When you’re trying to stay fit and healthy, there’s almost nothing more frustrating than chronic pain. When it occurs in the heel, it can be incredibly problematic because it prevents you from doing just about anything active.
Several conditions or injuries can cause heel pain. But in almost every case, recovery starts with rest. Icing and applying topical anti-inflammatories are often prescribed too. Specific exercises, massage, and stretch will also be on the list once the cause of the pain is determined. Surgery is a last resort if the condition has become severe and rest is not enough to improve the situation.
Let’s look at the most common causes of pain in the heel, and what they mean if you’re experiencing one of them:
The plantar fascia is a ligament webbing that runs under your sole from the heel to the ball of the foot. It connects the heel to the front of your foot and supports the arch, acting as a shock absorber for every step you take. It’s your foot’s natural cushioning and does the same job as the foam in your running or workout trainers.
Inflammation in the plantar fascia can cause pain. It starts off mild and can become increasingly severe if nothing is done to reduce the swelling. There are many causes of plantar fasciitis:
If taking your first steps in the morning causes pain under the heel, that’s an indication that you could have plantar fasciitis. This pain will ease up after a short while when your condition is still mild. As it gets more severe, the more time you spend on your feet, the worse the pain will get.
Solution: Massage of the area and stretching out of the ligaments all around the foot and lower leg is key to relieving the pain. Icing the bottom of the foot will also help. Once diagnosed, you must rest for anywhere up to two weeks, and only resume training or spending a lot of time on your feet once there’s no more pain.
You can also use a tennis ball. Place the ball under the arch of your foot. Slowly push your foot forwards and backward while applying pressure onto the ball in between your toes and heel. Do this for 30 seconds 2-3 times a day.
A spur is a calcium deposit that protrudes from your bone. It’s usually harmless and doesn’t always cause pain—it all depends on where the spur forms. Under your heel can be an incredibly painful place because you’re constantly stepping onto it.
A heel spur is often linked to a severe case of plantar fasciitis. The constant inflammation in the ligament leads to tears in the tissue that covers the heel bone. Over time, this builds and hardens into the calcium deposit.
Solution: Steroid shots and anti-inflammatory drugs can reduce joint swelling and reduce pain, and three to six weeks of rest is recommended. Physio can also aid in restoring strength, flexibility, and reducing pressure on the nerves. However, if none of these treatments are successful, surgery to remove the spur is required.
Also known as calcaneal bursitis by medical professionals, this condition occurs when the small fluid-filled sac at the back of the heel gets inflamed. This sac is called the bursa, and it sits between the Achilles tendon and the bone as a protective layer. You’ll feel pain towards the back of the heel, often deep inside the foot structure that usually gets worse as the day goes on.
Common causes for this inflammation include a hard knock to the back of the foot or landing on the heel awkwardly when moving around. An accident from aerobics and other high-impact sports can often be the culprit. Footwear that’s too tight and puts pressure on the back of the heel can cause this swelling too.
Solution: Icing the affected area several times a day will reduce pain and inflammation, as well as nonsteroidal anti-inflammatory drugs. Avoidance of the activities that cause or exacerbate the condition is suggested until it subsides. Proper fitting shoes with heel wedges (either over the counter or custom made) decrease stress on the heel too, and can help to prevent heel bursitis.
There’s a fat pad that sits just underneath the back end of your heel. Hard knocks or constant long hours on your feet can inflame this protective pad. Running and jumping for a prolonged period can also affect the health of this pad.
In severe cases, the pad can detach partially from the bone. This usually occurs after a major fall, a heavy jump, or landing awkwardly on the heel. This is extremely painful and can leave you unable to walk barefoot.
You essentially lose some of the foot’s shock absorption function when you damage the heel pad. It requires rest and time off of your feet to repair, just like you would do for any other major bruise or knock to your body. It can be difficult to get this downtime though because any standing or walking will inflame the pad again. Crutches are suggested as they allow for complete, accelerated healing.
Solution: Besides resting as much as possible, icing the heel twice a day for 10-15 minutes will help. Wearing correctly fitting shoes, investing in inserts or heel lifts, or a night splint that stretches the foot while asleep, are all options for treating this ailment.
