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Bunions, corns and curled-up hammertoes are among the more obvious causes of foot pain. But when it comes to your heels — a source of discomfort for almost 10 percent of adults age 50 and up — it may be less immediately clear.

“Older patients often write it off as just another inevitable side effect of aging or blame their heel pain on arthritis,” says Stephanie Hook, executive director of the American Board of Podiatric Medicine. “But the typical area of pain is not at a joint, so arthritis is likely not the case.” So why are your heels hurting? Below are common conditions that may explain the pain and steps for relief.

Plantar fasciitis and Achilles’ tendinitis are two of the main reasons your heels might ache. The first is caused by excess pressure on the plantar fascia, a band of tissue that attaches the heel bone to the toes, and the second is caused by overuse of the Achilles’ tendon, which connects calf muscles to the heel bone. Both can result in heel pain after a rest (for example, when you first get out of bed), as well as after exercise.

“When the plantar fascia or the Achilles’ tendon becomes inflamed, it can be caused by an increase in activity, an increase in body weight or from wearing old shoes, flat shoes, bad shoes or no shoes,” says Jacqueline Sutera, a podiatrist in New York City.

For older adults in particular, heels might hurt as a result of what’s known as fat pad atrophy. This condition occurs when the protective fat pad on the bottom of the heel and the ball of the foot thins, which leaves the heel bone with less of its natural cushioning. “The heels absorb the majority of the impact every time your foot hits the ground,” Hook says. “So as the fat pad starts to decrease, heel pain can increase.”

If heel pain comes on suddenly and is severe, alert your doctor to make sure it’s not something that needs immediate attention, such as a torn tendon. Otherwise, here are ways to ease the pain.

Do stretches that soothe. Stretching the calf and Achilles’ tendon a few times throughout the day can help alleviate plantar fasciitis and Achilles’ tendinitis discomfort. Because pain is often worst first thing in the morning, it’s helpful to do this calf stretch before you even get out of bed: Place a towel, belt or strap around the ball of the affected foot. With your leg straight, gently pull your toes toward you and hold for 15 seconds. Do one or two repetitions, two to three times a day.

Rub away pain. To ease plantar fasciitis, roll a ball, such as a golf ball, up and down the arch of the foot and along the sides to help loosen tight tissues. Rolling a frozen water bottle under your arch for 10 to 15 minutes a few times a day can also help.

Assess your footwear. It’s key that shoes are in good condition and offer arch support. Otherwise, they may “cause strain on the plantar fascia and the Achilles’,” Sutera says. For any kind of heel pain, avoid going barefoot, even around the house, and choose footwear that has some cushioning, a slightly raised heel, a wide toe box and a deep heel cup that hugs your heel and helps stabilize the foot. Also, make sure you’re wearing the right shoes for the activity you’re doing. For pickleball, for instance, you’ll want sneakers made for racket sports, which offer support for the side-to-side motion of the game. Walking sneakers are meant for forward motion only.

Use the right insoles. To make footwear more comfortable for plantar fasciitis or Achilles’ tendinitis, try drugstore or sporting goods store insoles with good arch support. If you think a thin fat pad is the culprit, a cushioning insole with a cupped heel is best. “That squeezes your heel gently and holds it in place to help optimize whatever is left of your fat pad,” Sutera says.

Switch up activity. If something you’re doing seems to worsen pain (this typically involves impact, like walking, jogging or a racket sport), give it a rest. Try an activity that’s easier on your heels, like swimming, riding a stationary bike or water aerobics.

If your heel pain hasn’t subsided after two weeks of diligent self-care, it’s time to see a podiatrist. Custom orthotics can add arch support and heel padding to your shoes. A podiatrist (or physical therapist) can show you how to tape your heel to compensate for fat pad loss, Sutera says. Cortisone injections can help relieve severe heel pain from inflammation on the plantar fascia.

Consumer Reports is an independent, nonprofit organization that works side by side with consumers to create a fairer, safer and healthier world. CR does not endorse products or services and does not accept advertising. Read more at <a href="http://www.consumerreports.org/">ConsumerReports.org</a>.

Sally Wadyka

How to relieve heel pain and when to see a podiatrist

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Woman with plantar fasciitis uses a spiky ball to massage her aching foot

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