Do your first few steps out of bed in the morning cause severe pain in your heel? Or
does your heel hurt after jogging or playing tennis?
Most commonly, heel pain is caused by inflammation of the plantar fascia, the
tissue along the bottom of your foot that connects your heel bone to your
toes. The condition is called plantar fasciitis.
Plantar fasciitis usually presents in one of two forms: a generalized type which
involves an area in the mid arch area of the foot (commonly associated with
a flat foot), and a localized type which usually involves the plantar aspect
of the heel (commonly associated with a heel spur). The treatment, (below),
of these two types of fasciitis is essentially the same.
Plantar fasciitis causes stabbing or burning pain that's usually worse in the
morning because the fascia tightens (contracts) overnight. Once your foot
limbers up, the pain of plantar fasciitis normally decreases, but it may
return after long periods of standing or after getting up from a seated
cases, you can overcome the pain of plantar fasciitis without surgery or
other invasive treatments. You can take steps to prevent plantar fasciitis
Plantar fasciitis usually develops gradually, but it can come on suddenly and be
severe. Although it can affect both feet, it more often occurs in only one
foot at a time. Watch for:
- Sharp pain in the inside part of the bottom of your heel,
which may feel like a knife sticking in the bottom of your foot.
- Heel pain that tends to be worse with the first few steps
after awakening, when climbing stairs or when standing on tiptoe.
- Heel pain after long periods of standing or after getting up
from a seated position.
- Heel pain after, but not usually during exercise.
- Mild swelling in your heel.
Under normal circumstances, your plantar fascia acts like a shock-absorbing
bowstring, supporting the arch in your foot. But, if tension on that
bowstring becomes too great, it can create small tears in the fascia.
Repetitive stretching and tearing can cause the fascia to become irritated
or inflamed. The causes of plantar fasciitis can be:
- Physical activity overload. Plantar fasciitis is common
in long-distance runners. Jogging, walking or stair climbing also can place
too much stress on your heel bone and the soft tissue attached to it,
especially as part of an aggressive new training regimen. Even household
exertion, such as moving furniture or large appliances, can trigger the
- Arthritis. Some types of arthritis can cause
inflammation in the tendons in the bottom of your foot, which may lead to
- Diabetes. Although doctors don't know why, plantar
fasciitis occurs more often in people with diabetes.
- Faulty foot mechanics. Being flat-footed, having a high
arch or even having an abnormal pattern of walking can adversely affect the
way weight is distributed when you're on your feet, putting added stress on
the plantar fascia.
- Improper shoes. Shoes that are thin-soled, loose, or
lack arch support or the ability to absorb shock don't protect your feet. If
you regularly wear shoes with high heels, your Achilles tendon, which is
attached to your heel can contract and shorten, causing strain on the tissue
around your heel.
Active in sports. Activities that place a lot of stress
on your heel bone and attached tissue are most likely to cause plantar
fasciitis. This includes running, ballet dancing and aerobics.
Flat-footed or have high arches. People with flatfeet
may have poor shock absorption, which increases the stretch and strain on
the plantar fascia. People with highly arched feet have tighter plantar
tissue, which also leads to poor shock absorption.
Middle-aged or older. Heel pain tends to be more common
with aging as the arch of your foot begins to sag, putting stress on the
Overweight. Carrying around extra pounds can break down
the fatty tissue under the heel bone and cause heel pain.
Pregnant. The weight gain and swelling that accompany
pregnancy can cause ligaments in your body, including your feet, to relax.
This can lead to mechanical problems and inflammatory conditions.
Being on your feet. People with occupations that
require a lot of standing on hard surfaces, or walking, including factory
workers, teachers and waitresses, can damage their plantar fascia.
A closet of poorly designed pumps, loafers and boots can mean plantar
problems. According to the "Madigan Army Medical Center," the type shoes listed below
can cause or exacerbate plantar fasciitis.
- Loafers (moccasins, deck shoes).
- Badly worn shoes.
- Shoes with little or no arch support.
- Shoes with a flexible shank (the shank is the middle part of the sole,
immediately in front of the heel).
If you have heel pain, try self-care measures, such as stretching and changing your
activities. Below are some additional tips:
- Do not wear shoes in the house. Going without shoes helps "rebalance" the
- Gently stretch your calves. Runners typically get PF because they get
tight calves and/or overstretch (or bounce stretch).
- Rest! Whatever you are doing, change it.
an anti-inflammatory like Ibuprofen.
- Measure your body fat. If it's in the double digits, you are too fat. To
fix that, eat smaller portions.
- Examine the soles of your shoes. If the wear pattern is not perfectly
flat, you have a posture problem and/or a foot alignment problem. Pronation
is the most common such problem.
There are many ways to stretch the calf muscles and tendons, the following
stretches are what we have found to be the most effective.[source:
- Step stretch. This is
a great stretch to do. Begin by finding a step, curb, and something you can
hold onto to maintain your balance. Remember to slowly ease into the
stretch. Bouncing may cause further trauma to the area. Balance
yourself on the balls of your feet. Slowly allow your body weight to gently
stretch the calf muscles until you feel tension. Hold this position for
stretch. While wearing shoes, locate a doorway. Reach through the doorway so
that you can balance yourself. Position one of your feet so that the ball of
the foot is firmly against the wall. The heel of the foot is firmly pressed
into the ground. Begin to slowly apply pressure by pulling your body towards
the wall, making your lower leg more perpendicular to the floor. Repeat with
the other foot.
avoid re-injuring the fascia and causing further pain, the APMA has the
- Always consult a foot specialist before starting a new
- Allow your body to adapt to the exercise program by starting
slowly. It takes time for the body to adapt to the additional stress.
- Purchase and maintain good shoes and replace them regularly.
Investing a little more money in good shoes will pay dividends in pain-free
- Remember to stretch your feet and Achilles tendon before and
- Always try to exercise on an even surface. Uneven surfaces can
but strange stressed on the foot and can result in pain.
- Avoid walking barefoot on hard surfaces. Without your shoes,
you fascia has to support your entire body weight.
- If it hurts, STOP. Don't try to bear through the pain.
- If you
don't see much progress after a few weeks of home treatment, see your family
doctor or a foot doctor (podiatrist).
- Seek help sooner if your pain worsens, despite home treatment. If you have
diabetes or another condition that causes poor circulation, see your doctor
for an early evaluation of any changes in your feet.
See our other articles for
nutrition and training tips that will help you prevent plantar faciities and
a host of other painful conditions.