Heel Pain

What is heel pain?

Heel pain is the most common problem of the foot and ankle. Overuse and too much stress to the feet can cause heel pain. Most cases of heel pain occur when there is irritation or inflammation of the fascia. Fascia is the tough tissue that supports the arch of your foot. The pain is usually felt the first thing in the morning when you are getting out of bed. After a few steps, the fascia will stretch out and the pain will go away.

What is the cause?

There are many other possible causes of heel pain. These include:

• wearing shoes with cleats or hard soles, or shoes that rub against the back of the heel
• doing too much standing or walking, especially on hard surfaces
• not stretching before exercise
• bruising from stepping on something hard like a stone
• having an overuse condition like bursitis or Achilles tendonitis
• putting extra stress on the feet from being overweight
• having an illness such as gout, arthritis, or psoriasis

The most common cause of heel pain is plantar fasciitis. When the fascia is inflamed it causes heel pain. The inflammation can be caused by too much running, jumping, or walking. Often people who have plantar fasciitis also have problems with heel spurs. A heel spur is a calcium deposit that may form where the fascia connects to the heel bone. A heel spur can sometimes cause pain.

A broken heel, or heel fracture, is rare because it takes a great amount of force to break the heel bone.

How is it diagnosed?

A healthcare provider will examine your foot and ankle.

What is the treatment?

Treatment of heel pain starts with resting the foot. If you are a runner, you may need to walk instead of run when exercising. You may need to add cross training, such as swimming or biking, instead of running. Exercises to make the foot stronger and to stretch the tendons or fascia are very important.

To treat this condition:

• You may need to do foot exercises before getting out of bed. These usually stretch the muscles of the foot and leg.
• Put an ice pack, gel pack, or package of frozen vegetables, wrapped in a cloth on the heel every 3 to 4 hours, for up to 20 minutes at a time.
• Raise your heel on a pillow when you sit or lie down.
• Your healthcare provider may recommend a heel cup, or shoe inserts called orthotics. You can buy orthotics at a pharmacy or athletic shoe store or they can be custom-made.
• Take an anti-inflammatory medicine such as ibuprofen, or other medicine as directed by your provider. Nonsteroidal anti-inflammatory medicines (NSAIDs) may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days.
• Your provider may give you an injection of a corticosteroid medicine.

Other treatments may include ultrasound, electrical stimulation, or hydrotherapy. These therapies may help to reduce the painful inflammation. Some providers may suggest taping the foot to relieve the strain on the tissues.

Surgery is rarely needed for heel pain, unless there is a fracture or severe arthritis. Surgery will only be done after trying other treatments first. Surgery does not always relieve the pain.

How long will the effects last?

You may find that the pain is sometimes worse and sometimes better over time. If you get treatment soon after you notice the pain, the symptoms should stop after several weeks. If, however, you have had heel pain for a long time, it may take many weeks to months for the pain to go away.

How can I prevent heel pain?

Taking good care of the feet can prevent most heel pain. This includes:

• Wearing good shoes that give proper arch support and cushioning to your feet.
• Wearing higher heeled shoes with heels made of soft rubber.
• Stretching the muscles of the foot and calf before walking, running, or any other strenuous activities.
• Starting exercise gradually and slowly increasing the intensity and length of time you exercise.

People who have diabetes, circulation problems, or arthritis need to pay special attention to their feet. They have a greater chance to get an infection and cuts take longer to heal.