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The heel bears a significant portion of the body's weight, especially when one walks a lot or engages in running.
This repeated stress can cause various disorders: plantar fasciitis (also known as plantar aponeurosis or inflammation of the plantar aponeurosis), heel spur (a small bony growth under the heel bone), or, in young athletes, Sever's disease.
To relieve these heel pains, it is essential to recognize the underlying mechanisms, address the triggering factors, and promote gradual recovery. We explain everything in this article!
Plantar fasciitis: the most common inflammation
Plantar fasciitis occurs when the plantar fascia – a fibrous band connecting the forefoot to the heel and supporting the arch of the foot – becomes irritated. The pain is concentrated under the heel, often more acute after a period of rest.
Runners who rapidly increase their training volume, people with flat feet (or very high arches), and those wearing worn-out shoes are particularly exposed: the arch no longer absorbs impacts correctly, the fascia pulls, becomes inflamed, and sensitive with every step.
Heel spur: a secondary bone reaction
A heel spur sometimes forms when fasciitis lingers; the bone reacts by building a small bony outgrowth at the insertion of the fascia. Long painless, it can eventually irritate neighboring tissues and amplify the pain to the point of making walking unpleasant.
An X-ray generally confirms its presence, but it is mainly the discomfort felt that guides the treatment: reducing the load on the heel, stretching the fascia, and, if necessary, using cushioning insoles.Sever's disease: the painful heel of the young athlete
In children and pre-teens, Sever's disease corresponds to an inflammation of the growth plate of the heel. The bone grows faster than the surrounding tissues; combined with intensive training, the picture becomes painful, especially during sprints or jumps.
Fortunately, this condition generally disappears after puberty: relative rest, icing, and sometimes a soft heel cup are sufficient to get through the sensitive phase.Relieve pain and promote healing
The first step is to moderate the activity that triggers the pain. Reducing running mileage, avoiding overly hard surfaces, and opting for cycling or swimming sessions allows the heel time to recover without completely losing fitness.
Applying ice for ten to fifteen minutes after exercise, elevating the foot, and using a cushioning heel pad reduce swelling and discomfort. A non-steroidal anti-inflammatory drug (NSAID) taken under medical advice can calm acute pain, but it does not replace mechanical adaptations.
In parallel, the fascia needs rehabilitation. Gently stretching the calf and plantar arch several times a day improves the flexibility of the connective tissue; a simple exercise consists of placing the forefoot on a step and letting the heel drop, holding the position for twenty seconds. One can also strengthen the arch by "scratching" the floor with the toes, with a towel under the foot, to strengthen the small plantar flexors.
The choice of footwear plays a decisive role. Models offering good cushioning and a slight drop (heel slightly raised compared to the front) reduce traction on the fascia. Worn-out soles must be replaced; most runners change their shoes between 600 and 800 kilometers.
In case of flat feet or high arches, a podiatrist can suggest corrective insoles to distribute pressure more harmoniously.
When to consult a doctor?
If the pain does not subside after two or three weeks of conservative measures, if the heel swells or reddens, or if walking becomes difficult, it is recommended to consult a doctor. An X-ray or an ultrasound will help differentiate between fasciitis, heel spur, stress fracture, or tendon injury.
In some cases, the practitioner may consider an infiltration or refer to physiotherapy for shockwave therapy, which is effective for stubborn fasciitis.
Preventing recurrence
Progressiveness, systematic warm-up, and foot strengthening remain the best guarantees of sustained practice.
It is better to increase your running distances by less than ten percent per week, regularly incorporate mobility exercises, and maintain a stable weight: every additional kilogram directly impacts heel strike.
Finally, alternating surfaces and varying paces limit repetitive stresses in the same area.
