Pain at the bottom of the heel is an affliction that befalls many physically active people, especially runners. When it does, the cause is usually plantar fasciitis.
Plantar fasciitis involves inflammation of a thick and fibrous band of tissue spanning the width of the bottom of the foot. This band also connects the heel bone (calcaneum) and toes. It therefore covers the entire area of the bottom of the foot. It is known as the plantar fascia.
Plantar fasciitis is usually caused by repetitive stress on the plantar fascia over an extended period. The activities that typically cause this stress include running, jumping and other high impact forms of exercise. These activities can especially cause bottom of heel pain when done on hard surfaces like concrete.
Other contributory factors are being overweight and exercising in worn out shoes that lack adequate cushioning. Wearing shoes with inadequate support for the arch of your foot can also be a risk factor. You can read about the detailed causes of plantar fasciitis here.
Plantar fasciitis develops most commonly between the ages of 40 and 60 years and is twice as common in women as it is in men.
In this article, we will discuss in detail the nature of the bottom of heel pain caused by plantar fasciitis. We will also describe the other symptoms typically experienced by those who fall victim to this unpleasant condition.
We will then move on to discuss how a doctor may go about confirming the cause of the pain. Home and physician office based treatments for the pain will then be summarized.
We will then conclude by suggesting how one can avoid this pain, or at least reduce the risk of experiencing it.
Nature Of Plantar Fasciitis Pain
As mentioned above, plantar fasciitis usually causes pain at the bottom of the heel. In some cases, it can also cause pain around the foot arches. The pain is sometimes diffuse over the heel only to localize later to the inner part of the heel bone (anteromedial aspect).
Many victims describe the pain as being akin to that from a bruise at the bottom of the foot. It tends to be worst when the victim wakes up in the morning and takes her first steps of the day. As the patient continues moving around, the pain may recede. It tends to improve also upon sitting. However, it may return after a daytime rest once the patient starts walking around again.
For some patients, the condition may irritate nerves located in the foot. This can then cause the pain to radiate into the ankle joint.
In the early stages of plantar fasciitis, the bottom of heel pain may disappear soon after taking weight off the feet.
If the plantar fasciitis remains untreated for a while, the pain may persist even after the patient sits or lies down.
People who have had plantar fasciitis and bottom of heel pain for a while (ie chronic plantar fasciitis) may experience tearing of the plantar fascia. In other words, the membrane surrounding the heel bone (periostium) is pulled away from it.
When this happens, the body will attempt to “fill in” the torn area with calcium. This calcium will eventually harden into a bone-like substance called a heel spur. A heel spur may be present either with or without pain due to the plantar fasciitis.
Diagnosing Bottom Of Heel Pain
If you have pain at the bottom of your heel similar to that described above, we suggest seeking medical advice. A doctor or podiatrist can diagnose the cause and suggest treatments.
To diagnose the cause, the doctor will ask questions about the nature of the pain and when it is most severe. He or she may also examine the structure of the foot and the patient’s gait (manner of walking). Tests are only rarely needed when the diagnosis is uncertain or to rule out other possible causes of heel pain. These include an X-ray of the heel or an ultrasound scan of the fascia.
The pattern of footwear can also be a telltale factor. If the shoes wear down on the inside part of the foot, this can be a sign of excessive foot pronation. Wear and tear at the outside of the shoe can point to excessive foot supination while walking.
Home Based Treatments
If the diagnosis confirms the presence of plantar fasciitis, your doctor may recommend the following home treatments as a first step:
Decrease the intensity of physical exercise for a period and allow the plantar fascia to recover naturally. Avoid running, excess walking or standing and undue stretching of the sole;
Wear a night splint to bed to keep the plantar fasciitis stretched out and avoid heel pain in the morning;
Apply ice or a cold pack to the bottom of the feet. Do this for periods of 15-20 minutes and at 2-3 hour intervals. This will reduce the pain and inflammation;
For further pain relief, use an over the counter medication like Tylenol (paracetamol) or a non steroidal anti inflammatory drug like Advil (ibuprofen);
Heel pads and arch supports (orthoses): these cushion the heel and support the arch of the foot;
Do not walk barefoot on hard surfaces
Start spending some time at home working on exercises that will relax the calf muscles. Examples of these exercises can be seen here;
Work with a specialist who can develop a physical therapy program of stretching exercises to loosen the calf muscles. Tight calf muscles are a contributory factor towards plantar fasciitis and its heel pain. Exercises to loosen up the Achilles tendon and the plantar fascia are usually helpful.
If the above conservative treatments do not succeed in relieving heel pain, doctors may suggest:
Cortisone injections into the bottom of the foot to directly combat the inflammation. This may relieve the pain for several weeks, but does not always cure the problem. Sometimes, the steroid injection can be repeated over a period of several weeks if the first one is not successful;
Shockwave therapy to accelerate the natural healing process.
This is usually done as a last resort if there has been no improvement in the pain after 12 months of trying other treatments. This can be either of two types of procedure:
Surgery to lengthen the calf muscles and reduce the stress on the plantar fascia (known as gastrocnemius recession);
Making a partial cut in the plantar fascia – again to relieve some of the tension on it. This is known as a “release” procedure.
How To Avoid Bottom Of Heel Pain
To avoid this unpleasant type of foot pain, we suggest taking some or all of the following steps:
Wear supportive shoes at all times and particularly when exercising on hard surfaces. Regular changing of training shoes used for running or walking;
If your plantar fasciitis is due to an insufficiently high arch, try wearing shoe inserts;
Avoid going barefoot and wear shoes whenever possible -even slippers are better than nothing. Walking around barefoot can place stress on the plantar fascia for those with flattened arches.;
Regular stretching of the plantar fascia and Achilles tendon, especially before exercise;