Most commonly, heel pain is due to inflammation of the plantar fascia — the tissue along the bottom of your foot that connects your heel bone to your toes and helps support the arch of your foot. The condition is called plantar fasciitis (PLAN-tur fas-e-I-tis).
Plantar fasciitis causes stabbing or burning pain that's usually worse in the morning because the fascia tightens (contracts) overnight. Once your foot limbers up, the pain normally decreases, but it may return after long periods of standing or after getting up from a seated position.
In most cases, you can kick the pain of plantar fasciitis without surgery or other invasive treatments. And you can take steps to prevent plantar fasciitis from recurring.
Plantar fasciitis usually develops gradually, but it can come on suddenly and be severe. Plantar fasciitis can affect both feet, but it usually occurs in only one foot at a time. Watch for:
- Sharp pain in the inside part of the bottom of your heel, which may feel like a knife sticking in the bottom of your foot
- Heel pain that tends to be worse with the first few steps after awakening, when climbing stairs or when standing on tiptoe
- Heel pain after long periods of standing or after getting up from a seated position
- Heel pain after, but not usually during, exercise
- Mild swelling in your heel
Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. But, if tension on that bowstring becomes too great, it can become irritated or inflamed. The causes of plantar fasciitis can be:
- Physical activity overload - Plantar fasciitis is common in long-distance runners. Jogging, walking or stair climbing also can place too much stress on your heel bone and the soft tissue attached to it, especially as part of an aggressive new training regimen. Even household exertion, such as moving furniture or large appliances, can trigger the pain.
- Arthritis - Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis.
- Diabetes - Although doctors don't know why, plantar fasciitis occurs more often in people with diabetes.
- Faulty foot mechanics - Being flat-footed, having a high arch or even having an abnormal pattern of walking can adversely affect the way weight is distributed when you're on your feet, putting added stress on the plantar fascia.
- Improper shoes - Shoes that are thin-soled, loose, or lack arch support or the ability to absorb shock don't protect your feet. If you regularly wear shoes with high heels, your Achilles tendon — which is attached to your heel — can contract and shorten, causing strain on the tissue around your heel.
Your risk of developing plantar fasciitis increases if you are:
- Active in sports - Activities that place a lot of stress on your heel bone and attached tissue are most likely to cause plantar fasciitis. This includes running, ballet dancing and aerobics.
- Flat-footed or have high arches - People with flatfeet may have poor shock absorption, which increases the stretch and strain on the plantar fascia. People with highly arched feet have tighter plantar tissue, which also leads to poor shock absorption.
- Middle-aged or older - Heel pain tends to be more common with aging as the arch of your foot begins to sag, putting stress on the plantar fascia.
- Overweight - Carrying around extra pounds can break down the fatty tissue under the heel bone and cause heel pain.
- Pregnant - The weight gain and swelling that accompany pregnancy can cause ligaments in your body — including your feet — to relax. This can lead to mechanical problems and inflammatory conditions.
- Wearing shoes with poor arch support or stiff soles - A closet of poorly designed pumps, loafers and boots can mean plantar problems.
Diagnosis can be easily made with a standard physical examination and accurate history. X-rays are rarely needed in the initial evaluation, but when done often reveal a bone spur in the heel.
In the past, bone spurs were often blamed for heel pain and removed surgically, but have since been found to not the cause of pain.
Almost all cases of plantar facsiitis can be treated without surgery, options include:
- Stretching - A patient directed stretching program is the most important way to treat plantar fasciitis. Stretching must be done every day, multiple times a day.
- Night splints - May recommend as well. This holds the plantar fascia and Achilles tendon in a lengthened position overnight so that they can be stretched more effectively.
- Orthotics - Your doctor may prescribe custom-fitted shoe inserts (orthotics), which are specially molded to your feet, to help distribute pressure to your feet more evenly. These are generally recommended if over-the-counter shoe inserts don't work.
- Anti-inflammatories - A short course of over the counter non-steroidal anti-inflammatories can be helpful.
SURGICAL OR OTHER PROCEDURES
If conservative treatment doesn't provide relief, you might consider:
- Corticosteroids - When other treatments don't work, your doctor may suggest one or two injections of corticosteroid medication into your foot for temporary relief. Multiple injections aren't recommended because they can weaken your plantar fascia and possibly cause it to rupture, as well as shrink the fat pad covering your heel bone.
- Extracorporeal shock wave therapy - In this procedure, sound waves are directed at the area of heel pain to stimulate healing. It's usually used for chronic plantar fasciitis that hasn't responded to more conservative treatments. Early studies on this procedure reported positive results, but some recent studies have had limited success in treating plantar fasciitis. More research may determine if extracorporeal shock wave therapy is an effective treatment for heel pain, and if so, what kind of machine and treatment regimen seems to work best.
- Surgery - Only a small percentage of people need surgery to detach the plantar fascia from the heel bone (plantar fasciotomy). It's generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot.
You can take some simple steps now to prevent painful steps later.
- Maintain a healthy weight - This minimizes the stress on your plantar fascia.
- Choose supportive shoes - Give stilettos the boot. Also avoid shoes with excessively low heels. Buy shoes with a low to moderate heel, good arch support and shock absorbency. Don't go barefoot, especially on hard surfaces.
- Don't wear worn-out athletic shoes - Replace your old athletic shoes before they stop supporting and cushioning your feet. If you're a runner, buy new shoes after about 400 miles.
- Start sports activities slowly - Warm up before starting any athletic activity or sport, and start a new exercise program slowly.
- Wake up with a stretch - Before you get out of bed in the morning, stretch your calf muscles, arch and Achilles tendon by reaching for your toes and gently flexing your foot. This helps reverse the tightening of the plantar fascia that occurs overnight.