At this time of year, you’re probably like many of my active patients. You look forward to heading to the mountains for a hike. That’s why when you’re suffering from foot pain and in particular heel pain, the subject of today’s video, it can be pretty distressing. Today I’m going to talk about “How to Stop Heel Pain in Hikers”

You probably already know if you’re prone to heel pain or plantar fasciitis. And very likely you’ve already experienced it.

Today I’ll be talking about how to prevent heel pain before you hit the trail and what to if  it starts to flare-up when you’re hiking.

I’ll discuss how to choose the right hiking shoe or boot for your foot type and for the type of hiking you do, how to stretch tight calf muscles, what to do if you have a flare-up on the trail, and what to do when you’re back home.

Buying Shoes and Boots to Prevent Plantar Fasciitis

Although it should go without saying that your hiking shoes or boots need to fit properly, you’d be surprised how many people come to my office with the wrong size shoes. Make sure to go to a store that specializes in hiking boots, to get the proper fit.

Go shopping in the afternoon when your feet tend to swell a bit and have your feet measured. Both the length and the width of your footwear is important. You want your boot to fit snugly but not too tightly. Your fitter should be able to tell if you have enough wiggle room in the toe box to ensure your toenails aren’t hitting the top of the inside of your boot.

Having your feet measured is the first step in this process. But wearing those boots and breaking them in long before you go out on that major backpacking trip is really important. While it’s not necessary for a trail shoe, a heavy duty boot will take awhile to break it. Don’t just walk around your house or neighborhood in it but break it in on shorter hikes.

You also need to consider your foot type when buying a hiking shoe or boot. Both a flat foot or a foot that overpronates and a high arched foot can put you at higher risk for heel pain or plantar fasciitis.

What's the difference? Well, in the flat foot type, the foot is flexible, collapses, the arch elongates, and pulls on the plantar fascia, which is the structure that attaches to the bottom of your heel. And this strong ligament, when it pulls too much, creates your heel pain.

The opposite is the high arched foot. When you hike that foot type strikes mostly the heel and ball, and not enough in the middle of the foot.

With a flat foot, the firmer boot or shoe is better. And use of over-the-counter or custom orthotics are recommended.  For the high arched foot, inserts are also helpful to increase contact in the middle of the foot avoiding excessive contact in the heel.

Keep in mind if the boots you buy are too stiff and you haven’t taken the time to break them in, they could cause a heel pain flare up.

Finally, you need to consider the type of trail you’re hiking on when choosing a boot or hiking shoe. Are you going less than 5 miles on a relatively little elevation and a smooth surface or will you be going backpacking over many miles, with a lot of elevation, and rocky terrain. Or somewhere in between.

In general, athletic shoes can be worn for leisurely hiking of short distances on a relatively even surface, including a dirt trail.

But once you get into a little rougher terrain, with more mileage and elevation, I advise wearing a trail shoe. And with rougher terrain yet, and extended overnight hiking, heavy duty hiking boots will be required.

Lacing techniques can also be helpful to prevent problems with the foot sliding around the shoe and development of heel pain. There are specific techniques described in my eBook, “How to Buy Hiking Boots to Prevent Plantar Fasciitis”.

It’s also important to purchase socks at the same time as you purchase boots. Learn about the best types of socks for hiking here! There’s clearly a great difference between hiking socks that are designed to decrease friction in your foot and prevent development of pain and blisters, and your cotton athletic socks, which are not advisable.

While you’re at the store it’s also a great idea to purchase some compression socks. These can be extremely helpful in supporting the foot, compressing the arch, and preventing heel pain from developing. They can also help decrease fatigue.

Stretching Tight Calf Muscles to Stop Heel Pain

I can’t overemphasize the importance of tight calf muscles in creating heel pain. The plantar fascia is a ligament that runs along the bottom of your foot. Because the plantar fascia and the calf muscle attach to the heel, if your calf muscle is too tight it will overpull the plantar fascia causing pain and inflammation.

If you don't do something to accommodate this problem, then you may well be plagued with heel pain when hiking.

What are the measures taken to accommodate this problem? One is stretching properly. And if you're out on the trail and overnight, this can be done daily. But even before you get there, you should be involved in a stretching program on a regular basis to ensure that you have the most flexibility of your ankle as possible, to avoid overpulling of your calf, Achilles tendon, and plantar fascia. Links to information about stretching are in the description below.

Treating Heel Pain on the Trail

Now, I’m going to discuss what can be done if you develop heel pain on the trail. First, you may need to rest the foot. This may mean actually stopping your hike, or decreasing the distance you're planning on hiking.

You can also add a heel lift to slightly raise your heel and relax the pull on the Achilles which decreases its force on the bottom of your heel. Purchase a pair of these heel lifts and keep them as part of your first aid kit in case you have a flare up. 

If the pain is mild and you have access to a cold stream, icing the heel, soaking the foot in the cold water may help you diminish the heel pain.

Should you have access to anti-inflammatory medication, ibuprofen can be taken, as long as you're not on another anti-inflammatory medication and not allergic to it or have significant problems with your digestive tract. This is usually limited to 600 milligrams three times a day with food, and taken for up to 10 days. Other topical analgesics, such as Biofreeze, can provide excellent temporary relief of heel pain.

Treating Heel Pain Back At Home

If you’ve developed a heel pain flare up on the trail, you’ll need to rest once you’re home and ensure the pain is gone before venturing back out to ensure you don’t develop further injury or even tearing of the plantar fascia.

Treatment of heel pain that is not resolved with the simple measures described thus far, will require a visit with your podiatrist. There your foot will be evaluated, the degree of inflammation and tightness of your calf assessed, and an appropriate program of therapy for acute pain instituted. This can include specialized taping, a walking boot, and use of a wonderful device called an AirHeel. These can all be done quickly and help you diminish your heel pain as soon as possible.

Continued taping, which you can do at home, may also be very beneficial in the early phase of treatment of plantar fascitis.

Finally, a newer treatment called MLS laser therapy uses concentrated light energy to stimulate the body's own healing process. This is particularly helpful for people with recurrent heel pain.

Finally, to get you back on your feet and out on the trail, custom orthotics are often prescribed and dispensed. Your heel pain will usually resolve in two to four weeks allowing you to hit the hiking trails once again.

In conclusion, if you’re experiencing heel pain and are frustrated because you can’t hike, give our office and call and we’ll get you in quickly for an evaluation and treatment.

Dr. Rion Berg
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A podiatrist in North Seattle treating families for over 40 years.