Q: I started working at a hardware store a couple months ago and I now have a sharp pain in my heels, especially when I wake up in the morning. I’ve been using an anti-inflammatory cream for about a week, but it’s not really helping. Is there anything else at the pharmacy I can try?
One of the most common causes of heel pain is a condition called plantar fasciitis. It occurs when the plantar fascia, a thick band of connective tissue that runs along the sole of the foot from the heel to the base of the toes, becomes irritated and inflamed. This structure plays an important role in supporting the arch of the foot and helping to absorb shock during walking or running.
Plantar fasciitis usually develops from repetitive strain rather than a single injury. Common contributing factors include standing for long periods of time, a recent increase in physical activity, wearing unsupportive footwear, higher body weight, or having either very high arches or very flat feet. Over time, this repeated stress causes small microtears in the plantar fascia, leading to pain and inflammation. A hallmark symptom is a sharp or stabbing pain at the bottom of the heel, which is often worst with the first steps in the morning or after periods of rest.
At the pharmacy, there are several over-the-counter options available to help manage symptoms and support healing. Oral anti-inflammatory medications such as ibuprofen or naproxen can help relieve heel pain and inflammation. However, these medications are not appropriate for everyone, especially for people with a history of stomach ulcers, kidney disease, uncontrolled high blood pressure, or those taking similar medications such as celecoxib or blood thinners such as warfarin. It is always a good idea to check with your pharmacist before choosing over-the-counter medications to make sure they are safe with your medical conditions, allergies, and current medications.
You mentioned using an anti-inflammatory cream, and many people are surprised to learn that products like topical diclofenac (e.g. Voltaren Emulgel) are often less effective for plantar fasciitis. This is because the plantar fascia sits deep in the foot, underneath thick skin, fat padding, and other tissue. These layers make it more difficult for enough medication from a topical product reach the site of inflammation.
While anti-inflammatory medications may help with pain, they do not address the underlying issue, which is repetitive strain on the plantar fascia. Proper footwear is one of the most important parts of treatment. Shoes should provide good arch support and cushioning at the heel. If you are standing for long periods at work, standing on an anti-fatigue mat can also help by reducing pressure on the feet and improving shock absorption, which helps to decrease strain on the plantar fascia.
Pharmacies also carry many over-the-counter orthotic insoles designed specifically for plantar fasciitis. These often include shock absorbing heel cups to reduce impact and firm arch support to help redistribute pressure across the foot. This helps prevent the plantar fascia from stretching further and supports healing.
These orthotics are available in both three-quarter length and full-length styles, with many full-length options designed to be trimmed for a better fit. As a general rule, insoles purchased at the pharmacy should be replaced every three to six months, depending on how often they are used. Over time, the materials compress and lose their ability to provide proper cushioning and support. When this happens, they are less effective at reducing pressure on the plantar fascia, which can slow healing or allow the symptoms to return.
Stretching is also an important part of treatment. Gentle stretching of the feet, Achilles tendon, and calf muscles, especially first thing in the morning and again later in the day, can help reduce tension on the plantar fascia. Stretching should create a gentle pull, not pain. If it hurts, the stretch is too aggressive and may worsen irritation. Applying cold therapy, such as rolling a frozen water bottle under the foot after activity, can also help reduce pain and inflammation. It is also helpful to temporarily reduce high impact activities like running or jumping until symptoms improve.
If symptoms continue despite these measures, referral to another healthcare provider such as a physiotherapist, podiatrist, or pedorthist may be helpful. They can provide targeted stretching, strengthening, and manual therapy, as well as recommend custom orthotics if needed. In more persistent cases, your family physician or nurse practitioner may also consider additional treatment options.