Heel Pain and Plantar Fasciitis: Causes, Home Care and When to Be Seen

What it involves

MedlinePlus describes heel pain as pain or discomfort at the back, bottom, or sides of the heel. The pain may be sharp, aching, or burning, and can range from mild to severe. It is most often the result of overuse, though an injury can also cause it, and one of the most common causes is plantar fasciitis.

Who this is for

• Adults with heel pain that has lasted more than a week or two of rest
• Patients whose heel hurts most with the first steps in the morning
• Patients who run, walk, or stand for long hours and have started to limp
• Patients who want to know whether a heel spur or a shoe change is the answer

What to expect

• Questions about when the pain began, when it is worst, and what your daily activity and shoes are like
• A physical exam of the heel, arch, and the calf and Achilles tendon above it
• A plain explanation of the likely cause and a home plan you can start right away
• A plan that may include medicine, stretching, a night splint, or a referral for imaging or physical therapy

Why heels hurt

MedlinePlus says the heel may become tender or swollen from:

• Shoes with poor support or shock absorption
• Running on hard surfaces such as concrete, or running too often
• Tightness in the calf muscle or the Achilles tendon
• A sudden inward or outward turning of the heel
• Landing hard or awkwardly on the heel

Conditions on the list

MedlinePlus names swelling and pain in the Achilles tendon, bursitis at the back of the heel, bone spurs in the heel, plantar fasciitis, and a fracture of the heel bone from landing very hard on the heel in a fall. MedlinePlus says to contact a provider if you cannot put weight on the foot, even after resting. Itching, peeling, or burning skin on the foot is a different problem from heel pain, and the athlete's foot guide covers the fungal causes.

What plantar fasciitis is

MedlinePlus explains that the plantar fascia is the thick tissue on the bottom of the foot that connects the heel bone to the toes and creates the arch. When it becomes swollen or inflamed, it is called plantar fasciitis, and it is one of the most common orthopedic foot complaints. The most common symptom is pain and stiffness in the bottom of the heel, dull or sharp, and the pain is often worse in the morning on the first steps, after standing or sitting for a while, and when climbing stairs.

Who is more likely to get it

MedlinePlus says you are more likely to get plantar fasciitis if you have foot arch problems, either flat feet or high arches, run long distances, downhill, or on uneven surfaces, are obese or gain weight suddenly, have a tight Achilles tendon, wear shoes with poor arch support or soft soles, or change your activity level. The obesity and BMI guide explains how weight is measured. It also says research has found that heel spurs are not the cause, since they show up on x-ray in people with and without plantar fasciitis.

What you can try at home

MedlinePlus suggests resting as much as possible for at least a week, applying ice for 10 to 15 minutes at least twice a day, and taking acetaminophen or ibuprofen. It also lists supportive shoes, a heel cup, felt pads or a shoe insert, night splints, and a walking boot to take pressure off the heel. To help prevent it, it advises keeping the calves, ankles, and feet flexible, warming up before exercise, and stretching the plantar fascia in the morning before getting out of bed.

Signs you should be seen

MedlinePlus says to contact your provider if heel pain does not get better after 2 to 3 weeks of home treatment, and also if:

• The pain is getting worse despite home treatment
• The pain is sudden and severe
• There is redness or swelling of the heel
• You cannot put weight on the foot, even after resting

What a visit involves

MedlinePlus says your provider performs a physical exam and asks when the pain began, whether it is worst on the first steps after rest, whether it is dull or sharp, whether it is worse after exercise or standing, whether you fell or twisted the ankle, and what shoes you wear. A foot x-ray may be ordered, and a physical therapist may teach stretching and strengthening exercises. If home steps do not work, it lists a boot cast for 3 to 6 weeks, custom shoe inserts, or steroid shots into the heel. Those would be arranged through a referral.

Sources

• MedlinePlus — Heel pain
• MedlinePlus — Plantar fasciitis