Heel pain

Heel pain is the most common problem of the foot and ankle. Adults usually develop the problem. Children may be affected if a growing bone becomes irritated. Heel pain may be at its worst when getting out of bed in the morning. The pain usually gets better after a few minutes of limping. The same thing may happen when sitting for a while, then getting up. There may also be aching pain when standing for a long time, or after a long day.

Examples of mechanical conditions that can cause heel pain include:

• overuse conditions like bursitis of the heel and Achilles tendonitis
• wearing a specific type or condition of shoe, like shoes with cleats, hard soles, or that rub against the back of the heel
• doing too much standing or walking (especially on hard surfaces)
• not preparing for exercise by stretching first and
• bruising from stepping on something hard like a stone

Overuse and too much stress to the feet are the primary contributors to having a painful heel. Too much running, jumping, or even walking can cause plantar fasciitis, the most common cause of heel pain. Plantar refers to the sole of the foot and fasciitis refers to inflammation of the fascia. Most cases of heel pain occur when there is irritation or inflammation of the fascia. The fascia is a fibrous band of tissue that connects the heel bone to the toes. The pain is usually felt the first thing in the morning when getting out of bed. After a few steps, the fascia will stretch out and the pain will go away.

Physical factors that may cause a painful heel include:

• changes to the cushioning in the heel pad
• heel spurs
• extra stress to the feet from being overweight and
• illnesses, such as gout, arthritis, and psoriasis

A heel spur is a calcium deposit that may form where the fascia connects to the heel bone. Often people who have plantar fasciitis will also have problems with heel spurs. Heel spurs may or may not be painful. If they cause chronic heel pain, medical treatment or surgical removal may be needed.

Treatment of heel pain starts with resting the foot. This may mean walking instead of running when exercising. Exercises to make the foot stronger and to stretch the tendons or fascia are very important. A healthcare provider may suggest exercises to do before getting out of bed. These usually stretch the muscles of the foot and leg. A cloth-covered ice pack can be put on the heel for no more than 20 minutes at least once a day, and up to 8 times a day. A heel cup or orthotics with an arch support may be put in the shoe.

Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen can be taken for the pain. Aspirin or medicines that have aspirin in them should not be given to anyone younger than 18 years of age. Taking aspirin is a risk for a serious illness called Reye's syndrome. NSAIDs should be taken with food or milk to prevent stomach upset. NSAIDs should not be taken by anyone who has been diagnosed with asthma, ulcer disease, or a bleeding disorder. Taking NSAIDs increases the risk of bleeding with trauma, dental work, surgery, or if taking blood thinners (anticoagulants).

Some providers may suggest taping the foot to relieve the strain on the tissues. Occasionally an injection of cortisone may be tried if the exercises, rest, ice packs, and NSAIDS have not helped the pain. Surgery is rarely needed for heel pain. If it is, it will only be done after several months of trying the treatment listed above. Surgery does not always relieve the pain.

Taking good care of the feet can prevent most heel pain. Other measures to prevent heel pain include:

• wearing good shoes that give proper arch support and cushioning to your feet
• stretching the muscles of the foot and calf before walking, running, or any other strenuous activities and
• when exercising, start slowly and gradually increase the intensity and length of time to perform the exercise

People who have diabetes, circulation problems, or arthritis need to pay special attention to their feet. A provider should be seen for any heel pain that does not get better with self-care.

Last Reviewed 2005

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

HIL File BONE3431.RF2 VRS# 4231 Data Version 7.0 Copyright 1999, 2002-2003 McKesson Health Solutions LLC. All rights reserved.