How to Avoid Heel Pain and Plantar Fasciitis

Co-authored by Miguel Cunha, DPM

Last Updated: May 16, 2023 Approved

The most common cause of heel pain is plantar fasciitis. It can be extremely painful, interfere with routine daily activities, and diminish the quality of life in the sufferer. The plantar fascia is the wide, flat piece of connective tissue that supports the sole of the foot from the heel to the toes. If this becomes torn, overstretched, or ruptured, the tendon may become inflamed in a condition known as plantar fasciitis. Preventing plantar fasciitis, as well as avoiding further injury once it does develop, can help to keep you on your feet and active.

Part 1

Part 1 of 3:

Avoiding Plantar Fasciitis

1
Take care of the plantar fascia. The plantar fascia is a ligament that consists of a thick band of tissue that runs from the heel bone to the toe area.The plantar fascia ligament provides support for the natural arch in your feet.^{[1]
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- Injury to the plantar fascia is the primary reason for heel pain. Plantar fasciitis is caused by damage to the ligament, causing it to become swollen, weakened, and irritated or inflamed.^{[2]
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2
Wear shoes that are supportive. Select shoes that fit well all around, have shanks and solid heel counters built in, and provide good support for your arch. If your arch isn't supported, it will collapse when you stand. That causes the plantar fascia to stretch, and you can develop micro-tears that result in inflammation and pain.^{[3]
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Expert Source

Miguel Cunha, DPM
Board Certified Podiatrist

Expert Interview. 1 May 2020.}
- A shank is a supportive strip that runs along the bottom of the shoe. It is not visible, so it is difficult to tell if the shoe manufacturer included a shank in the design. If the shoe is flimsy, and easy to bend in the middle, then it probably does not have a shank.^{[4]
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- The heel counter is also not visible, but the presence of a solid heel counter can be determined by pressing inward on the middle, upper area of the back part of the shoe. If it easily collapses to the inside, then the heel counter is not very strong. The more rigid and supportive the heel counter is, the more difficult it will be to push the upper back part of the shoe toward the inside sole.^{[5]
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3
Replace shoes with worn soles. Prevent heel pain and plantar fasciitis by discarding shoes with worn soles and heels.
- Worn soles and heels contribute to an uneven step with heel counters that have lost some of their support. Discard old shoes and replace with new ones that have the proper support.
4
Avoid going barefoot. Everybody likes to go without shoes at times, but limit the time you walk around without proper footwear.^{[6]
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- Walking barefoot significantly increases your risk of damaging the ligament that naturally supports your arches which can lead to heel pain and plantar fasciitis.^{[7]
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5
Warm up properly before exercise and cool down afterwards. The importance of stretches cannot be over-emphasized.^{[8]
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- Tight calf muscles can contribute to heel pain. The Achilles tendon stretches from the bone in the heel into the calf area. By stretching your calves, you can help relieve some of the pain due to plantar fasciitis.^{[9]
  X
  Expert Source
  
  Miguel Cunha, DPM
  Board Certified Podiatrist
  
  Expert Interview. 1 May 2020.}
- Performing exercises that stretch your feet can help to maintain the integrity of the plantar fascia ligament and prevent heel pain.^{[10]
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- Do three stretching exercises for your feet before and after exercising. The first involves standing with your hands placed on a wall and the toes of one foot also against the wall.^{[11]
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- Place one foot back, and keep your heel on the ground as you lean into the wall. Hold this for 30 seconds, switch legs and repeat.^{[12]
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  Research source} You can also follow the straight leg stretch by bending your back leg slightly. By doing the stretch both ways you will be able to stretch the muscles in your calf, where your Achilles tendon originates.^{[13]
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  Expert Source
  
  Miguel Cunha, DPM
  Board Certified Podiatrist
  
  Expert Interview. 1 May 2020.}
- While seated and without shoes, hold your toes and gently pull them upward until you can feel the arch of your foot stretch. Hold for 30 seconds, switch feet, and repeat.^{[14]
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- Place a towel or cloth object on the floor, grab the object with your toes, and pull it towards you. Hold the grasp for 30 seconds, switch feet and repeat.^{[15]
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  Research source} You can also use your thumbs to massage deep into your arch to help break down some of the scar tissue that might have developed on your plantar fascia.^{[16]
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  Expert Source
  
