Condition guide
It shows up as a stabbing pain in the heel with your first steps in the morning. Although people commonly call it a "heel spur", the real source of the pain is usually not a bony growth but strain on the band of connective tissue on the sole of the foot (the plantar fascia). The good news: the vast majority of patients get better without surgery.
The plantar fascia is a thick band of connective tissue on the sole of the foot that runs from the heel to the toes. It supports the arch of the foot and is stretched with every step. With repeated overloading, wear and pain develop where the fascia attaches to the heel. Although the "-itis" in the name suggests inflammation, the problem is usually wear in the tissue rather than inflammation.
It is usually diagnosed by examination: the pain is on the inner, lower part of the heel, is worst with your first steps in the morning and when you get up after sitting for a long time, and gets worse when you stand for long periods.
The bony growth on the heel seen on an X-ray (a calcaneal spur) is a common finding even in people with no pain at all, and on its own it does not explain the pain. The pain comes from strain on the fascia rather than from the spur itself.
That is why the aim of treatment is not to "dissolve" the spur or remove it with surgery, but to reduce the load on the fascia and strengthen the tissue. Even after the pain has gone, the spur usually still shows on the X-ray. In other words, the spur does not need to disappear for you to get better.
The American Physical Therapy Association's 2023 guideline puts stretching, manual therapy and short-term supports at the heart of non-surgical treatment.
Not recommended in the guideline: Adding therapeutic ultrasound to stretching exercises gives no extra benefit.
Exercises at home
You may feel mild discomfort during the exercises. If the pain is not clearly worse the next morning, it is safe to carry on. You will get the most benefit from the stretches if you do them before your first steps in the morning and after sitting for a long time.
Sit down and rest your painful foot on your other knee. With one hand, pull your toes back towards the top of your foot; feel a stretch in the sole of your foot, just in front of the heel. It is especially helpful before your first steps in the morning and after sitting for a long time.
10 seconds, 10 reps, 3 times a daySit on the floor or on your bed with your legs straight. Loop a towel around the front of your foot and hold the ends. Keeping your knee straight, pull the towel towards you; feel a stretch in your calf and the sole of your foot.
30 seconds, 3 repsPlace your hands on the wall and step your painful leg back. Keeping your back knee straight and your heel on the floor, move your hips towards the wall; feel a stretch in the upper part of your calf.
30 seconds, 3 reps, 2–3 times a dayIn the same position, bring your back foot a little further forward and bend your knee. Without lifting your heel off the floor, lower your hips; you will feel the stretch in the lower part of your calf, near the Achilles tendon.
30 seconds, 3 reps, 2–3 times a dayStand on a step and place a rolled-up towel under the toes of your painful foot, with your heel over the edge of the step. Holding on to the counter or a wall for support, rise up on one foot over 3 seconds, hold for 2 seconds, then lower over 3 seconds. As it gets easier, add weight with a backpack.
8–12 reps, 3 sets, every other daySit down and place a tennis ball or a water bottle under your painful foot. Roll your foot back and forth from the heel to the toes. When the pain is bad, chilling the bottle in the freezer first can also bring relief.
1–2 minutes, 2–3 times a dayThe aim is not to rest your heel completely, but to adjust the load to what the pain allows and to build the tissue's strength back up.
Video
From the YouTube channel of US physical therapists Bob Schrupp and Brad Heineck.
A stretch that targets the fascia on the sole of the foot.
A short routine to ease pain with your first steps in the morning.
Usually, yes, but it takes patience. With the right treatment, about 80% of patients recover within 12 months. Stretching, strengthening and managing the load speed up this process.
Very rarely. The bony growth seen on an X-ray is common even in people with no pain, and it is not the real source of the pain. Surgery is considered for a small number of patients who have not responded to any treatment over a long period.
A cortisone injection may give short-term relief, but the effect is temporary, and in about 2.4% of people who have more than one injection, the fascia can tear. Methods such as exercise, taping, a night splint and insoles should be tried first.
Overnight, your foot rests pointing downwards, so the fascia and calf muscles rest in a shortened position; with your first steps, these tissues are suddenly stretched. Stretching before you get out of bed and wearing a night splint reduce this pain.
Insoles help when used together with stretching and strengthening exercises, not on their own. The guideline recommends off-the-shelf or custom-made insoles for use alongside other treatments.
You do not need to stop completely. For a while, cut back on loads that clearly make the pain worse, such as running and jumping, and keep fit with cycling and swimming. As the pain eases, increase the load gradually.
Heel pain is usually harmless. However, see a doctor without delay if you have any of the following:
Sources
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İhsan Eren