There are many different causes of heel pain, but the most
common cause is plantar fasciitis (plan * tar fash* ee * I *
tis). If you experience a sharp pain in your heel when you
first step down in the morning, it is most likely due to plantar
fasciitis. This problem is a result of excess stress through a
long ligament type structure (the plantar fascia) in the
bottom of the foot. The excess stress causes tearing and
results in inflammation and pain. The classic symptoms are
pain in the heel at the first step in the morning, or upon
rising after long periods of rest. Many will complain of a
sharp pain in the heel when they step out of their car or after
finishing their lunch break. Other individuals only experience
heel pain at the end of the day or during certain types of
activity like running, soccer or tennis. The pain may extend
into the arch and feel achy at the end of the day.
Individuals develop plantar fasciitis for a variety of reasons.
One of the most common reasons for the development of
plantar fasciitis is wearing poor quality or worn out shoes.
Another common reason is starting a new activity, such as
walking or running, after a period of inactivity. Many active
individuals develop plantar fasciitis after incorporating hills,
stairs or uneven terrain into their training routine. A new job
that requires standing all day or switching to a job with a
harder surface, like cement floors, may contribute to it’s
development. Individuals with flatfeet or excess pronation
(rolling in of the feet) may have a natural predisposition for
plantar fasciitis. Regardless of how the problem started, the
treatment is aimed at decreasing the stress on the arch and
decreasing the inflammation.
1. Identify the cause: There is usually a reason for the
development of plantar fasciitis, but since the condition is
not typically associated with an acute injury it may be hard to
remember. The pain may have gradually developed after
starting a new training routine, changing the routine, running
or walking on a new surface, switching shoes, wearing
worn out shoes or starting a new job. Once the cause is
identified, stop the activity or modify it.
2. Avoid aggravating activities: Going up and down stairs,
walking or running on hills, squating, lifting heavy items and
walking on uneven terrain all aggravate this condition. Try to
decrease these by limiting the number of times you go up
and down the stairs and avoiding hills. If you must squat
down, keep the affected foot in front and flat on the ground.
Do not lift or carry heavy items including your kids. Use a
stroller or have your spouse, significant other or friend carry
them.
3. Stop running or walking: Aerobic activity is important to
maintain and cross training can help. Try biking or
swimming. Most walkers hate the stationary bike at the gym,
but remember this isn’t forever. Don’t drop your heel when
you bike and try to avoid standing and hills if you cycle
outdoors. If you participate in spin classes, you may need to
modify the class to avoid further injury to the foot. The
recumbent stationary bike may place excess stress through
the arch because of the position. The classic stationary bike
is more appropriate.
4. Use an ice massage: Freeze a sports water bottle or a
juice can and place it on the floor. Roll your foot over the
water bottle for at least 20 minutes twice a day. This helps
decrease the inflammation in the foot while stretching out
the arch.
5. Use a contrast bath: Icing helps decrease inflammation
occurring within a 48-72 hour period. To help decrease
chronic inflammation, try contrasting between ice and heat.
Start with an ice pack on the heel and/or arch for 5 minutes.
Switch to a heating pack or a hot water bath for 5 minutes.
Alternate between the two for 20- 30 minutes 3-4 times a
week. This may be more time consuming than the ice pack
alone, but can bring considerable relief.
6. Roll a ball under your foot: Take a tennis ball, soft ball or
even a rolling pin and roll your foot over it to help stretch out
the plantar fascia. This can be done while watching TV or
reading the paper. Rolling the foot over the tennis ball can
also be done at work if you have a desk job or during a
lunch break. (This should not cause pain. Don’t continue if
you have pain).
7. Stretch your calf in the morning: If you have pain in the
morning upon waking, place a towel or a belt on your
dresser. Before you get out of bed, wrap the towel or belt
around the ball of your foot. By pulling the foot towards you
and keeping your leg straight, you should feel a stretch in
the back of the calf. This will also stretch the bottom of the
foot. This is not time consuming or difficult to do, but it does
require adjusting to a new routine.
8. Stretch your calf throughout the day: Spend about 5-10
minutes each evening stretching the calf as described
above or with the runner’s stretch. To really help keep the
calf and the bottom of the foot stretched out, try and stretch
for 30 seconds, 10 times a day.
9. Take anti-inflammatory medications: Anti-inflammatory
medications, like naproxen or ibuprofen, will help decrease
the inflammation that occurs in the fascia as a result of the
tearing. You don’t want to mask the pain with these
medications. If you decrease the pain with the
anti-inflammatory medications but continue to participate in
an activity which causes tearing and inflammation of the
plantar fascia, you are not healing. Continue resting, icing
and stretching while you take the medications. Take the
medication with food and stop taking the medication if you
experience stomach discomfort.
10. Lose Weight: This is probably the last thing you wanted
to hear. In fact, there is a good chance that you have gained
some weight since the onset of your heel pain due to a
decrease in activity. But, there is no way around the fact that
increased weight on the body transmits to the feet.
Increasing the stress on the plantar fascia can worsen
plantar fasciitis, making it more difficult to treat. Eat smart
and try to incorporate aerobic activity which decreases the
impact on the feet.
11. Wear supportive shoes: This step may seem logical, but
most individuals don’t realize how many shoes lack support.
A supportive shoe will only bend at the toes. Test all of your
shoes and don’t assume your running shoe is a supportive
shoe. Take your shoe and flip it over. Grab the toe area and
the heel and try to fold the shoe. If the shoe bends in half,
then the shoe is not supportive. Don’t go barefoot. Get up in
the morning, do your stretch and then slip your feet in a
supportive slipper or clog. See the American Podiatric
Medical Association’s (APMA) list of approved shoes at
www.apma.org/ seal/sealaccategory.html.
12. Try anti-fatigue mats: These mats help to decrease the
stress through the heel and add some shock absorption to
the floor. The mats can be a great asset for employees who
work on a hard surface. You may want to consider them for
home if you spend many hours standing in a workshop or in
the kitchen. See the APMA’s list of approved anti-fatigue
mats at www.apma.org/ seal/sealaccategory.html.
13. Strengthen the muscles in your feet: Place a thin towel
on your kitchen floor. Place your foot over the base of the
towel closest to you. Bring the towel towards you by curling
the toes and gripping the towel as it slides under your foot.
Place marbles on the floor and pick them up one by one
with your toes and place them in a bowl.
14. Wear orthotics: Prefabricated orthotics are semi-rigid
inserts that fit into the shoe to help control motion in your
feet. Controlling abnormal motion in the feet can decrease
the stress in the plantar fascia. Soft inserts available at the
drug store may be comfortable, but they will not help control
abnormal motion.
15. Try a night splint: A night splint holds the foot at 90
degrees while you sleep. This keeps the foot and the calf
stretched out all night long. Night splints are an effective
treatment, but can be quite uncomfortable. Some individuals
have more luck with the sock night splints than with the rigid
splints. These devices are available online, but may be
covered by your insurance when dispensed by your doctor.
If your symptoms persist, see a podiatrist.
Christine Dobrowolski is a podiatrist and the author of
Those Aching Feet: Your Guide to Diagnosis and Treatment
of Common Foot Problems. To learn more about Dr.
Dobrowolski and her book visit
http://www.skipublishing.com/ .