IS YOUR HEEL BOTHERING YOU?


Heel pain is a very common complaint and an ailment that can be quite annoying.  When you get out of bed in the morning and the first thing you notice when you put your feet on the floor is soreness in your heel, your day is already off to a less than pleasant start.  Chronic foot issues, especially involving the heel (the calcaneus), can affect your lifestyle in many ways.  Because it is painful to bear weight, the ability to do your job may be adversely affected and it is usually very challenging to participate in an active exercise program outside of the pool.  This can lead to weight gain, increased stiffness, muscle weakness and generalized loss of well being.  The Center for Disease Control recommends 10,000 steps per day for people over 60 years of age.  That may be difficult if your heel hurts with each step so let’s look at some causes of heel pain and more importantly, ways to alleviate it.

Let’s explore some common causes of heel pain.  The most common diagnosis is plantar fasciitis.  The body has fascia throughout and it basically is a very tough connective tissue.  In the mid foot, this fascia is very thick and supportive as it supports the longitudinal plantar arch in the foot, giving a spring like support to the multiple small bones in the foot and giving extra support to the muscular tissue as well.  The foot has multiple arches but the plantar arch is large and the fascia here has to work extra hard to support this arch and the weight of your body.  If you have a “high arch” or pes cavus, the plantar fascia may be a bit shortened and less flexible.  If you have a “flat foot”, or pes planus, the plantar fascia may be somewhat lengthened or stretched out, therefore not able to give the arch the support that it needs.  Couple this with wearing footwear that does not always properly support the arch (shoes such as flip flops or the cute dressy shoes that women love to wear), going barefoot much of the time or working on hard concrete floors in a standing position for the majority of the day can be very taxing on the plantar fascia.  Another factor that may significantly contribute to heel and arch pain is chronic low back issues (more on that later).

The more tension that is placed on the plantar fascia, the more likely one is to develop a “heel spur”.  A heel spur is a calcium deposit that lays down on the anterior portion of the calcaneus at the attachment of the plantar fascia in response to the additional pressure.  These can enlarge over time requiring surgery to remove.  You can also get some spurring that occurs in the posterior aspect of the calcaneus in response to shortening of the Achilles tendon.  Spurs are generally indicative of a chronic long term problem and are more challenging to deal with as they may require more significant medical intervention such as surgical removal or cortisone injections.  The posterior aspect of the calcaneus (the heel) is shaped somewhat like a block and has a fat pad to help protect it and provide some cushion to it with weight bearing activities.  In some cases of heel pain this fat pad can become inflamed (hypertrophied) or  smaller (atrophied).  In either case, the application of tape to help support the fat pad can be very helpful in alleviating heel pain.

There are several conservative measures that can help alleviate heel pain and help you recover completely.  All inflamed tissue requires an element of rest, anti-inflammatory measures such as ice and ibuprofren, increased circulation, improved flexibility and improved strength to heal properly.  In the case of the foot, proper support is also very important.  A physical therapist can help you with all of these.  To begin with, a proper evaluation of your foot and lower extremities is necessary.  Depending upon the acuteness of your pain, rest and anti-inflammatory measures may be the first course of action.  The next step will be exercises including stretching and soft tissue mobilization of the lower leg and foot musculature.  It is important to do these exercises daily as all exercise will help to improve circulation which is key to starting the healing process.  Manual therapy to help restore flexibility to tight tissues or to mobilize restricted foot bones can also be helpful.  Proper support of tissues, either by applying special tape such as McConnell  tape or Kinesiotape can be very helpful in alleviating pain and providing extra support to the arch, the fat pad of the calcaneus or the Achilles tendon.  Guidance in proper footwear or orthotics will also be given.  Lastly, proper strengthening exercises for the lower leg and foot will be taught.  It is important in long term maintenance of chronic heel pain that  a proper exercise program is carried out and you may need guidance as to what types of exercise will be most appropriate for you.  Weight gain always makes heel pain worse so you need a good balance between being active enough to maintain a healthy weight and keeping your heel pain under control.

I mentioned earlier about how the low back can influence heel pain.  In some cases chronic low back pain can be a trigger for heel pain.  Simply stated, chronic low back pain can trigger the nerves in the spine to be more sensitive in sending messages to the muscles that they serve.  This increased sensitivity can cause the muscles to become more hypertonic (tight), even without you knowing it.  This is a common cause of chronic hamstring tightness as well as tightness in the calf musculature which in turn can affect how the muscles and the fascia in the foot can function.  So, if you’re having difficulty with chronic heel pain, getting your back in better shape can be extremely helpful.  This usually involves some general decompression of the spine (less sitting, more traction and flexibility to the spine), some core strengthening (of the abdomen and spinal musculature), increased mobility in the spine, pelvis and hips and proper posture.  Our Postural Program is a great tool for these issues or a physical therapist can help as well.

In Motion O.C. Physical Therapy and Fitness can help you live a healthier, pain free lifestyle!  Get your feet in better shape so that you can get moving!

Tami Coleman, PT, OCS, COMT, FAAOMPT

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