Heel pain

What causes heel pain?

Plantar fasciitis

The plantar fascia is a thick band of tissue on the bottom of your foot. It runs from your heel to your toes and supports your arch. When it gets strained and irritated, it causes pain on the bottom of the heel. This is called plantar fasciitis. It is the most common cause of heel pain in adults.

The classic sign is sharp pain with your first steps in the morning or after sitting for a while. The pain often eases after you walk a bit, then returns after long periods on your feet.

Other causes

• Achilles tendon problems: pain at the back of the heel, where the tendon attaches
• Stress fracture: a small crack in the heel bone, often after a jump in walking or running
• Pinched or irritated nerve: burning, tingling, or numbness in the heel or arch
• Fat pad thinning: less natural cushion under the heel, often with age

A heel spur may show up on an X-ray. Many people have spurs with no pain at all, so the spur itself is often not the main problem.

Who gets it?

• People who stand or walk on hard floors for work
• People with tight calf muscles
• People with very flat feet or very high arches
• People who have gained weight
• Runners or walkers who increase their activity quickly
• People who wear worn-out or unsupportive shoes

Home care

• Stretch your calf and the bottom of your foot, especially before your first steps in the morning
• Wear supportive shoes, and avoid going barefoot on hard floors
• Replace worn-out shoes
• Cut back on activities that make it worse for a while
• Roll your foot over a cold water bottle
• Use over-the-counter pain medicine if it is safe for you

In-office treatments

If home care isn't enough, Dr. Nafal may suggest:

• A stretching program shown step by step, sometimes with physical therapy
• Shoe advice for your foot type and daily routine
• Shoe inserts (orthotics): store-bought or custom-made to support the arch
• Night splints: a brace worn while sleeping to keep the tissue gently stretched
• Injections: a steroid shot to calm pain and swelling in some cases
• A walking boot for a short time when pain is severe

Plantar fasciitis often improves over several weeks to months. How quickly depends on how long you have had it and how steady you are with the plan.

When surgery is considered

Surgery for plantar fasciitis is rarely needed. It may be considered when pain lasts many months, often 6 to 12, despite steady non-surgical care. Options may include releasing part of the tight tissue or lengthening a tight calf muscle. Dr. Nafal will explain the pros and cons before any decision.

How Dr. Nafal can help

Dr. Nafal treats everyday foot problems like heel pain, as well as complex conditions. He takes time to find the cause of your pain, and he explains every option in plain words, including options that don't involve surgery.

Common questions

Why does my heel hurt most in the morning?

The plantar fascia tightens while you rest. Your first steps stretch it suddenly, which causes pain. Gentle stretching before you get up can help.

Do I need to get rid of my heel spur?

Usually not. Treating the irritated tissue is often what helps. Many people with spurs never have heel pain.

When should I see a doctor for heel pain?

Come in if pain lasts more than a few weeks, keeps you from daily activities, or started after an injury. Also come in if you have numbness, tingling, swelling, or diabetes.