Heel Pain and Plantar Fasciitis After 60

What plantar fasciitis feels like

Typical features:

• Sharp or stabbing pain under the heel or along the inner arch, often at the front-inner part of the heel.
• Worst with the first steps in the morning or after rest, such as after sitting for a long period, easing after a few minutes of walking.
• Worse after long standing or walking, especially on hard floors, in thin soles or barefoot.
• Tenderness when pressing the inner heel.
• Pain when climbing stairs or going on tiptoe.
• Usually in one foot, though both can be affected.

A heel spur (a small bony growth at the heel) is often seen on X-rays of people with heel pain, but also in many people without pain. The spur is not usually the cause; the fascia is.

Risk factors

• Age 40 to 70.
• Overweight or recent weight gain.
• Tight calf muscles and Achilles tendon.
• Flat feet or high arches.
• Prolonged standing or walking on hard surfaces, such as kitchen floors, markets and temples.
• Unsupportive footwear: flat chappals, thin soles, worn-out shoes, walking barefoot on marble or tiles.
• A sudden increase in activity.
• Diabetes and some inflammatory conditions.
• Thinning of the heel fat pad with age.

Other causes of heel pain: do not assume

Heel pain has many causes. See a doctor or podiatrist if the picture does not fit.

• Achilles tendon problems: pain at the back of the heel.
• Stress fracture of the heel bone: pain with weight bearing that persists, more common in osteoporosis, after an increase in activity or a minor injury.
• Fat pad atrophy: pain in the middle of the heel when walking on hard floors.
• Nerve entrapment: burning, tingling or numbness in the heel or arch; also tarsal tunnel syndrome and neuropathy.
• Arthritis, including inflammatory types and gout.
• Bursitis.
• Infection: hot, red, swollen heel, fever.
• Referred pain from the lower back or sciatica.
• Poor circulation: foot pain at rest or at night, cold feet.
• Tumour: rare, with persistent pain, particularly at night.

Seek medical advice if heel pain follows a fall or injury, is severe, wakes you at night, is accompanied by swelling, redness, fever, numbness, or does not improve after a few weeks of care; see foot massagers: comfort, circulation and cautions for a note on safe use with diabetes, and diabetic foot care at home if diabetes is present.

Home care: the basics

Most people improve with simple measures, sustained over weeks to months.

1. Reduce the load. - Avoid walking barefoot, particularly on hard floors, even at home. - Cut down long standing and walking for a time; use a stool to sit while working in the kitchen; see kitchen setup for seniors. - Do not push through severe pain. - Choose low-impact activity, such as swimming, cycling on a pedal exerciser or chair exercises, while the heel recovers; see pedal exerciser guide and chair exercises for seniors. - A stick in the opposite hand can offload the painful heel; see how to choose a walking stick.

2. Supportive footwear. Choose shoes with a cushioned, slightly raised heel, firm heel counter, good arch support and a flexible sole. Avoid flat, thin chappals and slippers; wear supportive footwear in the house. See choosing shoes for older feet and walking aids and footwear.

3. Heel cushions, arch supports and insoles. A cushioned heel pad or heel cup can reduce impact; an arch support or semi-rigid insole can ease strain on the fascia. Some people benefit from a custom orthosis. See insoles and orthotics for foot and heel pain.

4. Stretching. Stretching the plantar fascia and the calf is the most evidence-supported home treatment.

• Plantar fascia stretch: Sit, cross the sore foot over the opposite knee, and pull the toes back towards the shin with your hand until you feel a stretch in the arch. Hold 10 seconds, repeat 10 times, before getting out of bed and before standing after long sitting.
• Calf stretch against a wall: Stand facing a wall, one leg back with the heel on the floor, knee straight, lean forward until you feel a stretch in the calf. Hold 20 to 30 seconds, repeat 3 to 5 times, two to three times a day. Do a second version with the knee slightly bent for the deeper calf muscle.
• Towel stretch: Sit with the leg straight, loop a towel around the ball of the foot and pull gently.
• Rolling: Roll the arch over a frozen water bottle or a firm ball for a few minutes (see cautions below).

Stretch gently, not to the point of sharp pain. A physiotherapist can show correct technique; see stretching for stiff older bodies.

5. Strengthening. Once pain eases, strengthen foot and calf muscles, with exercises such as heel raises and towel scrunches, as taught by a physiotherapist.

6. Cold or heat. A cold pack or frozen bottle, wrapped in a cloth, on the heel for 10 minutes after activity may ease pain. Warm soaks may help stiffness. Take care if sensation is reduced; see heat or cold for joint pain.

7. Weight management. Even a modest reduction lowers the load on the feet, where appropriate; ask a doctor or dietician.

8. Night splints. Some people wear a splint at night that keeps the foot gently flexed, to stretch the fascia, but they can be uncomfortable. Use with advice.

9. Taping. A physiotherapist or podiatrist may tape the arch for short-term support.

10. Pain relief. Medicines and gels should be chosen with a doctor or pharmacist, bearing in mind your other conditions; see painkillers and older adults. Do not self-medicate with strong anti-inflammatory tablets if you have stomach, kidney, heart or blood pressure problems, or take blood thinners.

What to be careful about

• Rolling the foot or massage: gentle only; avoid hard pressure if you have diabetes, poor circulation, neuropathy, or fragile skin.
• Heat on numb feet: risk of burns.
• Spiked or hard rollers can bruise.
• Copper insoles, magnets and gadgets have little evidence.
• Cortisone injections may help but can weaken the fascia or shrink the fat pad; decisions are for a specialist.
• Shock wave therapy and other procedures are options for stubborn cases with a specialist.
• Surgery is a last resort, rarely needed.
• Home remedies such as turmeric paste, hot oil or herbal packs may soothe but should not be applied to broken skin. See effective home remedies for heel pain for general ideas, and ask a doctor if unsure.
• Walking on the toes to avoid heel pain can strain the calf and cause other problems.

Recovery expectations

Plantar fasciitis often improves within several weeks to months with consistent care, and the majority recover well within a year. Pain may return if you go back to old habits: unsupportive footwear, long standing on hard floors or stopping stretches. Keep up stretches and supportive shoes as a long-term habit. If there is no improvement after 6 to 8 weeks of conscientious home care, see a podiatrist or doctor.

Preventing recurrence

• Keep the calves flexible with daily stretches.
• Wear supportive shoes indoors and outdoors.
• Replace worn shoes and insoles regularly.
• Build up activity gradually.
• Maintain a healthy weight.
• Vary surfaces; use cushioned mats where you stand for long periods, such as the kitchen.
• Avoid going barefoot on hard floors.
• Check for foot health and diabetes control.

When to ask a professional

See a doctor or podiatrist if heel pain is severe, follows a fall, comes with swelling, redness, warmth, numbness or fever, wakes you at night, or has not improved after several weeks of care. Seek help promptly if you have diabetes and any heel or foot problem. A physiotherapist can teach stretches and strengthening and assess gait. An orthotist or podiatrist can provide custom insoles. A specialist can discuss injections, shock wave therapy or surgery for persistent cases.