Heel pain due to heel spurs is usually due to plantar fasciitis. Heel spurs are usually diagnosed via X-ray of the heel, foot, or ankle. The plantar fascia is a band of relatively inflexible tissue that connects the ball of the foot to the heel. Its main job is to prevent the arch of the foot from going flat when weight is put on the foot.
The plantar fascia becomes inflamed (plantar fasciitis) when there is too much pulling on the plantar fascia, either from too much weight on the foot, too much walking/running, not enough support, or from too much pulling on the heel due to short calf muscles. The process becomes self perpetuating as the plantar fascia tries to heal itself, because it almost always heals shorter than it was before, resulting in too much stretching of the fascia. The result is pain that is worst when you first put weight on the foot after it has been rested (for example, when you first get out of bed in the morning).
A heel spur develops when the body deposits calcium on the irritated fascia. Many people with heel spurs do not have heel pain, but many do. If you don’t have pain, you don’t need treatment.
Thankfully, there is a lot you can do for yourself at home to get the plantar fascia to heal properly.
1. Stretch the plantar fascia. If you don’t do this, you probably won’t get better. You will not notice immediate relief from stretching, and it might even hurt, though the pain should not be severe.
There are several stretches you can use. All should involving holding a position for at least 15-30 seconds, with 10 to 15 repetitions at least twice a day. Stretching should always be done gently and gradually, without bouncing.
- Plantar fascia stretch: Although it is possible to flex your toes up toward the knees without using your hands, this position does not stretch the plantar fascia enough. Sit with your ankle over the opposite knee and use your hand to pull the toes up as far as they can go and hold in the more extreme position.
- Leaning into the wall stretch: Stand facing the wall with your affected foot flat on the floor about 3 feet from the wall and the other foot about one foot from the wall. Lean slowly forward with your palms on the wall and allowing your elbows to bend, until you feel your calf muscle stretching. Hold this position. Repeat on the unaffected side.
- Step drop stretch: Stand on a step with both of your toes. Holding the rails on both sides with your hands, allow your heels to drop below the level of the step. Hold this position.
You can also prevent plantar fascia shrinkage throughout the day by wearing footwear that does not bend at the ankle, such as work boots or high top sneakers. It is also possible to spend the night with this type of shoe on. For some, it makes it impossible to sleep, but for others it brings welcome relief. Avoid shoes that force you to point your toes most of the day, like high heels.
2. Control inflammation. This step will control pain, but does not promote proper healing. Two techniques which are helpful are:
- apply ice. Use regular ice in a bag or frozen vegetables/fruit in a bag. Blue ice can produce frostbite. Apply to the bottom of your heel until the area stops feeling cold. Consult your doctor first if you have diabetes or any kind of nerve damage in the feet.
- take an anti-inflammatory. If you are healthy and do not take any other medicines, or if you get your doctor’s approval, you can take something like ibuprofen or naproxen to control the inflammation. Remember to take it with food. Acetaminophen is not anti-inflammatory but does help control pain.
3. Decrease stress on the plantar fascia. This step may help healing and also may help prevent future episodes.
- Wear shoes with good arch supports. You can either purchase expensive shoes (especially helpful if you are a runner) or buy over the counter arch supports (found in the pharmacy or shoe department).
- Wear heel cups. These are especially helpful in older people who have thin natural padding under their heels.
- Lose weight.
- Walk/stand on softer surfaces. If you have to work standing on a hard surface all day, sometimes standing on foam or rubber padding can help.
- Walk less until you stop hurting, then increase your mileage slowly. For exercise you may want to try non-weight bearing exercises like swimming or weight lifting, until your heel stops hurting.
- Do exercises to strengthen the muscles of the feet. This is especially helpful in sedentary, older people, who often have weak feet. For this exercise, sit in a chair with your shoeless feet flat on a towel. Keep your heel on the floor and use your toes only (in a toe curling motion) to pull the towel toward you. You should do at least 15 toe curls on both sides at least twice a day.
When to see your doctor.
1) You aren’t sure you have plantar fasciitis.
2) Your pain is getting worse instead of better even though you have used the above measures religiously for 2 or more weeks.
3) Your pain isn’t improving at all after at least 4 weeks.
4) Your pain is still significant after 12 months.
Your doctor may recommend other treatments such as a cortisone injection, orthotics, night splinting, physical therapy (for massage, iontophoresis, taping, or other therapies), or in extreme cases, casting, surgery, or shock wave therapy.
Goff, James D., and Robert Crawford. “Diagnosis and Treatment of Plantar Fasciitis.”American Family Physician 84.6 (2011): 676-82. Print.
Moses, Scott. “Family Practice Notebook.” Plantar Fasciitis. N.p., 22 Feb. 2012. Web. 03 Oct. 2013.