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.
It commonly is painful the first few steps in the morning or after rest. It tends to get worse the longer one stands during the day. It is caused by subtle changes in foot structure that occurs over time. These changes result in the gradual flattening of the arch. As this occurs a thick ligament (the plantar fascia) that is attached to the bottom of the heel and fans out into the ball of the foot is stretched excessively. This ligament acts as a shock absorber while walking. As the foot flattens it stretches. If it stretches too much it gets inflamed and causes pain. Over time the pull of the ligament creates a spur on the heel bone. It is important to realize that it is not the spur that causes the pain and therefore the spur does not need to be removed in most cases. This condition may also cause generalized arch pain called plantar fasciitis. This is an inflammation of the plantar fascial ligament.
A common factor that contributes to this condition is tightness of the calf muscles. Women who wear high heels and people who walk for exercise will often develop this problem because of the tightness that results in the calf muscle as a result of these activities. A non-supportive shoe also contributes to this problem. Weight gain is another factor in developing 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.
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.
Calf muscle stretching is very useful. The typical runners stretch by leaning into a wall is helpful. An alternative method of stretching is to stand approximately two feet from a wall. Facing the wall turn your feet inward so you are pigeon toed. Lean forward into the wall keeping your heels on the floor and the knees extended. Also keep your back straight and do not bend at the hips. Hold the stretch for 10 seconds and do the stretch ten times in a row. Do the stretching three times each day. Always stretch the calf muscles followingany form of exercise.
Wear a supportive sport or walking shoe. This can be supplemented with a good over the counter arch support.
Medications like Advil, Tylenol, or Aleve may be of some benefit. Always read the medications directions and warnings before use.
If the heel pain persists your foot doctor may suggest a cortisone injection, taping the foot to support the arch, night splints to stretch the calf muscles at night while you are sleeping or functional foot orthotics. On occasion surgery may be required to cure this condition. Orthotics should be tried before surgery and should be used following the surgical procedure (See surgical treatment of plantar heel pain).