Related Articles: Heel Pain

"Time Wounds all Heels" by Jeffrey Jacobs, C. Ped

Of all foot problems, heel pain among the most common and it can be the most debilitating. Understanding the causes of heel pain can go a long way toward preventing this most uncomfortable condition. 

Most heel pain is caused by “overuse”. This may be excessive weight, increased activity or wearing inappropriate footwear. The problem occurs when too much stress is placed on a connective tissue called the plantar fascia. The plantar fascia runs along the bottom of the foot and attaches to the calcaneus or heel bone. When we place weight on the foot, the foot naturally elongated as the mid foot drops (pronates) to absorb shock. This puts a strain on the attachment of the plantar fascia at the heel and causes pain, a condition known as plantar fasciitis. Eventually this can also lead to the development of a knob or heel spur. The heel pain associated with plantar fasciitis is normally worse first thing in the morning or after sitting for a long period of time. 

There are three components to treating and preventing plantar fasciitis. The first is wearing appropriate shoes. These may be good quality sneakers or walking style shoes that provide substantial arch support and foot control. Orthopedically designed sandals such as Birkenstocks that have a pronounced arch are also good. While soft, “cushion” soled shoes may seem like the right choice, they often may make the problem worse because of the lack of rear foot control. Walking barefoot or in flimsy shoes and slippers is not recommended. 

Since most shoes will not have an arch shape that is perfectly matched to your personal foot, a custom made insert or orthotic device may be helpful. Foot orthotics support the mid foot to help control the arch flattening that causes stress on the heel. Well made orthotics are comfortable to wear and can be used in a variety of footwear. Off the shelf arch supports can also provide some benefit. Cushioned heel cups are sometimes effective, not because they cushion the heel, but because they slightly elevate the heel. 

Stretching exercises are important to treating and preventing heel pain since it is often tightness of the muscles and tendons in the back of the legs and the plantar fascia itself that can cause strain on the heel. It is helpful to do some light stretching before rising from bed in the morning to loosen up before bearing load on your feet. 

Since weight has a significant impact on the feet and especially on the heel, shedding unwanted pounds will give you feet much needed relief. Unfortunately, heel pain can also limit activities that are beneficial to weight loss. Bicycling, water aerobics and rowing are great activities that have very low impact on the feet. Walking or running on a treadmill also reduces impact loads on the feet compared to harder surfaces. 

It is always recommended that you seek medical advice before treating chronic foot problems. Your doctor or podiatrist will diagnose your condition and may recommend specific treatment.