You’re headed out on your morning walk or jog when—ouch—the area beneath or behind your heel starts to throb. Join the club: Roughly 40% of Americans complain of the issue each year, according to a survey from the American Podiatric Medical Association. “The wrong shoes, repetitive strain, and natural aging processes can all contribute to heel pain,” says Christina Long, DO, a podiatrist at Wake Forest Baptist Medical Center in Winston-Salem, NC.
What can you do to ease the discomfort? First, learn the reason behind it—and then follow these expert guidelines to sidestep the pain.
1. Plantar Fasciitis
The most common cause of pain on the bottom of your heel, this condition strikes 2 million people each year. “The plantar fascia is a band of tissue that runs down the arch of your foot, connecting the toes with the heel,” says Irene Loi, DPM, a podiatrist at NYU Langone Medical Center in New York City. It helps the foot absorb shock, but repeated pressure from walking or running can cause inflammation. “The pain is usually the worst first thing in the morning, and after sitting or standing for a while,” says Loi.
There’s a reason it’s bad in the morning, explains Megan Leahy, DPM, a podiatrist at the Illinois Bone and Joint Institute in Chicago. “As you’re sleeping, your arch goes back up to its natural position along with your plantar fascia, but when you take a step first thing, it stretches out again and causes micro tears that create a lot of pain,” Leahy says. There’s a long list of issues that may set the stage for plantar fasciitis, including a tight calf muscle or Achilles tendon, wearing shoes that don’t offer enough arch support (bye-bye, ballet flats!), having flat feet, increasing your physical activity too quickly instead of gradually building up, and good old-fashioned wear and tear, says Leahy.
How to treat it: To ease the pain, you can take an over-the-counter anti-inflammatory, such as ibuprofen, and ice the area. “Freeze a bottle or cup full of water, and roll it on the bottom of your foot,” suggests Long. To prevent more irritation, rest your foot as much as possible and wear supportive shoes. “You need to replace your shoes at least every 6 months, or 4 months if you run or walk every day,” says Long.
Stretching your calves and feet loosens the muscles, which can ease the pressure on the plantar fascia. Incorporate these two stretches into your daily routine:
• Towel stretch: Sit with your legs straight in front of you. Place a rolled towel around the ball of one foot, holding the two ends with each hand. Gently pull the foot toward you, holding for 15 to 30 seconds. Switch sides.
• Heel raise on the stair: Stand on a bottom stair. Move your feet back so that your heels fall off of the edge. Holding the wall or rail for support, shift your weight to one foot and lower that heel toward the floor. Hold for 15 to 30 seconds. Switch sides.
Ache bothering you for more than a few weeks? See a doctor, who can rule out underlying issues, such as a heel spur, a bony formation on the bottom of your heel that can worsen inflammation. He or she may also suggest that you wear a splint while you sleep to stretch out the calf and support your foot. (Here are some more heel stretches to help ease your pain.)
2. Fat Pad Atrophy
Over the course of a lifetime, our feet step more than 100,000 miles. So it’s no wonder that the natural cushioning eventually wears down, like the tread on the bottom of your sneakers. Thinner fat pads increase the pressure on your heel—a reason why it’s the second most common cause of heel pain, according to a study published in the Annals of Rehabilitation Medicine.
How to treat it: Rest, ice, and anti-inflammatory medicine can temporarily quell the throbbing, but providing the right support can prevent it altogether. Skip the high heels or flats, and opt for a pair of supportive shoes. You may want to a wear a heel lift, suggests Long. These inserts transfer some of your weight to the front of your foot, relieving pressure on your heel. Treading carefully can also help. Trywalking or running on a soft surface, such as grass or a track instead of pavement, and avoid high-impact activities, like jumping.
3. Achilles Tendinitis
The largest tendon in your body, the Achilles tendon connects your calf with your heel bone. “Wear and tear on the calf and backside of your heel can cause inflammation,” says Emily Beyer, DPT, a physical therapist and running specialist at the Mayo Clinic in Rochester, MN. This is often brought on by overuse from activities like walking and jogging. Tight calf muscles can also add stress to the tendon. (Be careful, as Achilles injuries are some of the hardest to recover from.)
How to treat it: “Exercises can relieve the pressure and realign the fibers of the Achilles tendon,” says Beyer. She recommends doing the towel stretch and calf heel raises—either off a step or on the floor—to stretch and strengthen the tendon. “Massaging your calf and tendon also brings blood flow to the area, which can encourage healing,” she says. (Here are 3 signs you have tendinitis.)
Leahy says that, as with plantar fasciitis, the sooner you address the issue, the better. Her recommendation: Take tension off the tendon by wearing a heel lift in your shoe. If the pain persists for more than a few weeks, see a physician, who can look for an underlying issue. He or she may also refer you to a physical therapist, who can study the way you step and suggest ways you can relieve tendon pressure.
4. Stress Fracture
You’ve decided to follow through with your New Year’s resolution of walking or jogging. That’s great, but suddenly ramping up your mileage or intensity can put excess strain on the heel. This can lead to severe bruising or a small crack in the bone, called a stress fracture. While a stress fracture can occur in just about any bone, the bones in your feet, including your heel, are especially prone to them because they absorb repetitive pounding day after day, Leahy says.
How to treat it: If you suspect a stress fracture, see a doctor, who may diagnose the condition based on an imaging test or your symptoms alone. “Stress fractures usually start with a stress reaction, which is swelling and inflammation in the bone,” Leahy says. “If you can catch it in the stress reaction phase, treatment is much easier.” Rest and TLC are the best prescription for a stress fracture, says Long. You may need to wear awalking boot or brace and use crutches until the bone heals.
This disease, which causes inflammation of the joints, may strike you rfeet. You may be at increased risk if you have flat feet. “When the foot is constantly rolling in, it causes impingement of the joint, which becomes chronically inflamed and can lead to arthritis,” Leahy says. Although it generally affects bones in the middle of the foot, arthritis can also affect the joint that connects the heel bone, and you can develop a condition called post-traumatic arthritis in your heel if you’ve ever had an ankle injury. “If you damaged the cartilage in your heel, the inflammation can, over time, lead to arthritis,” she says.
How to treat it: Rest and anti-inflammatory medications offer relief. “Strong foot muscles help support the joint and lessen the impact on the joint,” says Beyer, who suggests the same stretches as those recommended for Achilles tendinitis. You should also see your doctor, who may suggest using a shoe insert to help stabilize the foot.