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Heel Pain, Causes, Prevention & Treatment

Heel pain is a common symptom that has many possible causes. Although heel pain sometimes is caused by a systemic (body-wide) illness, such as rheumatoid arthritis or gout, it usually is a local condition that affects only the foot. Following are some details on the most common causes of heel pain, and ideas for prevention and treatment.

 

Plantar fasciitis

Plantar fasciitis is a painful inflammation of the plantar fascia, usually brought about by overwork or being overstretched. This causes intense heel pain along the bottom of the heel during the first few steps after getting out of bed in the morning. This heel pain often goes away once you start to walk around, but it may return in the late afternoon or evening.

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Heel Spur

A heel spur is an abnormal growth of bone at the area where the plantar fascia attaches to the heel bone. It is caused by long-term strain on the plantar fascia and muscles of the foot, especially in obese people, runners or joggers. As in plantar fasciitis, shoes that are worn out, poorly fitting or poorly constructed can aggravate the problem. Heel spurs may not be the cause of heel pain even when seen on an X-ray. In fact, they may develop as a reaction to plantar fasciitis.

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Trapped Nerve

Compression of a small nerve (a branch of the lateral plantar nerve) can cause pain, numbness or tingling in the heel area.

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Achilles tendonitis

Achilles tendonitis is pain at the back of the heel where the Achilles tendon attaches to the heel, often triggered by overuse, especially by excessive jumping during sports. However, it also can be related to poorly fitting shoes.

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Prevention

You can help to prevent heel pain by maintaining a healthy weight, by warming up before participating in sports and by wearing shoes that support the arch of the foot and cushion the heel. If you are prone to plantar fasciitis, exercises that stretch the Achilles tendon (heel cord) and plantar fascia may help to prevent the area from being injured again. You also can massage the soles of your feet with ice after stressful athletic activities. Sometimes, the only interventions needed are a brief period of rest and new walking or running shoes.

If your heel pain is related to a specific sport or exercise regimen, a period of rest may bring relief. Once your heel is pain-free, you may need to modify your training program to prevent your pain from returning. Most heel pain goes away in a short period of time, either on its own or after treatment.


Treatment

Treatment of heel pain depends on its cause:

  • Plantar fasciitis - Most doctors recommend a six- to eight-week program of conservative treatment, including temporary rest from sports that trigger the foot problem, stretching exercises, ice massage to the sole of the foot, footwear modifications, taping of the sole of the injured foot, and acetaminophen( Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen ( Advil, Motrin and others) for pain. If this conservative treatment doesn't help, your doctor may recommend that you wear a night splint or a short leg cast, or he or she may inject corticosteroid medication into the painful area. Surgery is rarely necessary and is not always successful.
  • Heel spur - Conservative treatment includes the use of shoe supports (either a heel raise or a donut-shaped heel cushion) and a limited number of local corticosteroid injections (usually up to three per year). As in plantar fasciitis, surgery is a last resort.
  • Calcaneal apophysitis - This condition usually goes away on its own. In the meantime, conservative treatment includes rest and the use of heel pads and heel cushions.
  • Bursitis - Treatment is similar to the treatment of heel spurs. Changing the type of footwear may be essential.
  • Pump bump - Treatment is similar to the treatment of bursitis and heel spurs. In rare cases, the bony growth at the heel may need to be removed surgically.
  • Local bruises - Heel bruises can be treated by applying an ice pack for the first few minutes after injury.
  • Achilles tendonitis - This condition is treated conservatively with rest, NSAIDs and physical therapy.
  • Trapped nerve - If a sprain, fracture or other injury has caused the trapped nerve, this underlying problem must be treated first. In rare cases, surgery may be done to release the trapped nerve.

Prognosis

Although the outlook depends on the specific cause of the heel pain, most people respond to conservative, nonsurgical therapy. For example, at least 90% of people with plantar fasciitis heal within 6 to 8 weeks of conservative therapy, or conservative therapy followed by 6 to 8 weeks of night splints. Less than 5% of people with plantar fasciitis require surgery.

Heel pain may return if you return too soon to your previous level of exercise or sports participation.

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