Heel Pain: Causes, Prevention and Treatment

Overview of Heel Pain, Heel Spur, Plantar Fasciitis

Heel Pain, Heel Spurs, and Plantar fasciitis are all often described as “A sharp severe pain that hits when first standing from lying down or sitting position. A stone bruise-type pain or burning arches may also accompany this condition.

This pain seems to get better as you warm up or walk it out, but remains a dull ache when standing for long periods. The pain usually returns in the morning or following rest”.

Strain on the plantar fascia is aggravated by over pronation

Pain and inflammation of the plantar fascia and surrounding tissue is an extremely common problem experienced by a wide variety of people. The most common cause of this problem is excessive rolling in of the feet (over pronation).

When the feet roll inwards the arch collapses and the foot elongates. This elongation stretches all of the structures on the bottom of the foot (ligament, muscles and nerve) and Achilles tendon causing heel and arch pain where they insert into the heel bone (calcaneus).

The plantar fascia is the main ligament on the underside of the foot. It runs from the calcaneus (heel bone) to just behind the toes. The plantar fascia helps to keep the foot from spreading out and rolling in.

When the foot is not properly aligned the bones of the foot unlock causing the foot to roll in. This places excess stretching stress on the plantar fascia. The plantar fascia alone is unable to maintain the arch contour and with overuse becomes painful and inflamed.

With every step, during physical activity, the foot pronates and elongates. This stretches the plantar fascia and causes heel pain.

Our orthotic innersoles (foot supports) align the foot in the most efficient functional position and maintain the arches of the foot. This relieves the strain on the plantar fascia and reduces foot pain.

Docpods orthotics and footwear come in a variety of styles to suit almost any shoe and offer pain relief.

What is the cause of heel pain?

Plantar fasciitis is the most common cause of chronic heel pain in adults. It has been described with various graphic terms associated with physical activities e.g. tennis heel, joggers heel or policeman’s heel.

Other causes of heel pain

There are other health conditions that cause heel pain. Severs disease, retrocalcaneal bursitis, tarsal tunnel syndrome, stress fracture, fat pad contusion (fatty tissue under the he heel. calcaneal bursitis, bone spurs, stress fractures, Achilles tendinitis, and sever’s disease (growth plate irritation in the heel in children) to name a few.

These are aggravated by foot mechanics, and some are growth-related such as Sever’s disease. We discuss these in our other heel pain articles.

What happens to the foot with heel pain, heel spurs and plantar fasciitis?

Within the foot, there is a tough sheath of tendons that maintains the normal arch of the foot from underneath known as the plantar fascia. The plantar fascia normally has a narrow end that is attached below the calcaneus (heel bone).

The wider end fans out to be attached to the underside of the toe bones. When intact, it maintains the arch of the foot and also acts as a shock absorber for the foot.

This fascia acts like a hammock, bearing the weight of the foot. The fascia normally has elastic and flexible properties that permit free movement of the foot and allow it to perform its shock-absorbing function.

Repeated strain causes injury and pain

Plantar fasciitis occurs when there are repeated small injuries to the fascia, this is usually due to physical exercise, over pronation or poor footwear. These injuries are too tiny to be repaired and occur as a part of daily stress and strain on the foot.

When there are repeated injuries to the fascia, a new tougher scar tissue forms. The new tissue that is formed is often not as supple or elastic as the original one.

This scar tissue gives rise to the condition where the ability of the fascia to maintain the arch is slowly lost, as the plantar fascia is not as flexible as it needs to be.

When the plantar fascia is damaged and becomes scarred, it effectively shortens due to the scarring from injury. When the plantar fascia cools down when at arrest the length of the plantar fascia is further shortened.

This occurs when the foot is not bearing weight when at rest, as happens at night when the person is in bed. As soon as the first steps are taken in the morning, the foot needs to bear weight.

This causes the arch of the foot to flex and the fascia to stretch to bear the weight, like a hammock. It is this stretching that leads to pain, as the plantar fascia is stressed.

The pull at the heel bone, where it is attached, can eventually give rise to the formation of small bone extensions at the heel bone, where the fascia is attached. These are called heel spurs and these aggravate the condition. After bearing weight or walking, the fascia warms up and becomes more flexible.

This relieves the stabbing heel pain however this is only temporary. The inflammation from repetitive small injuries within the plantar fascia remains and the pain also persists as a dull ache.

At the end of the day, the pain regains its earlier intensity, although it is not a stabbing pain.


Cause of heel pain and plantar fasciitis

Repeated stress and strain on the fascia is the common reason for the development of this condition. Over-pronation is the number 1 cause of excessive strain on the plantar fascia.

Excessive weight or obesity is also a common cause, this results in the extra load being placed on the foot and this causes further overpronation. People who need to stand for long hours are also common victims.

Walking or standing barefoot or on hard ground or wearing shoes with hard heels can also lead to this condition or aggravate an existing one. Aging that leads to loss of the flexibility of the fascia is also commonly associated with plantar fasciitis.

Most patients are between 40 and 70 years of age. People with problems in the arch of the foot, like those with flat feet or very high arch, are susceptible to plantar fasciitis. Sportspeople or people who are active can suffer from plantar fasciitis if they have faulty foot mechanics that can result in over-pronation.

Typical clinical presentation of heel pain and plantar fasciitis

The most common complaint related to plantar fasciitis is heel pain after long periods of non-bearing weight. The patient usually complains of stabbing pain in the heels, while taking the first few steps in the morning.

