Heel pain is most commonly caused by plantar fasciitis, which is the swelling of the tissue that connects the heel bone to the toes at the bottom part of the foot, also known as the plantar fascia.
Plantar fasciitis is often described as sharp pain in the middle of the heel, which is typically worse after periods of rest when fascia contracts. The pain usually becomes more bearable as the
muscles loosen up during the low-impact walking, but can return even worse after extended periods of walking or standing. The plantar fascia serves as a shock absorber and supports the footâs arch.
Too much tension on the plantar fascia can cause inflammation and swelling. Fortunately in most cases, plantar fasciitis treatment is fairly conservative. Plantar fasciitis exercises, medications and
orthotics are usually all thatâs needed to manage the pain. Most severe cases may require surgery.
Plantar fasciitis tends to strike those who overtrain, neglect to stretch their calf muscles, or overdo hill work and speedwork. Plantar fasciitis can also be caused by biomechanical flaws, including
flat, high-arched feet and a tight Achilles tendon; excessive pronation; sudden increases in training mileage; beginning speedwork; wearing worn running shoes; running on hard surfaces, like asphalt
or concrete; or wearing high heels all day before switching into flat running shoes.
Plantar fasciosis is characterized by pain at the bottom of the heel with weight bearing, particularly when first arising in the morning; pain usually abates within 5 to 10 min, only to return later
in the day. It is often worse when pushing off of the heel (the propulsive phase of gait) and after periods of rest. Acute, severe heel pain, especially with mild local puffiness, may indicate an
acute fascial tear. Some patients describe burning or sticking pain along the plantar medial border of the foot when walking.
After you describe your symptoms and discuss your concerns, your doctor will examine your foot. Your doctor will look for these signs. A high arch, an area of maximum tenderness on the bottom of your
foot, just in front of your heel bone. Pain that gets worse when you flex your foot and the doctor pushes on the plantar fascia. The pain improves when you point your toes down. Limited "up" motion
of your ankle. Your doctor may order imaging tests to help make sure your heel pain is caused by plantar fasciitis and not another problem. X-rays provide clear images of bones. They are useful in
ruling out other causes of heel pain, such as fractures or arthritis. Heel spurs can be seen on an x-ray. Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not
routinely used to diagnose plantar fasciitis. They are rarely ordered. An MRI scan may be used if the heel pain is not relieved by initial treatment methods.
Non Surgical Treatment
Night splints are treatment that can help stretch your calf and the arch of your foot. Night splints are a type of brace that holds your foot in a flexed position and lengthens the plantar fascia and
Achilles tendon overnight. This can prevent morning pain and stiffness. Special orthotics, or arch supports, for your shoes may help alleviate some of the pain by distributing pressure, and can
prevent further damage to the plantar fascia. A boot cast may be used to immobilize your foot and reduce strain while the plantar fascia heals. A boot cast looks like a ski boot and can be removed
Surgery is considered only after 12 months of aggressive nonsurgical treatment. Gastrocnemius recession. This is a surgical lengthening of the calf (gastrocnemius) muscles. Because tight calf muscles
place increased stress on the plantar fascia, this procedure is useful for patients who still have difficulty flexing their feet, despite a year of calf stretches. In gastrocnemius recession, one of
the two muscles that make up the calf is lengthened to increase the motion of the ankle. The procedure can be performed with a traditional, open incision or with a smaller incision and an endoscope,
an instrument that contains a small camera. Your doctor will discuss the procedure that best meets your needs. Complication rates for gastrocnemius recession are low, but can include nerve damage.
Plantar fascia release. If you have a normal range of ankle motion and continued heel pain, your doctor may recommend a partial release procedure. During surgery, the plantar fascia ligament is
partially cut to relieve tension in the tissue. If you have a large bone spur, it will be removed, as well. Although the surgery can be performed endoscopically, it is more difficult than with an
open incision. In addition, endoscopy has a higher risk of nerve damage.
You may begin exercising the muscles of your foot right away by gently stretching them as follows. Prone hip extension, Lie on your stomach with your legs straight out behind you. Tighten up your
buttocks muscles and lift one leg off the floor about 8 inches. Keep your knee straight. Hold for 5 seconds. Then lower your leg and relax. Do 3 sets of 10. Towel stretch, Sit on a hard surface with
one leg stretched out in front of you. Loop a towel around your toes and the ball of your foot and pull the towel toward your body keeping your knee straight. Hold this position for 15 to 30 seconds
then relax. Repeat 3 times. When the towel stretch becomes too easy, you may begin doing the standing calf stretch. Standing calf stretch, Facing a wall, put your hands against the wall at about eye
level. Keep one leg back with the heel on the floor, and the other leg forward. Turn your back foot slightly inward (as if you were pigeon-toed) as you slowly lean into the wall until you feel a
stretch in the back of your calf. Hold for 15 to 30 seconds. Repeat 3 times. Do this exercise several times each day. Sitting plantar fascia stretch, Sit in a chair and cross one foot over your other
knee. Grab the base of your toes and pull them back toward your leg until you feel a comfortable stretch. Hold 15 seconds and repeat 3 times. When you can stand comfortably on your injured foot, you
can begin standing to stretch the bottom of your foot using the plantar fascia stretch. Achilles stretch, Stand with the ball of one foot on a stair. Reach for the bottom step with your heel until
you feel a stretch in the arch of your foot. Hold this position for 15 to 30 seconds and then relax. Repeat 3 times. After you have stretched the bottom muscles of your foot, you can begin
strengthening the top muscles of your foot. Frozen can roll, Roll your bare injured foot back and forth from your heel to your mid-arch over a frozen juice can. Repeat for 3 to 5 minutes. This
exercise is particularly helpful if done first thing in the morning. Towel pickup, With your heel on the ground, pick up a towel with your toes. Release. Repeat 10 to 20 times. When this gets easy,
add more resistance by placing a book or small weight on the towel. Balance and reach exercises, Stand upright next to a chair. This will provide you with balance if needed. Stand on the foot
farthest from the chair. Try to raise the arch of your foot while keeping your toes on the floor. Keep your foot in this position and reach forward in front of you with your hand farthest away from
the chair, allowing your knee to bend. Repeat this 10 times while maintaining the arch height. This exercise can be made more difficult by reaching farther in front of you. Do 2 sets. Stand in the
same position as above. While maintaining your arch height, reach the hand farthest away from the chair across your body toward the chair. The farther you reach, the more challenging the exercise. Do
2 sets of 10. Heel raise, Balance yourself while standing behind a chair or counter. Using the chair to help you, raise your body up onto your toes and hold for 5 seconds. Then slowly lower yourself
down without holding onto the chair. Hold onto the chair or counter if you need to. When this exercise becomes less painful, try lowering on one leg only. Repeat 10 times. Do 3 sets of 10. Side-lying
leg lift, Lying on your side, tighten the front thigh muscles on your top leg and lift that leg 8 to 10 inches away from the other leg. Keep the leg straight. Do 3 sets of 10.