Heel pain is most often caused by plantar fasciitis—a condition that's sometimes also called heel spur syndrome when a spur is present. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation or, rarely, a cyst. Because there are several potential causes, it's important to have heel pain properly diagnosed. A foot and ankle surgeon is best trained to distinguish between all the possibilities and determine the underlying source of your heel pain. Long story short, plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed-resulting in heel pain.
Treatment of Heel Pain
Treatment of plantar fasciitis begins with first-line strategies that you can begin at home:
•Avoid going barefoot. When you walk without shoes, you put undue strain and stress on your plantar fascia.
•Ice. Putting an ice pack on your heel for 10 minutes several times a day helps reduce inflammation.
•Limit activities. Cut down on extended physical activities to give your heel a rest.
•Shoe modifications. Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia. Your shoes should provide a comfortable environment for the foot.
•Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may help reduce pain and inflammation.
•Lose weight. Extra pounds put extra stress on your plantar fascia.
•Shoes prerequisites. Wear shoes that fit well—front, back and sides—and have shock-absorbent soles, rigid shanks and supportive heel counters. Also, wear the proper shoes for each activity. Don't wear shoes with excessive wear on heels or soles. If you have experienced painful heels, try wearing your shoes around your house in the evening. Don't wear slippers or socks or go barefoot.
•Prepare properly before exercising. Warm up and do stretching exercises before and after running.
•Pacing. Pace yourself when you participate in athletic activities.
•Resting and nutrition. Don’t underestimate your body's need for rest and good nutrition.
If you still have pain after several weeks, see your foot and ankle surgeon, who may add one or more of these approaches:
•Padding and strapping. Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia.
•Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis.
•Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.
•Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal.
•Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.
•Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.
•When to contact the doctor. If the pain persists longer than one month, you should visit a podiatrist for evaluation and treatment. Your feet should not hurt, and professional podiatric care may be required to help relieve your discomfort.
•Exercise precautions. If you have not exercised in a long time, consult your podiatric physician before starting a new exercise program. Also, begin an exercise program slowly. Don't go too far or too fast.
•Shoe replacement. Purchase and maintain good shoes and replace them regularly.
•Stretching exercises. Exercises that stretch out the calf muscles help ease pain and assist with recovery. You may also try gentle calf stretches for 20 to 30 seconds on each leg. This is best done barefoot, leaning forward towards a wall with one foot forward and one foot back.
•Walking on surfaces. Avoid uneven walking surfaces or stepping on rocks as much as possible. Moreover, avoid going barefoot on hard surfaces.
•Treadmill tips. Vary the incline on a treadmill during exercise. Nobody walks uphill all the time.
•Listen to your pain. If it hurts, stop. Don't try to "work through the pain."
•Surgery. Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you.