The policeman’s heel

Dr. Sylvester Ikhisemojie

This is an interesting name for a disturbing problem. It has its origins in the initially higher proportion of the disease seen in the early policemen who developed the disability as a result of their daily beat. The walking, the foot patrols around their neighbourhoods in those days several centuries ago before the introduction of the patrol car or the squad car depending on which type of English you wish to speak, is believed to have been the cause for many.

It is a puzzling phenomenon which causes immense pain in the foot between the heel and the middle of the foot. It is more common in women than in men. It is also more easily seen in the years between the when people are reaching the peak of their strength and when they retire. Therefore it is more common between the ages of 40 and 60 years. It is characterised by severe pain in the area of the heel, worse on waking up in the morning and improving within the first few minutes after waking up and commencing the normal movements around the house.

The policeman’s heel is a common problem which is seen in one person out of every 10. Many people will experience it at some point during their active lives. People who spend long hours on their feet standing, walking or even running are more likely to develop this problem. It is believed to develop as a result of the inflammation of a sac of protective fluid surrounding the heel bone, known as a bursa. The bone in question is called the calcaneum. Connecting this bone to the middle of the foot is a tough tissue called the plantaris fascia which usually is responsible for the ability of the foot to maintain its shape. This configuration in the foot helps it to also act as a shock-absorber. When either the bursa or the fascia becomes inflamed, pain results. Technically, the conditions are separate but they share many similar features as a result of which we shall consider them together in this essay. Usually, direct injuries to the bursa would involve the fascia but the same is not necessarily true the other way round. In the end, the entire foot is condemned to suffer. This disease, known medically as plantar fasciitis is the most common cause of pain in the foot. The former called plantar calcaneal bursitis is the true policeman’s heel. However, you must always allow your doctor make the distinction for more effective treatment.

Often, the pain involves the entire foot, but it is worse usually in the region of the heel and the sole of the foot. It is a distressing kind of pain which fortunately goes away on its own after many months, with or without treatment. It begins when the plantar fascia, a band of tissue in the foot becomes thickened or damaged as might occur in a fall into a man-hole or in jumping from a high wall, fence or building with a fracture of the heel bone resulting. Many situations like this will cause bruising to occur in the heel, pain will be the result and such pain can then be relieved by resting the foot or using pain medications. Although the symptoms generally start gradually, many of the cases listed above will cause such pain to develop suddenly with the person unable to walk without having severe pain. Limping is the result and athletes, who can also suffer from this condition, are then unable to continue with their relevant training.

As can be appreciated from all the above, the policeman’s heel can be seen in many ordinary people who are not policemen. Long distance runners as would have been seen in many participants at the Lagos marathon would have suffered from it at some point in their lives or career. Pressing directly on the heel will elicit pain. It is a problem also seen in soldiers who spend long hours on their feet marching or performing sentry duties. Any sudden stretching of the sole due to too much strain or what may be described as overuse will cause such pain. A jogger who suddenly increases the distance he usually runs or their speed of running can suffer such damage. So also is he who has poor starting technique at the beginning of a race when he takes off at the blast of the whistle.

A runner whether professional or amateur, who change their running surface will probably suffer as above when they change their training from a grass field for example to a paved road. So also is the person who runs with shoes that do not have adequate padding, shoes or boots that are unable to take some of the cushion off the heel.  Shoes or boots lacking the amount of adequate padding or support that can support the foot make it much easier to sustain damage to the foot and the heel. Similarly, people who previously led a sedentary lifestyle and have suddenly taken up sports are likely to suffer from this problem. And as we have frequently seen on this page, those who are overweight or obese and want to take up some form of sport are prone to developing this problem. Similarly at risk are people who exercise with the wrong kind of footwear. The pain caused in this condition is often described as stabbing in nature. Sometimes, people just refer to such pain as an ache. The very first steps taken in the morning upon waking up are the most painful; or after a long period of rest when no weight has been placed on the foot.

The problem is easy to diagnose when your doctor has taken your history and examined the foot. Investigations are seldom necessary or even useful. Occasionally, X-rays are taken of the foot to exclude fractures in that area especially if there has been a fall or an accident.  Also, an ultrasound scan of the sole is rarely necessary to confirm the diagnosis because most times, all it will show is a thickened fascia with associated swelling in plantar fasciitis. Usually, firm pressure exerted with the fingers at about two finger breaths from the edge of the heel will cause sharp pain. Treatment is usually a combination of some pain relievers, rest of the foot and the wearing of sensible, comfortable footwear. There is proper footwear for every activity and such should be adhered to in managing this problem. With the passage of time, it resolves.

Ask the doctor

Dear doctor, thank you very much for your past help. I have a 14-year-old son who complains frequently about having pain in his left knee. Sometimes, the knee becomes stiff and he falls down. What do you advise us to do? This is very worrisome and he wants to take up football as a vocation. Thank you. 0802xxxxxxx

Well, you should worry because the danger he faces is in the falling. He could fall for instance while crossing a road or in the toilet and hit his head at some hard object with sad consequences. I would suggest that you visit an orthopaedic surgeon without delay so that he can have a proper examination of his two knees and possibly have X-rays done as well. The findings obtained will determine what treatment he should get.

