Heel pain can be a real pain in the … well, heel! Whether you’re an avid runner, spend long hours on your feet or love walking around barefoot, heel pain can really put a damper on your day.
While some of us may believe in the mantra “no pain, no gain,” persistent pain isn’t something you should ignore. With the help of Justin Roberts, MD, a foot and ankle orthopedic surgeon with Banner Health, we’ll walk you through all you need to know about heel pain and things you can do to make it feel better.
What causes heel pain?
Being bipedal (walking on two legs) creatures, we put a lot of pressure on our heels. Our heels bear the weight of our entire bodies every time we stand, step, walk or run. It’s no wonder they can sometimes get sore and painful.
“As humans who walk upright, our calf muscles and Achilles tendons get stronger and tighter naturally over time, especially if they aren’t stretched regularly,” Dr. Roberts said. “This continuous stress on the heel and surrounding joints can often lead to chronic heel pain.”
Here are some reasons your heels may be barking at you:
Plantar fasciitis
The most common cause of heel pain is plantar fasciitis. This occurs when the thick band of tissue (the plantar fascia) that runs across the bottom of your foot becomes irritated. “The plantar fascia connects your heel bone to your toes and helps support the arch of your foot,” Dr. Roberts said.
Plantar fasciitis can happen due to several reasons:
- Overuse: Doing activities that involve repetitive stress on your feet, such as running, jumping or standing for long periods, can strain the plantar fascia and lead to tiny tears in the tissue.
- Wrong shoes: Wearing shoes that don’t support your feet well or have thin soles can put extra pressure on the plantar fascia and hurt it.
- Foot problems: Things like flat feet, high arches or poor body mechanics can stress the tissue.
- Overweight or obese: Carrying extra weight puts more strain on the plantar fascia.
Achilles tendonitis
Achilles tendonitis occurs when the Achilles tendon, the large band at the back of your ankle that connects your calf muscles to your heel bone, becomes inflamed.
Here’s how it happens:
- Overuse: Activities that involve repetitive movements of the foot and ankle, such as running, jumping or climbing stairs, can strain the tendon.
- Tightness and imbalance: Tight calf muscles or weak calf muscles can increase the strain on the Achilles tendon during movement.
- A rapid increase in activity: If you suddenly start doing more intense activities without warming up properly, you can overload the tendon and hurt it.
- Wrong shoes: Wearing shoes that don’t support your feet well or don’t have enough padding in the heel can put extra strain on the Achilles tendon.
Other less common causes of heel pain include:
- Heel spurs: Long term, repetitive strain can cause a plantar bone spur to develop on your heel. Many people with plantar fasciitis have plantar bone spurs.
- Fractures or stress fractures: Tiny cracks (hairline fissures) in the heel bone can happen due to repetitive stress or a sudden increase in activity.
- Damage to the fat pad: Over time, especially with aging and repetitive stress, the fat pad beneath the heel can lose its volume and thickness, increasing the risk for heel pain.
- Nerve problems: Certain nerve conditions like tarsal tunnel syndrome, peripheral neuropathy and nerve entrapment syndrome may cause heel pain.
Kick heel pain to the curb
Most cases of heel pain can be treated without surgery and with home care. Your treatment may include:
- Rest and ice: Give your feet a break and apply ice packs to reduce swelling and pain.
- Proper footwear: “Wearing supportive shoes with good cushion and avoiding barefoot walking on hard surfaces is important,” Dr. Roberts said. Avoid wearing high heels and flip-flops.
- Take non-steroidal anti-inflammatory drugs (NSAIDs) as needed: NSAIDs help decrease pain and swelling, but it’s important to follow the dose directions on the bottle.
- Stretching exercises: Stretching is critical to both prevent and treat heel pain. Simple stretches can help improve flexibility and reduce tension in your muscles and ligaments around the heel.
There are several ways to do this:
- Foot roll: Roll your foot gently back and forth on a round object like a frozen water bottle, tennis ball or foam roller. Do this for a minute before switching to your other foot.
- Calf stretch: Stand facing a wall with one foot forward and the other back, keeping both heels flat on the ground. Lean forward, bending the front knee while keeping the back leg straight. Hold for 30 seconds and switch sides.
- Towel stretch: Sit on the floor with your legs stretched out in front of you. Place a towel around the ball of one foot and gently pull until you feel a stretch in your calf and the bottom of your foot. Hold for 30 seconds and switch sides.
When to see your provider or specialist
See your health care provider or an experienced foot and ankle specialist if you continue to experience the following after four weeks of home care and stretching:
- Sharp or stabbing pain in the bottom or back of your heel, especially with the first steps in the morning or after long periods of rest.
- Tenderness and swelling around the heel area.
- Difficulty walking or standing for long periods due to pain.
“The cause of pain can usually be diagnosed simply with a physical exam and weight-bearing X-rays,” Dr. Roberts said.
In addition to home care, your provider may recommend some additional steps to avoid pain in your heel:
- Lose weight: If you are overweight, shedding some pounds can reduce the pressure on your feet.
- Wear supportive shoe inserts: If you have high arches or flat feet or just need extra support, orthopedic inserts may help.
- Start slow and build up: Progress slowly when starting a new exercise routine to decrease the chances of a stress injury by doing too much too soon.
- Cross train: Mix up low-impact exercises, like swimming and cycling, to decrease wear and tear on your feet and heels.
However, if you experience signs of an infection, such as fever, fatigue and weight loss, severe pain or numbness in your foot, seek immediate medical attention.
Bottom line
Heel pain is a common concern that can affect your daily activities and quality of life. If home remedies fail to provide relief, talk to your provider or a Banner Health orthopedic specialist, who can offer personalized care and support to get you back on your feet. Don’t let heel pain hold you back from enjoying life.
