imageMost pain associated with the heel can be tied to one disorder: plantar fasciitis . "There is a ligament called the plantar fascia which attaches at the heel bone and then runs through the arch and into the toes," explains podiatrist Lowell Scott Weil, Jr. "Its function is to support the arch in an arch position. If you bend your toes back, you can feel a tight band in your arch. That is the plantar fascia."

Forces acting on the foot while walking or running 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. 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 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.

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.

Prevention

"We see a lot of shoe gear problems, especially with runners," notes Douglas Hale, a podiatrist in the Seattle area. "However, bad shoe selection also can cause heel pain in people who walk for exercise or who are on their feet a lot in their jobs. It should be stressed that price alone is not an indicator of quality in shoes."

He suggests three things people should look for in a shoe (whether for walking or running):

  • Hold the back of the shoe where your heel is located and try to squeeze the two sides together. If there is a sufficiently firm heel counter, you will not be able to collapse it.
  • Take the toe of the shoe and bend it up toward the heel. The shoe should bend at the front, not in the middle. If it bends in the middle, the shoe is too flexible and will not provide enough support.
  • Put one hand on the heel and the other on the toe. Twist the shoe like you are trying to wring out a towel. The less you can twist it, the more support there is for your foot.

Another preventive measure is to do stretching exercises 2-3 times a day. One stretch you can do is to place one foot behind you and lean forward keeping your knee stiff. Hold that position for 15-20 seconds, then switch. Repeat this on each leg at least three times per session.

Diagnosis

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

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:

  • Switch to a good pair of shoes.
  • Try using over-the-counter shoe inserts.
  • 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 medicine (eg, ibuprofen, naproxen). Follow the directions on the label or those given by your doctor.
  • Avoid activities that cause a pounding of the foot. Bicycling and swimming are good alternatives for exercise during this time.
  • If the pain is not gone within 7-10 days or becomes so bad that you have trouble walking, talk to your doctor.

Other Treatment Options

"Stretch splinting” at night can be tried to improve symptoms and reduce the duration of activity limitation. Other treatments could include:

  • Physical therapy
  • Steroid injections or botox injections in the heel
  • Shock wave stimulation
  • Splints used to keep the foot straight while sleeping
  • Cast to keep the foot immobilized
  • Surgery as a last resort