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. The fascia is a fibrous band of tissue that connects the heel bone to the toes. The pain is usually felt the first thing in the morning when 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, hard soles, or that rub against the back of the heel
• doing too much standing or walking, especially on hard surfaces
• not preparing for exercise by stretching first
• bruising from stepping on something hard like a stone
• having an overuse conditions like bursitis and Achilles tendonitis
• having extra stress to 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 even walking. Often people who have plantar fasciitis will also have problems with heel spurs. A heel spur can sometimes cause pain. A heel spur is a calcium deposit that may form where the fascia connects to the heel bone.

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 check for problems by testing the foot's sensation and movement.

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.

Treatment may also include:

• Exercises: You may need to do foot exercises before getting out of bed. These usually stretch the muscles of the foot and leg.
• Ice: A cloth-covered ice pack can be put on the heel for no more than 20 minutes at a time at least once a day, and up to 8 times a day.
• Shoe inserts: A heel cup or orthotic with an arch support may be put in the shoe to help with pain.
• Medicine: Anti-inflammatory medicine such as ibuprofen can be taken for the pain. Adults aged 65 years and older should not take non-steroidal anti-inflammatory medicine for more than 7 days without their healthcare provider's approval. Occasionally an injection of cortisone may be tried if exercise, rest, ice packs, and other medicines have not helped.

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, except occasionally for a fracture. If it is, it will only be done after trying other treatments first. Surgery does not always relieve the pain.

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 the heel made of soft rubber.
• Stretching the muscles of the foot and calf before walking, running, or any other strenuous activities.
• Beginning 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.