The pain often dulls with more walking or bearing of the body weight, only to intensify during the day or while walking barefoot on hard surfaces.

After long periods of sitting or non-weight bearing, the pain may come back with great intensity. The patient may limp due to the pain, often avoiding putting weight on the heels and literally tiptoeing.

Walking on the toes can further aggravate the pain.

How heel pain, heel spurs, and plantar fasciitis diagnosed

It is very important to get an accurate diagnosis of your heel pain. Palpation (touching) the underside and sides of the heel the patient may complain of pain. There may be mild swelling and redness over the heels and surrounding tissue.

Standing on the tip of the toes (foot downward) may aggravate the pain in the heels. Similarly, an attempt to bend the foot so as to bring the toes towards the shins (dorsiflexion) can also be painful.

X-rays of the foot to check for heel spurs are sometimes helpful but not always necessary. MRI images may be recommended, to detect the actual thickening of the inflamed fascia and the swelling around the fascia.

Podiatrists might want to exclude other causes of heel pain like injury or contusions, fractures, tearing of tendons, inflammation of fluid-filled sack inside the foot (called bursitis), nerve pain, infections of the small joints, tumors, etc.

Prevention of heel pain, heel spurs, and plantar fasciitis

Avoidance of high-impact sports like running, jumping, volleyball, basketball, etc. can help the fascia to heal and prevent the onset of pain. Walking barefoot, especially on hard surfaces, can also prevent aggravation of the condition.

Other exercises, where the feet will not have to take the body weight, such as swimming or cycling, can be done. Well-fitting and supportive shoes with soft supportive innersoles can do wonders for the aching heels of plantar fasciitis.

At times, an ice pack and some anti-inflammatory medication can also help relieve the pain. Night splints that hold the foot in position while sleeping can prevent early morning pain. Regular stretching of the calf muscles will ease muscle tightness and may bring relief.

Innersoles help to limit over pronation and prevent pain. These provide adequate support to the arch of the foot and ease the tension of the fascia, allowing it to heal as well as function more efficiently.

Long-term consequences are heel pain, heel spurs, and plantar fasciitis

With treatment, most cases can be resolved, however, the treatment time usually depends on the amount of time the condition has been untreated for. Some patients may need to undergo surgery to correct the problem.

Treatment Options for Heel Pain, Heel Spur, Plantar Fasciitis

An abnormal walking style (gait pattern) is observed in most people who experience heel pain. The repetitive nature of walking (over 10,000 steps per day) can lead to repetitive stress injuries in the heels and lower limbs.

1. Rest

Activity should be limited to those, which are unlikely to aggravate the injured site such as swimming and cycling. Limiting any activity that will aggravate your heel such as strenuous exercise will help in your recovery.

2. Ice

Ice will help reduce pain and swelling in the area and will also help to reduce the pain involved with the injury. Ice should be applied for 10 minutes 3 times per day for the first 72hrs. Ice should also be applied following the activity.

3. Anti-inflammatory medication

Treatment with Anti-inflammatory medication will also reduce the pain and inflammation associated with the injury and will speed up recovery. Anti-inflammatory medication can be purchased over the counter from your chemist (Neurofen).

4. Strapping

Treatment with strapping helps to rest the injured site without limiting your activity. Strapping is also used to temporarily correct any mechanical abnormality in foot function. If strapping has reduced the amount of heel pain then an insole can be used as a permanent measure. Strapping is best applied by an experienced podiatrist.

5. Stretching & Strengthening

Stretching of the calf muscle group and the Achilles tendon (muscles on the back of the heel) will help to relieve the tension on the plantar fascia in walking. Tight calf muscles are a major contributor to heel pain. When the calf muscle and Achilles tendon are tight the ankle joint does not function correctly and forces the foot to over pronate.

There are 2 methods of calf stretching exercises that help to relieve heel pain, one with a leg straight and one with the knee bent. It is beneficial to do both stretches. We also recommend stretching both feet not just the pain-affected foot. Please see our stretching articles for how to perform these stretches.

6. Orthotic Insoles

Orthotic insoles are used to rest the foot and pressure on the heels, and Achilles tendon and to prevent heel pain. When there is a mechanical deformity in the bony structure of the foot (usually rolling in).

Innersoles balance the foot which allows it to function more efficiently and relieves the strain on the plantar fascia. Orthotic insoles help to limit the pronation-related damage caused by flat feet and over-pronation. Please note if your pain persists you should book an appointment with your Podiatrist asap.

7. Wear Shoes

Good supportive shoes are essential to control foot mechanics and unload the plantar fascia. It is also important to wear supportive shoes that will help to rest the foot. High heels will usually aggravate heel pain. Wearing supportive shoes like running shoes will help to support and cushion your feet. Shoes that fit properly are as important as the quality of the shoe.

8. Cortisone Injection

Usually used in long-standing cases of heel pain that have responded poorly to the above treatments

9. Body Weight

It is documented in the literature that people who have a BMI (Body mass index) greater than 25 are more likely to experience heel pain. Maintaining a healthy weight will help to unload your feet and aid in the healing of your heels.

10. Surgery

When all of the above treatment options have not relieved your pain, a consultation with an orthopedic surgeon is suggested. This usually involves removing part of the plantar fascia from the heel bone. This should only be considered when all of the measures have failed and you have done a systematic review with your Podiatrist.

Recovery Time

The recovery time will depend on how long the pain has been left untreated. If treatment is started immediately a recovery time of two to three weeks is possible. Often we see patients that have left their heel pain untreated for months. This can take months of treatment to get results.