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.
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.
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.
If the diagnosis confirms the presence of plantar fasciitis, your doctor may recommend the following home treatments as a first step:
If the above conservative treatments do not succeed in relieving heel pain, doctors may suggest:
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:
To avoid this unpleasant type of foot pain, we suggest taking some or all of the following steps:
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