Sever’s disease or calcaneal apophysitis commonly occurs in children between the ages of 7 and 15 years old. It’s a microtrauma that hits the heel bone from overuse while the bone plates are growing and forming. Once you have finished growing, the plates are stable, and you won’t suffer from this condition—even from extreme activities.
You’ll see Severs disease most often in athletes pushing themselves to their limits. Running is a common cause, but other sports that have a high impact on the feet can also be to blame. The pain is felt in the area at the back of the heel, right where the Achilles tendon inserts into the bone.
Solution: This is a repetitive trauma injury and needs rest to heal. If the person continues to be active, the pain will only increase. There could be a risk of the bones not forming properly in the foot, which is very serious.
Other treatment avenues to consider are regular icing of the area and supportive shoes that reduce the stress placed on the heel bone. A physical therapist can advise of strengthening and stretching exercises that will help too.
This is another condition that’s only really seen in teenagers because it stems from the heel bone not being fully formed yet. Excessive rubbing of the heel bone into the back of the foot can cause too much bone to form, creating a painful sensation when walking. It’s essential to watch the formation of the foot and the way your teenager walks to assess if this could be a problem.
Flat feet are the most common cause of heel bumps. This is when the arch is not properly developed, and the foot pronates incorrectly. Wearing high heels too young can create and exacerbate this condition. The foot is very delicate as it develops, and improper shoes can have a major impact on how the bones form. High heels should only be worn once the bones have fused and are in their proper place.
Solution: Orthotic inserts are an excellent way to prevent and treat heel bumps. These inserts position the foot correctly when walking, running, or standing, and provide support in weaker areas. Soft tissue massage and icing the area help too but are not long-term solutions.
Pronation in itself is not a bad thing. Everyone has pronation of some kind—it’s the motion of the foot through your stride. Neutral pronation is when the ankle is straight and the foot rolls slightly inward with each step. You then get overpronation and supination, which can cause problems and pain in the foot. This is especially problematic in runners and hikers over longer distances.
Supination is when the ankle bends outwards and you roll through the outside of your foot as you walk or run. Most people with this condition have high arches and rigid feet. This can lead to plantar fasciitis and sore heels from too much time on your feet. You can develop problems with your Achilles tendon in the ankle and heel area too.
Overpronation is when you roll too far through your foot with each step. This usually occurs because of flat feet, due to a low arch not keeping the foot and ankle straight. Again, this can lead to plantar fasciitis, as well as shin splints and knee pain in runners.
Solution: Although treatment won’t always alleviate it completely, the good news is there are plenty of shoes that offer arch support for pronation and supination. This is especially important for runners or those doing high-impact sports. The cushioning will keep the ankle and the foot in the best position while moving. You may also need orthotic inserts that offer extra support, and these can be custom made to fit your feet. Additionally, doing exercises that strengthen your arches and the surrounding muscles will help to keep your feet in the right position, and correct your stride.
There are several remedies you can try to ease heel pain before you end up in surgery, or take the heavy medication route. Just be sure to check with a healthcare professional—a doctor or physiotherapist—before you embark on any self-care routines. If your injury is already serious, you will need the help of an expert to recover fully, and not do any more damage.
Take a regular water or soda bottle, fill it with water, and pop it into the freezer. Roll this frozen bottle under your foot with a bit of pressure. The hard surface gives you a massage, and the ice reduces inflammation.
Have two buckets, one with hot water and the other with cold water. Make them as hot and cold as you can stand without it being dangerous. Start with your feet in the hot bucket for 3 minutes and then transfer into the cold for one minute. Repeat for up to 15 minutes in total.
Begin at the base of your heel and massage outwards in a circular motion with your thumbs. Use small, smooth, even movements, and increase the pressure gradually. Then, massage your foot lengthwise along the plantar fascia, starting at the ball and going down towards the heel. Alternatively, you can use a hardball or foam roller and roll your foot over it, increasing the pressure as you go.
Flex and bend your foot up and down 10 to 20 times before you stand. Heel pain can be debilitating and will put a stop to your fitness regime. The best course of action is to identify the cause, then treat the condition accordingly. We’ve covered the most common causes of heel pain and outlined several treatment options for each. However, sometimes, you may need medical intervention if the condition persists, or increases in severity.
Always listen to what your body tells you—pain indicates there’s something wrong. The sooner you embark on a treatment plan, the faster you’ll be back on your feet, ready to exercise and pain-free.