressure. Cortisone injection is effective. Night splints to keep the foot at a 90° angle may help, but can be uncomfortable. Surgery may be necessary for persistent cases.
- Dr Jean Watkins is a retired GP in Hampshire