Heel Pain

Heel pain is a very common complaint with patients who attend the foot clinic. The most common condition that causes heel pain is Plantar Fasciitis.

Plantar Fasciitis is a very common 'overuse' injury that can strike at any time, at any age, men or women. The most common time for experiencing heel pain is first thing in the morning, after you get out of bed or after resting, and after you have been sitting for a while or driving. Once you resume walking for a while, the symptoms usually become less severe. However, if the condition persists, you will notice that pain in the heel will become worse as the day goes on or the longer you have been on your feet. It is also characterized by being intermittent or some days it actually feels like it is improving, only to be followed a few days later by becoming worse.

The Plantar Fascia is a non-elastic band of fibrous tissue that is connected to your heel bone and runs through the bottom of your foot spreading into five bands and attaching to the metatarsal joints of the forefoot. The heel pain comes from pulling of the fascia from the heel bone, causing pulls and tears, inflammation and pain. You can also get some micro-tears along the fascia, which could result in arch pain and forefoot pain. The longer this goes on, the more pulling on the heel bone, the more new bone will be created at these sites. The result is a heel spur, which is common on x-ray, but not the actual cause of the heel pain.

Treatment for this condition is recommended as soon as possible, as it only worsens with time. At the Kingston Foot and Ankle Clinic, we will take plaster of paris casts of both feet in the non-weight bearing position. We then make custom made orthotic appliances to support the plantar fascia and eliminate the pull on the heel and the forefoot. These orthotics slip right into your footwear and allow the healing of the plantar fascia while you go on with your daily activities (much like an arm sling). Pain usually subsides within a few days, depending on the length of time the condition has been going on and the severity of the tear.

For persistent heel pain, we use laser therapy. The laser is used to break-up or disperse inflammation at the site of the tear to reduce pain and accelerate the healing process. This is a painless procedure where you sit comfortably in the chair and the pedorthist applies the light therapy and then the laser to the affected area. Treatments generally last from 20-30 minutes.

At home we recommend that you rest the feet as much as possible, and replace high-impact exercise with lower impact activities while you are still having heel pain. Extra weight gain can also aggravate the problem, so keep your body weight in check and put off lifting heavy objects as this puts more stress on the plantar fascia.

We also recommend that you switch to a more supportive shoe for most of the day, even in the house. Take out an old pair of running shoes for in the house so you have them by your bed. This will avoid stepping into the floor in the morning without support. You will need these with your orthotic appliances in them, and wearing them first thing out of bed will greatly improve your speed of recovery.

Hot and cold therapy is also very beneficial to reduce some pain, especially after you get home from work. You should put the feet in moderately warm water for 2-5 minutes followed immediately with 2-5 in (5-12 cm) of cold water (or use ice packs). You can do this several times a day to a maximum of 10 times per session. This process greatly reduces the inflammation and promotes healing.

There a few exercises that you can do to prevent re-injury but take caution while the heel pain still persists:

1. Use a cold soft drink can sideways on the floor and roll your foot over, back and forth, massaging the muscles in the arch. 2 minutes at a time, several times per day, go gently if pain is still persistent.
2. Towel curls can strengthen the plantar fascia by trying to pull the towel towards you, on the floor, with your toes. You can add a weight to the towel to make it more difficult. Make the towel come towards you like an accordion.
3. Try curling your foot around a can or the shin of your other leg. Repeating this exercise strengthens the muscles in your foot as it tries to grab around another object.
4. Stand with your feet together, then rotate your knees outward while you are attempting to stay on the floor using the muscles of your feet. Hold for about 10 seconds and then relax. Repeating this exercise will take some pain away in acute cases that are very painful, and is also beneficial in prevention.

Other conditions that can produce heel pain include a fracture of the heel bone, slivers or embedded objects, fissures or severe cracks in the skin, plantar warts and problems with the fatty padding.

It is important to attend the foot clinic to make sure you know what is making your heels sore. A proper diagnosis and treatment plan will ensure prompt complete recovery so you can get on with life!