  Miguel Cunha, DPM
  Board Certified Podiatrist
  
  Expert Interview. 1 May 2020.}
6
Apply ice. At the first sign of pain, apply ice to the bottom of your foot and heel.^{[17]
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- One method to apply ice to the bottom of your foot and heel area while standing with support is to gently roll a frozen 12 to 16 ounce water bottle along the bottom of your foot. Do this for about 15-20 minutes at a time.^{[18]
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  Expert Source
  
  Miguel Cunha, DPM
  Board Certified Podiatrist
  
  Expert Interview. 1 May 2020.}
- Another method is to massage the bottom of your foot with an ice pack wrapped in a towel. Rub an ice pack gently over the tender area on your heel for 15 to 20 minutes, 3-4 times a day.
If your job requires constant standing, take measures to provide anti-fatigue matting to help prevent heel pain and take care of your plantar fascia ligaments.^{[19]
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8
Maintain a healthy weight. If you are overweight, take steps to lose weight. Your feet and heels will be healthier if the load they carry is lighter.
- People that are overweight are at greater risk of developing heel pain and plantar fasciitis. The more weight you are carrying on your feet, the more likely they are to suffer as the years go by.
9
Increase your activity level gradually. Overdoing physical activity takes its toll on your body, including your feet.
- Pace yourself during exercise. If you are starting a new sport or physical activity, increase your activity level gradually to avoid sudden strain on your muscles and abrupt added stress on your feet.
- Avoid foot injury from heavy landings from jumping. If jumping is involved in your sport or exercise routine, take care to provide shoes that provide the proper support.
Elevate your feet if possible, especially shortly after exercise, to prevent fluid accumulations and allow your feet to rest.

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Part 2

Part 2 of 3:

Preventing Further Injury

1
See a specialist if you have pain. Once heel pain begins, or if you have a history of plantar fasciitis, see a foot doctor to evaluate the condition and recommend treatment options.^{[20]
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Expert Source

Jarod Carter, DPT, CMT
Physical Therapist

Expert Interview. 11 June 2020.}
- Do not ignore heel pain. Once it starts, it can get worse - and when it gets worse, it can be excruciating. You may be contributing to the damage by waiting to seek treatment.
- Pain from plantar fasciitis often is felt with the first steps of the day. Your doctor can prescribe medications and therapies that can help to treat the problem.^{[21]
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2
Seek medical attention if symptoms persist for more than 2 weeks.^{[22]
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Expert Source

Jarod Carter, DPT, CMT
Physical Therapist

Expert Interview. 11 June 2020.} See your doctor if your symptoms are not improving, getting worse, or if your pain is sudden and severe.^{[23]
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- Medical attention is warranted if the area becomes reddened or swollen, or if you are not able to put any weight on your foot.^{[24]
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3
Use crutches or other support. It may prove helpful in reducing the pain and allowing the area to heal by taking weight off the foot by using some type of support while walking.^{[25]
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- Reduce walking as much as possible for 7 to 10 days.^{[26]
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4
Consider custom orthotics. Upon recommendation by your doctor, custom orthotics may help to treat the condition, reduce the pain, and help to prevent any further damage.^{[27]
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- Custom orthotics are inserts designed specifically to help establish a solid foundation based on the problems you are having with your feet.
- There is some controversy about custom-fitted orthotics primarily surrounding their high cost and lack of scientific research that support their use.^{[28]
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  PubMed Central
  Journal archive from the U.S. National Institutes of Health
  
  Go to source}
- Many doctors recommend trying heel supports that can be purchased at a local drugstore before investing in custom orthotics.^{[29]
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  National Health Service (UK)
  Public healthcare system of the UK
  
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5
Take prescription medications. In some cases, prescription medications and/or steroid injections may help to reduce the inflammation and help to manage the pain.^{[30]
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- The most common over-the-counter medication group recommended are those that are considered anti-inflammatory agents. Medications that fall in this group include ibuprofen, naproxen, and aspirin.^{[31]
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- Follow your doctor’s instructions regarding the use of any prescription or over-the-counter medications.
6
Stretch before you get out of bed. Use a belt or towel wrapped around the ball of the foot, and pull on both sides of the belt to stretch the ball and top of the foot towards the body.^{[32]
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- Stretching the foot, plantar fascia ligament, and heel area in this manner reduces the pain felt with the first mornings steps.^{[33]
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7
Use night splints. For people that experience intense pain with their first steps in the morning, using night splints can help to reduce the pain and assist with mobility.^{[34]
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- Night splints provide consistent pressure, keeping the foot and heel in a somewhat strained position. By doing so, the first morning steps are much less painful as the muscles and ligaments involved are healing.^{[35]
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8
Participate in physical therapy. Working with a physical therapist can help to improve your functioning so that you can bear weight on your injured foot and reduce the amount of pain.^{[36]
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Expert Source

