I have really bad foot pain when I get out of bed in the morning... what's going on? DR SCURR reveals the common condition to blame, why it gets worse as you get older and exactly how to treat it
I have trouble putting weight on to my feet when getting out of bed due to painful heels. The right one in particular stays sore until I get going. Why might this be?Alan Weir, Waterlooville, HampshireDr Martin Scurr replies: Severe heel pain when putting weight on your feet is a classic sign of plantar fasciitis – or inflammation of the plantar fascia, a band of tissue that runs along the bottom of the foot from the heel to the toes.Typically the pain is worse first thing in the morning as the tissue tightens overnight and then stretches when you stand up. This gradually eases over the next few minutes.Plantar fasciitis is most common from middle-age, simply as a result of tissue ageing, and is typically triggered by unsupportive footwear or a sudden increase in exercise – such as a long walk. Or both.It’s diagnosed by pressing on a point on the underside of the heel, called the medial calcaneal tubercle, which will cause acute pain if the fascia is inflamed.If there is any doubt, you may be offered an X-ray – there might be a spur of new bone extending into the fascia from the heel bone, which is a result of inflammation and repair mechanisms. Damage to the Achilles tendon can also cause heel pain, though at the back of the heel rather than under it. Also pain tends to occur throughout the day as the tendon comes under load.I suggest you see a physiotherapist or a podiatrist who will confirm the diagnosis and show you stretches that can improve flexibility and pain. Typically foot pain is worse first thing in the morning as the tissue tightens overnight and then stretches when you stand up, says Dr Martin ScurrAn orthotic insole under the heel can help as it takes the strain off the inflamed tissue. You can buy these online or on the High Street, but your healthcare professional can best help you find the type you need.In some cases, this treatment doesn’t relieve the pain and you may need to be referred to an orthopaedic specialist for a corticosteroid injection – though this is a last resort (not least because it is painful and risks include rupture of the plantar fascia).On a recent morning flight to Portugal I fainted in my seat for 30 seconds before take-off. I was taken by ambulance to hospital, but all checks were clear. Should I worry about flying? I’m 81.Alex Jones, ManchesterDr Martin Scurr replies: A faint – known as a vasovagal episode – is a brief loss of consciousness and can be brought on by anything that causes a drop in blood pressure significant enough to temporarily cut normal blood flow to the brain.All manner of things could do this – from the early travel, perhaps after a sleepless night (a lack of sleep reduces the body’s ability to regulate blood pressure) or anxiety about missing the flight.In addition, standing in queues at security or at the gate can allow blood to pool in the legs, reducing flow to the brain.In your longer letter you mention you ate breakfast before boarding and this may have contributed. Digestion requires extra blood flow to the stomach, so if your heart rate and blood vessels fail to adjust, blood pressure drops throughout your body, depriving the brain of blood which could have made you feel faint.In older adults this is not uncommon, especially in those with blood pressure problems (you mention you are on ramipril, a drug for high blood pressure). Usually it occurs within an hour of a meal.Mild dehydration, especially if you deliberately reduced fluid intake prior to travelling to avoid needing the loo during the flight, can also be implicated.I am trusting that the doctor who examined you in A&E listened to your heart carefully and presumably an electrocardiogram (ECG) was carried out to rule out any abnormalities.Some heart rhythm disorders, such as atrial fibrillation, can come and go and may not be detected by an emergency ECG or with a stethoscope. I’d ask your GP for a 24-hour ECG (you wear a monitor at home and it sends the results to your doctor).If all is well in respect of your heart, there is no reason why you should not fly in future – though perhaps seeking assistance to reduce stress and the time spent standing might be a sensible precaution.Infection with meningococcal group B (MenB) bacteria overwhelms the body so quickly that anyone who contracts it can become ill at breakfast time and die by teatime. The bacteria cause the lining of the brain to swell and spread to the blood, swiftly leading to deadly sepsis.Time is so much of the essence that GPs always carry injectable antibiotics to be given the moment it is believed that a patient has the infection – before even calling for an ambulance.It is a matter of pride that in 2015 we were the first country in the world to offer a vaccine, Bexsero, which protects against all strains of MenB. Before this, children received the ACWY vaccine – which protects against other meningococcal bacteria strains.But recent outbreaks of MenB (which led to the death of sixth‑form student Lewis Walters last month) have caused great public anxiety. That’s why I welcome the news of a catch-up programme, to offer teenagers too old to have had the Bexsero vaccine, from July.This will ensure all those at highest risk of this lethal disease can be protected. For to lose teenagers from MenB when it is preventable is both shocking and little short of unethical.