Dear doctor, I usually feel sharp pains in the left side of my stomach. It happens mostly when I walk long distances or when I walk for about eight to 13 minutes. I have been noticing this for a while now and I am scared. Is it not appendicitis? 0815xxxxxxx

If you do this kind of physical exertion infrequently, you could experience the sort of pain you now have. It has nothing to do with appendicitis because you have observed correctly that only exercise brings it about. If it was appendicitis, there will be other symptoms such as an aversion to food and nausea. Occasionally also, there may be a mild fever. In addition to that, it is usually the case the appendicitis occurs in the right side of the abdomen. If you were one of those peculiar people who have theirs on the left side, you probably would have had an idea of that possibility before now because of some other features not related to appendicitis that you might have showed up with earlier in life. This complaint seems more than likely to be a muscle cramp which you can treat with a simple massage or with pain relievers.

Dear doctor, I am 46 years old and have a wonderful marriage that is blessed with three children. Recently, I observed that I am no longer able to have sex with my wife more than once at night. We are still satisfied but I am curious to understand why that is happening at this age. I think I am still young enough to do more. 0812xxxxxxx

You have to understand that after the age of 40 years, many of the things you were once able to do begin to be less easy. Strength is reducing at a one percentage point per annum for every year you live beyond 40. The testosterone level, the hormone that determines your masculinity, also begins a slow downward spiral. As a result of these changes, your sexual prowess, if you will, also diminishes. However, I do not see your complaint as a problem because if you go once and both of you are satisfied, once is therefore enough. The rest may actually be punishment. Some other people of your age are even unable to sustain an erection and frequently have to be aided to achieve what you can still do without stress.

Dear doctor, my urine is deeply yellow and I feel some burning sensation when I urinate. What medications can you prescribe for me to treat this problem sir?  0809xxxxxxx

The yellow urine may just be an indication that you are drinking enough water. During this time of the year, your intake of water and other fluids must be very liberal so that your urine can have a normal colour. Additionally, any medicines you are presently taking including multivitamins and food supplements can deeply affect the colour of your urine. The burning sensation you experience while urinating may be due to an infection which you can only determine when you do a urine culture. In the end, it is your doctor who will tell you what kind of urine tests you should be doing the result of which will guide your treatment.

Dear doctor, my daughter of 14 months sweats every night within one hour of taking a bath. The incidents started after six months of life. The sweating starts from the chest and back to her shoulders. She drinks a lot of water and the sweat soaks the bed sheet always. What is responsible for this? Thank you sir. 0802xxxxxxx

At this time of the year, depending on what kind of house you live in and in what part of the world you are in, such a problem has to be taken into the proper context. To live in a single room apartment for example, in the heart of the city with poor ventilation and incessant power cuts, you will have a child who sweats like you have described. They are not able to tolerate much heat. If however, you live in a well aerated flat or duplex and your child sweats like you have just described, you must see a paediatrician to help find out what the problem is. If nothing else seems to be wrong with your baby, she feeds normally and there is no fever and no cough, the chances are that she is in dire need of air-conditioning which will remove this problem like magic.

Dear doctor, my son has bow legs (knock knees). They are very bad and now make him seem shorter than his age mates. What is the solution sir? Thank you.  0802xxxxxxx

That is a very interesting problem. First of all, you should see an orthopaedic surgeon for a thorough evaluating of your son’s condition. That will aid his treatment which may include the use of drugs as well as an operation down the line or a corrective operation alone as the problem becomes clear. You will find orthopaedic surgeons in the teaching hospitals, federal medical centres and the national orthopaedic hospitals around the country. If you live in Lagos, you will also find orthopaedic surgeons at some of the general hospitals as well. In any of these places, they will be able to solve the child’s problem.

Dear doctor, Thank you very much for the good work you have been doing through your column in SUNDAY PUNCH.

May God Almighty reward you abundantly. I need your advice on a predicament I have been passing through. I have been experiencing a burning sensation in my right leg, precisely my between my knee and ankle. I have carried out a blood sugar test as suggested by some pharmacists. The result was negative. Besides, I do not have a history of diabetes in my immediate and extended families. When I apply some prescribed ointment on it at times, I get some relief but it returns later. I have started feeling funny about the other leg and I am really afraid now. What do you think is responsible and what is the solution? Thank you. xxxx@xxx.co.uk

Sorry to be responding to your mail these many days late. I believe that your sensation is due to a nerve problem. As a result, you need to visit a neurologist for consultation and examination. You will not get the proper treatment from a pharmacist. We are not even certain at this point whether you saw a genuine pharmacist. But see a physician for starters and let the system run your problem through the mill for its expected solution. Do that soon and best of luck.

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