Jarod Carter, DPT, CMT
Physical Therapist

Expert Interview. 11 June 2020.}>
- Recent work suggests that manual manipulation of the foot by a trained physical therapist may be helpful in restoring mobility.^{[37]
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If other measures have not worked for you, then your doctor may recommend corticosteroid injections. These injections can provide some temporary pain relief, but they are not recommended as a long-term solution since repeat injections can damage the plantar fascia.^{[38]
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Part 3

Part 3 of 3:

Avoiding Other Causes of Heel Pain

1
See your doctor promptly if you have heel pain. Heel pain often goes ignored, which allows the underlying problem to worsen.^{[39]
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- If rest is possible, many conditions that cause heel pain may resolve on their own. But since most people do not have the option to stay off their feet for a week or so, the condition often continues to develop, leading to more pain and discomfort.^{[40]
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- While plantar fasciitis is the most common cause of heel pain, it is not the only possible condition that can cause discomfort in your heel area.^{[41]
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2
Distinguish between plantar fasciitis and other conditions. Common causes of heel pain can be broadly divided into two areas. Those areas include problems that cause pain beneath the heel, and those that cause pain behind the heel.^{[42]
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- Common problems that cause pain beneath the heel, other than plantar fasciitis, include stone bruises and heel spurs.
- Stone bruises occur when you step on something small and solid that bruises the fat pad on the bottom of your foot beneath your heel.
- This type of injury will gradually get better with rest, and staying off your feet as much as possible for the time recommended by your doctor.
- Other medical conditions can also lead to pain in this area, such as infection, neuropathic pain, nerve pain from S1 radiculopathy and entrapment syndromes, such as entrapment of nerves in the tunnels of the foot.^{[43]
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  PubMed Central
  Journal archive from the U.S. National Institutes of Health
  
  Go to source}
3
Avoid stone bruises. This type of injury can be avoided by wearing shoes instead of going barefoot.^{[44]
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- Selecting shoes with thick and flexible soles can also help to prevent this type of injury by preventing small, hard objects from penetrating through to your heel area.
4
Avoid heel spurs. Heel spurs are small, bony protrusions made of calcium deposits that can be seen on X-ray. In many cases, heel spurs are caused by chronic cases of plantar fasciitis.^{[45]
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Cleveland Clinic
Educational website from one of the world's leading hospitals

Go to source}
- The treatment of a heel spur is the same as that for plantar fasciitis, which includes rest, stretching exercises, heel inserts in some cases, and wearing properly fitting supportive shoes.
- Heel spurs can be avoided by seeking early treatment for heel pain caused by plantar fasciitis, and by taking the same preventive measures.
- Some of those measures include consistently wearing supportive shoes, maintaining a healthy weight, avoiding excessive physical activity, using anti-fatigue matting if you must stand for long periods of time or on concrete floors, and getting enough rest.
5
Seek medical attention for pain that occurs behind your heel. Your doctor can determine the cause of your pain.^{[46]
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- In some cases, you may have inflamed the area that connects the Achilles tendon to the heel bone. If treatment is delayed, the area may become thickened, red, and swollen.^{[47]
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- The condition may progress to include tenderness and warmth to the touch, and may become too painful to wear normal shoes.^{[48]
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- Your doctor may recommend heel inserts of a specific height to avoid continued irritation, stretching exercises, taking over-the-counter anti-inflammatory agents such as ibuprofen, naproxen, or aspirin, wearing open-back shoes until the area is healing, applying ice to the area, and rest.^{[49]
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6
Avoid injury behind your heel. This type of injury often occurs from running, or other active sports, without wearing the proper footwear.^{[50]
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- Wearing shoes that fit properly, prevent your foot from sliding in and out easily, and those with supportive heel counters can help to avoid developing this type of heel pain.^{[51]
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Tips

Consider biking or swimming as alternative sports if your heel pain is persistent.

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Select the proper footwear for the activity you are participating in. This includes sports as well as normal daily wear.

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If you are a runner, be aware of your environment when running. Running on an uneven road or on a track may produce improper foot movements. This can lead to overpronation of your foot on one side, which can contribute to the development of plantar fasciitis.

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