Your heel is the back part of your foot. A band of tissue called the plantar fascia connects the heel bone to the bones in the ball of your foot. Nerves run from the heel up the inside of your ankle and into your leg. When you feel pain in the bottom of your heel, the plantar fascia is most likely inflamed. Overuse or excess body weight can cause the tissue to tear or pull away from the bone. Sometimes the inflamed plantar fascia also irritates a nerve, causing more pain.
What Causes Heel Pain?
Wearing shoes with poor cushioning can irritate the tissue in your heel (plantar fascia). Being overweight or standing for long periods can also irritate the tissue. Running, walking, tennis, and other sports that put stress on the heels can cause tiny tears in the tissue. If your lower leg muscles are tight, this is more likely to occur. A tight Achilles tendon can also contribute to heel pain.
You may feel pain on the bottom or on the inside edge of your heel. The pain may be sharp when you get out of bed or when you stand up after sitting for a while. You may feel a dull ache in your heel after you've been standing for a long time on a hard surface. Running can also cause a dull ache. If a nerve is irritated, you may feel burning or a shooting pain in your heel.
Preventing Future Problems
To prevent future heel pain, wear shoes with well-cushioned heels. And do exercises prescribed by your doctor to stretch the plantar fascia and the muscles in the lower leg.
Your doctor's first concern is to reduce your symptoms. Using ice and heat, taking medications, and limiting activity help control pain and swelling. Follow all of your doctor's instructions. Returning to activity too soon may cause your symptoms to come back.
Ice and Heat
Ice helps prevent swelling and reduce pain. Place ice on the painful area for 10 minutes. Repeat the icing several times a day. If you already have swelling, using heat may help. Apply a heating pad or hot towels to the tendon for 30 minutes 2-3 times a day.
Your doctor may tell you to take aspirin or other anti-inflammatory medications. These reduce pain and swelling. Take them as directed. Don't wait until you feel pain. In more severe cases, cortisone may be injected to relieve pain.
Rest allows the tissues in your foot to heal. Stay off your feet for a few days, then slowly work back into activity. If you do high-impact activities, such as running or aerobics, try other activities that place less strain on your foot. Cycling and swimming are good choices.
The plantar fascia is a ligament-like band running from your heel to the ball of your foot. This band pulls on the heel bone, raising the arch of your foot as it pushes off the ground. But if your foot moves incorrectly, the plantar fascia may become strained. The fascia may swell and its tiny fibers may begin to fray, causing plantar fasciitis.
Plantar fasciitis is often caused by poor foot mechanics. If your foot flattens too much, the fascia may overstretch and swell. If your foot flattens too little, the fascia may ache from being pulled too tight.
With plantar fasciitis, the bottom of your foot may hurt when you stand, especially first thing in the morning. Pain usually occurs on the inside of the foot, near the spot where your heel and arch meet. Pain may lessen after a few steps, but it comes back after rest or with prolonged movement.
A heel spur is extra bone that may grow near the spot where the plantar fascia attaches to the heel. The heel spur may form in response to the plantar fascia's tug on the heel bone.
Bursitis is the swelling of a bursa, a fluid-filled sac that reduces friction between a ligament and a bone. Bursitis may develop if a swollen plantar fascia presses against a plantar bursa.
First, your doctor relieves pain. Then, the cause of your problem may be found and corrected. If your pain is due to poor foot mechanics, custom-made shoe inserts (orthoses) may help.
To relieve mild symptoms, try aspirin, ibuprofen, or other medications as directed. Rubbing ice on the affected area may also help.
To reduce severe pain and swelling, your doctor may prescribe pills or injections. Physical therapy, such as ultra sound or stretching exercises, may also be recommended.
To reduce symptoms caused by poor foot mechanics, your foot may be taped. This supports the arch and temporarily controls movement. Night splints may also help by stretching the fascia.
If taping helps, your doctor may prescribe orthoses. Built from plaster casts of your feet, these inserts control the way your foot moves. As a result, your symptoms should go away.
If Surgery Is Needed
Your doctor may consider surgery if other types of treatment don't control your pain. During surgery, the plantar fascia is partially cut to release tension. As you heal, fibrous tissue fills the space between the heel bone and the plantar fascia.
Every time your foot strikes the ground, the plantar fascia is stretched. You can reduce the strain on the plantar fascia and the possibility of overuse by following these suggestions:
Lose any excess weight.
Avoid running on hard or uneven ground.
Use orthoses at all times in your shoes and house slippers.