How to avoid and treat heel pain: expert tips for relief
Written in association with:
Orthopaedic surgeon
Published: 18/09/2024
Edited by: Conor Lynch
Heel pain is a common issue that affects individuals of all ages and activity levels. It is often caused by factors such as poor footwear, overuse, or underlying medical conditions. The most frequent culprit behind heel pain is plantar fasciitis, an inflammation of the plantar fascia—a thick band of tissue connecting the heel bone to the toes.
Other common causes include Achilles tendinitis, heel spurs, or bursitis. Fortunately, there are effective strategies to both prevent and treat heel pain. Here, a distinguished consultant orthopaedic surgeon tells us how heel pain is usually treated and managed.
Heel pain prevention
One of the simplest preventive measures is wearing proper footwear. Shoes that offer sufficient cushioning and arch support can significantly reduce the risk of developing heel pain.
It's essential to choose shoes that support the arches and provide shock absorption. In addition to footwear, regular stretching is key in maintaining flexibility and preventing heel pain. Stretching the calf muscles and the plantar fascia itself can help keep these tissues limber and less prone to injury.
Exercises to stretch out the calf muscles focusing on the gastrocnemius muscle are very important. Incline boards can be used or simply standing on a thick book with the knees straight is and easy way to stretch them. Other exercises to help stretch the plantar fascia itself can be helpful.
If symptoms are worse first thing in the morning due to the calf muscles having been tight overnight a simple way to help is to use night time splints. For example, Strassburg socks are probably the best tolerated splints and are often helpful.
Maintaining a healthy weight is another important factor in preventing heel pain. Excess body weight places increased pressure on the feet, especially the heels, which can lead to pain and discomfort over time.
Gradually increasing physical activity levels can also help avoid overuse injuries to the feet and heels. Rapidly ramping up the intensity of workouts or activities can put undue stress on the heels, leading to inflammation and pain.
If heel pain does occur, rest and ice are simple yet effective treatments. Resting the foot and applying ice for 15-20 minutes several times a day can reduce inflammation and alleviate discomfort. However, ice and rest are good in the early stages but for longstanding issues they aren’t really helpful.
For heel pain that doesn’t settle with simple treatments there are very successful options to try. A small surgical procedure under local anaesthetic and sedation to release the tight medial head of the gastrocnemious muscle (PMGR) has low risks, low down time and a good chance of improving symptoms is one option.
Shock wave treatment (ESWT) is another strategy this requires about 3-4 sessions every 1-2 weeks. This converts a chronic problem into a new acute issue to hopefully allow it to heal. Rarely, steroid injections can help but this have risks themselves ( rupture, painful, infection) so I try and avoid this option. Before any intervention is planned a MRI scan is often helpful to confirm there isn’t any other issue that could be causing the heel pain.