Heel pain most often comes from plantar fasciitis: irritation of the thick band of tissue (the fascia) that runs along the sole from the heel to the toes. People call it heel spurs, because on an X-ray you can sometimes see a small bony growth. The spur is rarely the cause of the pain, though: many people have a spur without pain, and others have pain without a spur. It is most common between the ages of 40 and 60 and in people who stand or walk a lot.
Symptoms
- Sharp pain in the heel with the first steps in the morning.
- Pain after sitting, when you get up again.
- The pain eases as you move around but builds towards the end of the day.
- A tender spot on the underside of the heel, on the inner side.
- Pain when walking barefoot on a hard floor.
- Pain after standing in one place for a long time, for example at work.
- Sometimes pain along the arch of the foot.
Many people describe the first steps in the morning as stepping on a nail. After a short walk the pain eases, because the fascia loosens up. Plantar fasciitis usually affects one foot, but it can be in both.
Why it happens
- A lot of standing or walking on a hard surface.
- A sudden increase in running or walking.
- Running on hard ground or uphill.
- Stiff calves and Achilles tendon.
- Being overweight.
- Flat feet or a very high arch.
- Shoes with a thin sole or no support.
The fascia works like a spring for the arch with every step. When the load grows faster than it can adapt, it becomes irritated where it attaches to the heel. The pain often starts after a change of job, new shoes or a new sport.
How we treat it
Kaloyan checks exactly where the pain is, the flexibility of your calf and how you walk. He often starts with ultrasound therapy on the heel and the fascia to calm the irritated tissue. Kinesio taping supports the arch of the foot and reduces the pain when walking between visits. If the calf or the muscles of the foot are tight and have tender points, Kaloyan adds dry needling. Releasing the fascia with Ergon, a special tool that heats up, also helps a great deal. The needles are optional: if you don’t like the idea, he works with his hands and exercises.
He shows you exercises for the foot and calf to do at home every day, especially in the morning. Most people first notice that their morning steps get easier. A course is usually 2–5 sessions, and the pain often takes several months to go away completely. Kaloyan will also look at your shoes and tell you whether an insole or a heel pad could help. If the pain continues for more than a few months despite the exercises, Kaloyan will refer you to an orthopaedic doctor for other options.
What you can do yourself
- Don’t walk barefoot on hard floors. Wear shoes with a soft sole and arch support, at home too.
- Before you get up in the morning, move your foot around a few times.
- Cut down running and long periods of standing for a while.
- If you stand for long at work, change position and use a soft mat under your feet.
- If you are overweight, every kilogram you lose reduces the load on your heel.
When to see a doctor first
Heel pain is rarely dangerous. See a doctor first if:
- the pain started after a fall or a jump;
- the heel is swollen, red or warm;
- you have numbness or burning in the foot;
- both heels hurt, together with pain in your back or other joints;
- the pain is severe at night too, while you rest.
