Overview
Heel pain is one of the most common foot problems. The most frequent cause is plantar fasciitis, inflammation of the thick band of tissue (plantar fascia) running along the bottom of the foot from heel to toes. Pain is typically worst with the first steps in the morning or after long periods of rest.
How common is it?
Plantar fasciitis affects approximately 1 in 10 people at some point. It is particularly common in middle-aged adults and in runners.
Causes and risk factors
Repeated strain on the plantar fascia causes micro-tears and inflammation at its attachment to the heel bone. Tight calf muscles and flat or high-arched feet increase stress on the fascia.
Common risk factors
- Flat feet or high arches
- Tight calf muscles or Achilles tendon
- Sudden increase in activity or mileage (runners)
- Prolonged standing on hard floors
- Wearing unsupportive footwear
- Obesity
- Age 40 to 60
Symptoms
- Sharp stabbing pain at the bottom of the heel, especially with the first steps in the morning
- Pain that improves with movement but worsens after prolonged activity or at the end of the day
- Tenderness on pressing the inner edge of the heel bone
- Occasionally a bony spur on X-ray (incidental finding)
When to see a doctor
See a doctor if pain is severe and not improving after several weeks of self-care, if it affects walking, or if it came on after an injury. Physiotherapy referral is very effective.
Diagnosis
Clinical diagnosis. X-ray may show a heel spur but this is not the cause of pain. Ultrasound confirms plantar fascia thickening and inflammation. MRI excludes other causes if diagnosis is uncertain.
Treatments
Stretching exercises
Regular calf stretches and plantar fascia stretches (particularly before getting out of bed) are the most effective first-line treatment. Should be done 3 times daily.
Orthotics and footwear change
Supportive insoles with heel cushioning and arch support, combined with cushioned shoes, significantly reduce symptoms. Wearing shoes all day (avoiding barefoot walking) is advised initially.
Corticosteroid injection
Injection into the site of maximum tenderness provides significant short-term relief in cases resistant to conservative treatment.
Self-care and lifestyle
- Stretch your calf and plantar fascia before your first steps every morning
- Avoid walking barefoot on hard surfaces
- Ice the heel after activity to reduce inflammation
- Reduce running mileage and cross-train (cycling, swimming) while healing
Prevention
Regular calf stretching, wearing supportive footwear, gradual increases in exercise, and maintaining a healthy weight reduce plantar fasciitis risk.