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image Most pain associated with the heel can be tied to one disorder: plantar fasciitis. The plantar fascia is a long, thin ligament in the bottom of your foot that connects the heel to the front of your foot and helps support your arch.

Forces acting on the foot from excess pressure or repetitive activity cause the arch to flatten out. At the same time, the plantar fascia is trying to keep this from happening. These opposing forces put tremendous stress on the tissue, causing microtears in the ligament. When enough continuing stress exceeds the body’s ability to heal itself, the tissue under the heel becomes injured and painful.

Symptoms

The symptoms of plantar fasciitis include severe heel pain, especially first thing in the morning. Most people say that it hurts from "the instant their heel touches the ground." Some even feel pain and stiffness when starting to walk after sitting for a while. It gets worse after prolonged weight-bearing, walking, or standing. Pain can also radiate into the arch or sole of the foot.

Plantar fasciitis is often seen in persons over 40 years old or in those who are overweight. There is also an increase in visits to doctors during the spring and summer months as people resume activities involving walking or running. Among runners and other athletes, shoes that do not support the foot properly commonly lead to plantar fasciitis.

Diagnosis

Diagnosis is most often made by assessing the place (middle of the bottom of the heel) and timing of the pain. The doctor will also question you on your activity levels and history of pain.

While fractures, infection, and arthritis can also occur, the place and timing of the pain is usually different. Sometimes an x-ray or other imaging test is needed to exclude these other causes.

Treatment

Over-the-Counter Remedies

Some treatment options include:

  • Rest your foot. Avoid activities that cause pain. Bicycling and swimming are good alternatives for exercise during this time.
  • Perform calf stretches and plantar fascia stretches.
  • Switch to a good pair of shoes that fit the heel snugly and offer arch support.
  • Try using over-the-counter arch supports or soft heel pads.
  • Night splints to help keep your feet pointed up and the plantar fascia stretched while you sleep.
  • Put ice on the heel for 20 minutes, three times a day. Other options include special Blue Ice gel packs available at most pharmacies and many running supply stores.
  • Use a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen or naproxen to reduce pain and swelling. Follow the directions on the label or those given by your doctor.

Other Treatment Options

If home remedies are not working, your doctor may try more aggressive treatments. These treatments may include:

  • Physical therapy—to improve strength, flexibility, and range of motion
  • Custom made orthotics
  • Steroid injections or botox injections in the heel
  • Shock wave stimulation
  • Cast to keep the foot immobilized
  • Surgery as a last resort

Be aware that it may take several months for your injury to heal completely. Do not return to sports or normal activity until your doctor says it is okay to do so.

  • American Academy of Orthopaedic Surgeons

    http://www.orthoinfo.org

  • American Podiatric Medical Association

    http://www.apma.org

  • Canadian Orthopaedic Foundation

    http://www.canorth.org

  • Canadian Podiatric Medical Association

    http://www.podiatrycanada.org

  • Heel and arch pain. Foot and Ankle Center website. Available at: http://www.footankle.com/heel-arch-pain2.htm. Accessed January 31, 2014.

  • Plantar fasciitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 13, 2013. Accessed January 31, 2014.

  • Plantar fasciitis and bone spurs. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00149. Updated June 2010. Accessed January 31, 2014.