Taking Care of Heel Pain

Stretching
Heel pain can be very aggravating, especially when taking those first steps in the morning. The key to decreasing and possibly eliminating heel pain is to stretch your heel cord and plantar fascia. The heel cord is the Achilles tendon, which connects the gastrocnemius and soleus muscles in the calf to the heel bone. The plantar fascia is a thick tissue that runs along the bottom of your foot, connecting the heel bone to the toes and maintaining the arch.

You can stretch your heel cords as shown in Figure A-C and your plantar fascia as shown in Figure D. You can also stretch your plantar fascia by modifying the exercise shown in Figure C. Place a rolled towel under the toes of your back foot when doing the stretch; you will feel a gentle stretch along the bottom of your foot in addition to the back of your calf. Each stretch should be painfree and held for 30 seconds. Complete five repetitions of the stretches four to five times each day. When stretching in the standing position, keep your heels down and your toes pointed straight ahead or slightly inward. Always do standing stretches with your shoes on*. In addition to these stretches, your doctor may recommend that you wear a splint that maintains a gentle stretch on your heel cords overnight.

Additional pain relievers
Treatments to add to your stretching program include wearing good-quality shoes, icing the painful area, and massaging the arch. Do not walk barefoot; walk in shoes with good heel and arch supports such as high-quality walking or running shoes. Keep a pair of shoes next to your bed so you can put them on before taking your first step. Your doctor may recommend that you wear an additional arch support or a heel cup in the shoes.

Icing your foot can help relieve pain. Rub a frozen bottle of water or an ice cup over the tender areas for five minutes two times each day. Massage your foot by rolling a tennis, golf ball, or baseball along your sole and heel. This friction massage can help break up adhesions and stretch the plantar fascia. Do this for five minutes two times each day.

If you are a runner or just started a walking or running program, evaluate your training for errors such as warming up improperly, increasing mileage too quickly, running hills excessively, running on surfaces that are too hard, or wearing broken down shoes. Adjusting your training program can help relieve your pain. While recovering from heel pain, walk or jog in a pool or crosstrain by biking and swimming. These activities maintain your cardiovascular fitness without stressing your heel cord or plantar fascia.

Heel pain takes time to go away. Be patient and remember that no treatment is a substitute for STRETCHING!

Teri LaSalle, M.S., P.T., ATC
Columbus, Georgia

Further reading
1. Candelora P, Hunter S. Overuse foot injuries. In: Baker CL, ed. The Hughston Clinic Sports Medicine Book. Philadelphia, PA: Williams & Wilkins; 1995: 603-618.
2. Cornwall M, McPoil T. Plantar fasciitis: etiology and treatment. J Orthop Sports Phys Ther. 1999;29:756-760.