Heel pain is one of the most common foot problems encountered by physicians. Once a fairly complex problem to diagnose and treat, studies today indicate that conservative measures should be incorporated as the first line of treatment. The most common type of heel pain is due to a condition called plantar fascitis. The plantar fascia is a fibrous band of tissue that normally extends from the heel to the ball of the foot in a “bow string” fashion. When the plantar fascia becomes over-stretched or strained, excruciating pain is most commonly felt under the heel.
A recent heel pain study, performed by the American Orthopaedic Foot & Ankle Society (AOFAS), clearly demonstrated that for the initial treatment of plantar fascitis, an over-the-counter, custom-fitted, or custom-made foot orthosis (depending on the foot deformity and the degree of severity), a well-structured shoe, and a routine of stretching exercises, is the best way to relieve heel discomfort.
Symptoms of Heel Pain
When you first get up in the morning, the pain in the bottom of the heel is a dull, intermittent pain or bruise-like feeling which may progress to a sharp, persistent pain. But after walking for a few minutes, the pain slowly disappears. As the day continues and your activity level increases due to sports activity or work related issues, the pain may return. Whenever you sit for a period of time and get up, the pain returns until the foot limbers up. Even when you get out of a car after driving for a time, there will be pain. Although both feet can be affected, it usually occurs in only one foot.
Cause of Heel Pain
Heel pain is generally the result of faulty biomechanics (excessive pronation) which places too much stress on the heel bone and the soft tissues that attach to it. The cause of pronation can be due to trauma, genetic formation, ridged big toe joint, ankle fixation, leg difference, surgeries that failed to get the results needed, or, more often, to tight calves.
Tightness of the calves can prevent the foot from going through the normal flexible movements during motion and creates an excessive inward rotation of the foot. This creates an abnormal amount of stretching and pulling on the fascia, which causes tears and inflammation in the soft tissue. Excessive pronation may also contribute to injury to the hip, knee, and lower back.
Treatment of Heel Pain
Treatment is not as easy as A-B-C, but it does involve simple steps to relieve the pain and inflammation. But don’t expect a quick cure. It can take up to six months or longer before your heel is back to normal. The goal of treatment is to heal the tears and decrease inflammation, as well as prevent the condition from recurring. Although you may find the slow course of healing frustrating, patience is important. Following are the key elements in relieving heel pain.
REST: Use pain as your guide. If your foot is too painful, rest it.
FOOT ORTHOSIS: An orthosis is designed to support and align the lower extremity, prevent or correct deformities, substitute for function, and relieve pain. Despite the uniqueness of each patient, mechanically speaking, the general goals of orthotic therapy are the same for all. Dysfunctional movement patterns, such as pronation, must be discouraged and muscle weakness must be controlled to provide a stable stance phase during periods of weight transfer. Each orthosis must realign mechanical levers of the forefoot and hind foot in all three planes of motion to provide a stable base of support. While its goal is to improve foot function, which is what every orthosis aims for, a foot orthosis can only achieve its goal in conjunction with a shoe.
SHOES: The success of the foot orthosis to achieve its goal relies on the foundation, called the shoe, that the foot orthosis rests on. To maximize the efficiency of the foot orthosis, the shoe must meet the following requirements:
- Proper fit to the foot and its shape with the foot orthosis in the shoe.
- As wide of a base or sole as that of the foot orthosis.
- Firm heel counter extended as far forwards as possible on both sides.Firm sole to ensure a natural contact with the ground causes minimal rolling.
- Ample room inside of the shoe to allow the foot orthosis to lay flat.
- Tie shoe in order to gain as snug a fit as possible over the instep and around the heel.
- In some cases extra depth in the toe area.
- You should never walk barefoot! Birkenstock, Finn Comfort, or Chaco are recommended for around the house or at times when not in orthotics.
- When there is any fixation in either forefoot or hind foot, a rocker sole may have to be added to the shoe(s) to assist in the normal function of the foot.
STRETCHING: Three-quarters of individuals suffering from heel pain can find significant relief with a regular stretching program that includes calves/Achilles tendon and plantar fascia stretching. Adding a foot orthosis and well-structured shoes leads to an even better result. The stretching exercise at the end of this page has been recommended by the American Orthopaedic Foot & Ankle Society.