Ouch! The Painful Heel

Last week we looked at excessive pronation (improper foot movement) as being one of the main causes of many types of foot problems.  Today let’s look at one of the most agonizing places your feet can hurt…your heel!  Heel pain comes in many varieties.  Pain on the back of your heel is usually related to your Achilles tendon (the largest tendon in the body!) and is something we will discuss in the future.  Today we are talking about pain on the bottom of the foot, around your heel and often extending into the arch of your foot.  Most people describe the pain as being worst first thing in the morning.  When they get out of bed it gets slightly better after they’ve taken a few steps and then it becomes more painful as the day goes on.  This is a very common condition called plantar fasciitis, also called jogger’s heel, tennis heel, policeman’s heel or a heel spur.

The plantar fascia is a band of tissue that runs from your heel to your toes on the bottom of your foot.  Over time the fascia can become tight and becomes inflamed.  When this happens, it starts to pull on the heel bone which often results in a small overgrowth of bone, called a heel spur.  The interesting thing is that it is not actually the heel spur causing the pain, but the tissue pulling on it.  That is why it is usually unnecessary to do surgery to remove the heel spur itself.  We can simply decrease the inflammation to eliminate the pain.

What causes plantar fasciitis?  Often it is a combination of factors.  Obesity, prolonged standing or walking, athletic activity and non-supportive shoes are some of the risk factors we have some control over.  Unfortunately there are other factors at play that we do not have much control over such as the structure and alignment of the bones in our feet, ankle and legs.  As we discussed last week excessive pronation or one leg that that is shorter than the other can also cause plantar fasciitis.

So now we know a little bit about plantar fasciitis what do we do about it?!  There are several steps to take:

  1. The first and most important step is to decrease the amount of time we spend on our feet.  To maintain your exercise regimen try riding a bike or going swimming instead of walking or running. 
  2. Assess your shoes.  Avoid flat shoes such as flip-flop’s, and make sure your arches are well supported.  Bring your shoes to your appointment with a podiatrist to have them evaluated.
  3. Stretching and ice.  In the morning, before getting out of bed, stretch your feet/legs by pointing your toes toward your stomach while you are still lying down.  You should feel a stretch in your calf.  Also, place a water bottle in the freezer and when frozen, put it on the floor and roll your foot over it.  The ice helps reduce inflammation and the rolling motion helps stretch the fascia.  It also feels great after a long day!
  4. Custom orthotics: this is often the best way to recover from the pain, and prevent it from coming back.  Orthotics address the structural issues of your foot so it is important that they  are well made by a qualified podiatrist
  5. Medication: Over the counter anti-inflammatory medications can help and sometimes your podiatrist can offer a corticosteroid injection into the area that will reduce the inflammation and help you heal faster
  6. Surgery. As a last resort, if the pain continues and all other options have been exhausted there is a simple surgical procedure that may help.  It takes about 20 minutes and can be done in the foot doctor’s office.  The recovery is extensive however and the surgery should only be a last resort

Heel pain can be aggravating and cause great disruption to your daily life.  Activities as simple as going to buy groceries can become daunting.  The good news is, you don’t have to live in pain.  Give some of the above strategies a try, and see your local podiatrist for more help.  You can be heel pain free!

Posted on June 20, 2013 .