Long-distance runners and professional athletes get it, and so do sedentary people. The young are usually exempt, but the older you are, the more likely you are to have it
We’re talking about heel pain, which almost everyone experiences eventually. About two million Americans suffer from heel pain at any given time, and it remains the most common disorder seen in foot clinics.
Heel pain is most often caused by plantar fasciitis, an inflammation of the thick fibrous band of tissue (plantar fascia) on the bottom of the foot that connects your heel bone to the base of your toes. The pain tends to be particularly severe when you put weight on your heels first thing in the morning or get up after a long period of sitting. It usually lessens after you’ve been moving for a half hour or so.
The following can bring on plantar fasciitis:
- Wearing high heels or thin-soled flats
- Vigorous and/or prolonged participation in sports or weight-bearing exercise, especially in ill-fitting shoes
- Walking and/or running on hard surfaces a lot
- Being overweight
- Having tight calf muscles that limit how far you can bend your foot upward at the ankle
- Very flat feet or very high arches
- Differences in leg length
- Overpronation (your foot rolls inward too much as you walk or run)
Heel pain can, of course, have other causes. It may come from minute fractures of the heel bone, or from inflammation of the tendons (tendinitis) or fluid-filled sacs called bursae (bursitis) in the foot. Arthritis can also cause heel pain, and diabetes can be part of the problem too. A bony growth on the heel bone, known as a heel spur, can develop along with plantar fasciitis.
What to do for plantar fasciitis
Plantar fasciitis generally heals by itself; the average episode lasts nine months. For a first or severe episode of heel pain, it’s a good idea to see a physician, who may refer you to a physical therapist and/or podiatrist.
Heel pain is very amenable to self-treatment. As with many aches and pains, no one treatment works for everybody. In fact, there’s no evidence that one therapy is better than another. Try the following:
- Limit your activities and keep weight off your foot when possible.
- Don’t stop exercising, but avoid high-impact activities that stress the heel. Try cycling and swimming.
- Lose weight if you are overweight.
- Try over-the-counter pain relievers such as acetaminophen, aspirin, or ibuprofen.
- Make sure your shoes are comfortable and well-cushioned and have shock-absorbent soles. They should have good construction at the heel that keeps your foot from slipping up and down. Don’t wear thin-soled shoes.
- A soft silicone heel cushion or heel cup or an orthotic insert for your shoe can also be helpful. You can buy reasonably priced heel cushions and inserts at the drugstore. Your doctor may suggest custom-made orthotic inserts. Specially designed and cast for your foot, they typically cost about $400 or more, including for the examination and casting. Some medical insurance plans cover them. But it’s not clear that these are any more effective than the ready-made kind.
- Ice your heel, for 20 minutes three or four times a day.
- Massage your foot or roll it over a tennis ball.
- To combine the benefits of icing and massage, roll your heel and arch back and forth over a can of frozen juice concentrate or an ice-filled plastic bottle.
- First thing in the morning, stretch your plantar fascia. Sit and cross your legs so the affected foot rests on the opposite knee. Grab the base of the toes and pull towards the shin, so you feel the stretch across the sole of the foot. Hold for 10 seconds; repeat 10 times. In a 2010 German study, people who did this three times a day for eight weeks experienced significant improvement, more so than those receiving shockwave therapy (see below).
- Try unilateral heel raises (high-load strength training). A 2015 Danish study found that they decreased pain from plantar fasciitis better than plantar-specific stretching.
- Also stretch your calf muscles: Leaning on a table, place one foot six to 12 inches in front of the other. Slowly squat, keeping both heels on floor. When heel of rear foot starts to lift and you feel the stretch across the bottom of that foot, hold position for 10 seconds. Straighten up; repeat 10 times, then switch legs and repeat.
- Do toe-strengthening exercises, such as picking up a towel with your toes.
When heel pain persists
If your pain does not improve with self-treatment, and if it keeps you awake at night or if you cannot walk without limping, your doctor may suggest treatments such as night splints, taping of the heel (usually done by a podiatrist or physical therapist), shockwave therapy (which involves pulses of high-pressure energy), low-level light therapy, or a steroid injection (used cautiously). A phsyical therapist may also work on trigger points in the calf that may be involved in plantar fasciitis.
Some studies find these treatments beneficial; others do not. If your doctor suggests surgery, get a second opinion. Surgery is seldom necessary except for the removal of a heel spur and then only in some cases.