Overview of Heel Pain

Heel pain is one of the most common foot pains at this time.  There are approximately 73 million adults in the US reported who have experienced heel pain. Every year about two million people visit a physician for the treatment of heel pain. It is the most common foot condition treated by healthcare providers.

Common Causes of Heel Pain

• Wearing shoes that are too stiff behind the toes and do not allow bending of the foot to occur. Wearing shoes that have a lack of support in the heel. Wearing very tight shoes or high heeled shoes that interfere with the movement of the toes. If you are wearing high heeled shoes and not stretching, you’re causing a significant muscle imbalance.  Many work boots and cowboy boots can be considered high heel shoes.
• Standing in one spot for a prolonged time. Walking incorrectly and very slowly, not moving through the foot properly. Many of the shopping activities we do will cause us to walk incorrectly, eventually leading to heel pain and other foot problems. After joint replacements or other trauma surgery, walking is often impaired when returning to normal activities.
• Doing strenuous activities without proper conditioning and stretching.
• Age tends to cause us to walk more cautiously, with a shorter step and a slower pace. This kind of walking is detrimental to proper foot function. In addition, the protective fat pad on the bottom of the heel also tends to get smaller and stiffer as we age.

Conditions That Lead to Heel Pain

• Plantar fasciitis, which is the most common, causing more than 90% of heel pain. If you have heel pain that is worse in the morning when you first get out of bed and prevents you from really putting full weight on the foot as you walk, then you have pain again at the end of a day when you have been on your feet, you might have plantar fasciitis. Even if you have had trauma to the heel, plantar fasciitis may still be present.
• Heel bone (calcaneal) stress fracture
• Injury to the foot
• Fat pad loss on the bottom of the heel, (when the heel pad thins from aging or some medications)
• Nerve compression (compression of the nerve around the ankle or heel)
• Soft tissue or bone tumors (cancerous or non-cancerous)
• Skin lesions such as a plantar wart, corn, or scar tissue
• Paget’s disease of bone (a metabolic problem with the bone that results in weakening of bone and stress fracture)
• Sever’s disease (an inflammation of the growth plate in the heel bone in children that can mimic plantar fasciitis and has a similar presentation to plantar fasciitis)
• Lower back pinched nerve
•  Inflammatory arthritis (not the kind of arthritis from wear and tear) with these forms of arthritis, there will often be pain in other parts of the body as well. (Reiter’s syndrome, psoriatic arthritis, ankylosing spondylitis, or rheumatoid arthritis)
• Heel pain can also be associated with pain in other parts of the foot. Once you have foot pain, you compensate for the pain and it can cause pain in other locations.

Risk Factors for Heel Pain

• Obesity (Body Mass Index greater than 35)
• Occupations which require standing for a prolonged time, walking in very small spaces regularly, or carrying heavy loads regularly
• Wearing the wrong shoes
• Having a flatter foot or a foot that rolls to the inside too much
• Walking on hard concrete surfaces most of the time
• Not wearing proper insoles to allow normal motion of the foot to occur
• Doing strenuous activity without proper shoes, stretching, and insoles to allow the foot to move normally
• Walking downhill for prolonged periods without proper stretching of the Achilles tendon

What Activities are Limited by Heel Pain?

Just about all activities will be limited by this condition; it will be uncomfortable to do anything on your feet. The heel pain generally tends to improve as you’re on your feet more during the day allowing you to do either work or recreational activities. The problem is, you have to wake up the next morning and go through that unbearable pain again.

Your heel pain is letting you know that something is not right with the way your foot is working. It’s telling you that you need to change something to fix the problem. Continuing to be active on the foot when it is sore like this will result in other problems.

How does our Cluffy Solutions address this?

Our Cluffy Lux Step shoe insole is uniquely constructed to address all of the elements causing heel pain. The Cluffy Wedge improves the mobility of the foot. When the mobility of the big toe and the ball of the foot improves, this results in a stabilizing through the arch of the foot structure and increased motion of the ankle. The ankle moves better because the arch structure is more stable, and then the arch can move, instead of the ankle when it is unstable. Improved motion of the foot behind the toes, can cause a total realignment of the whole lower extremity bone structure and cause a considerable improvement in foot function.

Once mobility of the ankle is improved, then the gastrocnemius tendon (part of the Achilles tendon), can be stretched normally when walking, and this results in proper tension of the plantar fascia. When the ankle moves correctly, then the knee can become more stable, the hip can move better, and the lower back becomes more stable. Body mechanics dictate that a mobile segment is followed by a stable segment that is followed by a mobile segment, then a stable segment, etc.

Support of all three arches in the foot structure is also important, particularly when standing. The Cluffy Lux Step shoe insole is the only insole on the market today that supports all three arches in the manner we do, worthy of a utility patent from the U.S. Patent and Trademark Office.

Padding on the heel is important to absorb the shock of walking or running, and the Lux Step provides this. As people age, they may lose some of the flexibility of the fat pad on the bottom of the heel. (This can result from taking certain medications.) This heel cushion makes a big difference almost immediately for heel pain.

Proper Shoe Selection

Proper shoe selection is very important for heel pain resolution. The shoe must allow the foot to bend properly and also support the heel in a more normal position. Please see our shoe selection guidelines for further details and recommendations concerning the choice of a shoe. It is important to state that the shoe alone is often not going to be enough to overcome the symptoms of heel pain.

It is often necessary to stretch. We recommend stretching the plantar fascia and muscles that have become too tight as a result of improper function of the foot. The most common muscles to become tight are the flexor hallucis longus (FHL), the gastrocnemius tendon (Gastroc), the hip flexor tendons, including the iliopsoas and the rectus femoris. Our foot pain relief guide can  provide more information on proper stretching techniques. 

Walking properly is also important for the resolution of heel pain. Often, when people have heel pain, they walk with a very short stride and a shuffling type of gait pattern. It is necessary to walk at a faster pace, take a longer step and roll through the big toe properly, swing the arms, and walk like you mean it. This will allow for proper flexibility of the foot structure and proper stretching of the muscles which have become tight over time.

Other remedies used to reduce pain are topical pain salves on the heel and arches, anti-inflammatory medication (such as Advil or Nuprin), and gel cold packs applied to the heel twice a day. These methods are considered temporary and do not address the root cause of the problem, but can be very useful in the resolution of pain once the root cause of the problem is identified and properly addressed.

When to See a Doctor

If you have followed our recommendations, and are not seeing any improvement within three months, it is a good idea to see a doctor for an evaluation.

Further workup for heel pain may involve x-rays, CT scans, MRI scans, bloodwork, and possibly nerve conduction velocity and EMG studies. Several specialists may be consulted in making a diagnosis and managing your care. Your doctor will discuss different therapies and options for resolution of your pain, once they make a diagnosis.

About the Author

James Clough, DPM is a Podiatric Foot and Ankle Surgeon with over 37 years of experience in clinical practice. In his pursuit to help more of his patients with common foot pains, he developed the Cluffy Wedge, which has been successful in the marketplace. His customers then wanted an insole with the Cluffy Wedge in place and after many years, trying to create a best-in-class product, he developed the Cluffy Lux Step Insole. This was introduced to the market in 2019. This insole is uniquely different from the other common brands of insoles sold on the market today. The need for an over the counter, affordable and simple solution was clear to him. His research indicates that the Lux Step is successful for most common foot pain problems, as the root cause of many of these issues has not been readily understood.

It is his goal to empower the consumer with an insole that is highly effective and inexpensive to deal with the root cause of most foot pains. This a powerful tool to let you return to your life without foot pain. Dr. Clough continues to see patients in Polson, Montana.