Although runners and other athletes often get painful heels, heel pain can affect anyone. If the pain originates in the plantar fasciathe thick connective tissue under the skin on the bottom of the foot and the sides of the heelthe condition is called plantar fasciitis. The plantar fascia, which acts as a kind of bowstring for the arch of the foot, can develop small, painful tears under repeated stress.
Other sources of pain may be minute breaks in the heel bone or a heel spur, which is a bony growth on the underside of the heel bone. Tendinitis or bursitis may also be part of the painful heel syndrome.
Symptoms of Heel Pain
- Discomfort in the heel first thing in the morning, when you put pressure on your foot.
- Stabbing, burning or throbbing pain
- Cramping in the legs and lateral knee, ankle and leg pain
- Headaches due to stress by walking in pain
- The pain may ease up as the day goes on, though it may worsen if you are running or walking.
What Causes Heel Pain?
Sometimes there is more than one contributing cause. More commonly, one of the following factors promotes the heel trouble.
- Bad biomechanics. This is another way of saying abnormalities in your walking or running gait that stress your heel bone and the tissues attached to it. Your heel should be the first part of your foot to hit the ground when you are walking and ideally the arch distributes your weight toward the outside of your foot and then toward the ball of it. But if your feet roll inward (pronate) or outward (supinate) excessively, the weight isn’t properly distributed and the plantar fascia and heel bear too much weight.
- Being overweight. Excess pounds stress the heels, as does habitually carrying heavy loads.
- Growing older. Although no scientific study shows that older people are more prone to heel pain, it’s probably true that they are. As you grow older, the pads that protect the heel from injury, like pads under a carpet, can wear down and thus fail to provide the shock absorption they once did.
- Frequent running, walking or tennis playing. These vigorous weight-bearing activities stress the heel, especially if a person also has excessively pronating feet or other biomechanical problems.
What If You Do Nothing?
Heel pain will often clear up on its own—though it may take months to do so. However, if pain is severe and you begin limping, over time this can can put adverse stress on other body parts, including your ankles, knees, hips and back.
Home Remedies for Heel Pain
- Rest. If your heel does begin to hurt, rest is the first line of defense. Limit your activities for a few days.
- Take over-the-counter anti-inflammatories. Nonprescription NSAIDs (aspirin, ibuprofen and naproxen) should help reduce pain, though they won’t accelerate healing.
- Apply ice. Massage your heel with a small plastic jar or cup filled with ice or do foot-rollers: roll your heel over an ice-filled plastic jar or a container of frozen juice. Afterward, pull your toes upward with your fingers.
- Do some stretching stretches. Tight calf muscles can tighten the fascia and contribute to heel pain.
- Cross train. Cross train with non-weight-bearing activities such as swimming, water running in deep water or bicycling in order to protect the heel while maintaining physical conditioning.
- Gradually resume running or walking. Once pain diminishes, slowly return to your previous level of physical activity. Reduce your training intensity if pain returns—you need to find a happy medium between rest and activity.
- Be patient. It can take months for the problem to go away. However, for nearly everyone, the prognosis is complete recovery.
Plantar Fasciitis: Inexpensive, Effective Home Remedies
According to two years of national research by the American Orthopaedic Foot and Ankle Society (AOFAS), involving 76 men and 160 women, a few simple exercises and over-the-counter shoe inserts are by far the most effective way to treat heel pain arising from the plantar fascia. Stretching and cushioning over a period of six to eight weeks are all it takes in most cases to cure a painful heel.
The first line of treatment consists of two simple exercises to stretch the Achilles tendon (at the back of the foot) and the plantar fascia. These should be done several times throughout the day. Dr. Glenn Pfeffer, chairman of the AOFAS Heel Pain Study Group, has suggested 15-second stretches every waking hour.
Next, buy a silicon heel cushion at the drugstore and wear it in a comfortable shoe with shock-absorbent soles. The Bauerfeind Viscoheel (silicon) was one brand used in the study; the Tuli heel cup (rubber) and the Hapad Comforthotic (the cheapest, made of felt) were also used. Silicon worked best of the three simply because it provided the most cushioning.
Some groups in the experiment only did the stretching exercises: 72 percent got better with just exercise. But the results for those who combined cushions with exercise were really impressive. From 80 to 88 percent of those using rubber or felt showed improvement, as did 95 percent with silicon. Surprisingly, all of these treatment methods worked better than a custom arch support, which was also tested. Other recent studies, too, have found that exercises and cushioning the foot constitute the first line of treatment for heel pain.
Calf stretch (achilles tendon). Standing two to three feet from a wall, place one foot near wall, keeping feet perpendicular to it. Lean forward and place forearms against wall, keeping rear knee straight (but not locked) and rear heel on floor. Hold for 10 seconds, feeling the stretch in calf. Repeat 10 times. Then switch legs and repeat. For a variation, keep the rear knee slightly bent during the stretch.
Heel stretch (plantar fascia). Stand near table or counter and lean forward on it. Slowly squat while trying to keep heels on floor. When heels just start to lift off floor and you feel the stretch across the bottom of feet, hold position for 10 seconds. Straighten up, then repeat 10 times.
- Buy shoes that offer support. Make sure they have shock-absorbent soles, rigid shanks and some extra padding in the heels. Good ankle counters are important, too, so your foot doesn’t slip up and down.
- If you are overweight, try to slim down. This will take pressure off your tired and overtaxed feet.
- Pace yourself. If your feet hurt when you are exercising or playing sports, take a break. Try to judge if your feet have been hurting from overdoing it in your sport or other activity.
- Check your gait. Have an orthopedist or podiatrist check your gait and stance to see if your feet pronate excessively.
- Check the surfaces. Avoid exercising on non-resilient surfaces like concrete.
- Switch shoes. If you must wear dress shoes for work, wear athletic shoes to and from your place of employment, as well as at home.
- Discard or repair any shoes with worn-down heels and soles.
- Get adequate rest.
Beyond Home Remedies: When To Call Your Doctor
If heel pain is severe enough to wake you at night and doesn’t improve over time with self-care measures—heel pain often persists for several months—you may need the advice of a physician or podiatrist to figure out what’s causing it. Also contact your physician if you suspect an infection, arthritis, gout, diabetes or other ailment that could be a contributing factor to your heel pain.
If your heel pain is due to a biomechanical problem, your plantar fascia and heel may bear too much stress. A specialist in foot mechanics may be able to correct the problem with a custom-made orthotic device.
What Your Doctor Will Do
After a close examination, which may include an x-ray and blood tests, your doctor may recommend any of several options, including taping and strapping of the heel, orthotic devices, medication and special exercise, depending on what your diagnosis is.
Surgery is seldom necessary, except in some cases for removal of a spur. If your physician suggests surgery, be sure to try other treatments first. As with any surgery, you should get a second opinion.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media