Physical Therapy for Heel Pain
Stop Tip-Toeing Around Heel Pain
Get Help for Painful Heels!
As many as 1 in 10 people will experience pain in their heel or heels at some point in their life. That is to say, heel pain is fairly common but that doesn’t mean you will welcome its presence. In fact, heel pain can range from mildly annoying to quite painful and given that many of us walk as our primary form of mobility, it can be quite disruptive to our lives. If you are dealing with heel pain you are probably wondering what may be the cause. Let’s look a little deeper at the heel itself and discuss some of the common causes of heel pain treated by physical therapists.
ANATOMY OF THE HEEL
The heel refers to the back part of the foot. From a bony standpoint it is composed of the calcaneus bone. The calcaneus sits below the talus, the bone that articulates with the two lower leg bones to form the ankle joint. In front of the calcaneus are the tarsal bones which then connect to the long bones in our foot. The calcaneus is a sturdy bone that supports the weight of our leg and body and plays an important role in walking or gait. It acts as a short lever for our calf muscles to point the foot and bend the knee during walking, running and jumping activities.
The calcaneus provides an insertion point for several muscles and ligaments as it is the largest and broadest of all the foot bones. As mentioned above, the calf muscles (gastrocnemius and soleus) insert along the posterior aspect of the calcaneus via the achilles tendon. Other muscles that attach there are the abductor hallucis (flexes and moves the big toe outward), flexor digitorum brevis (flexes the outer four toes), quadratus plantae (supports the arch and helps flex the toes), abductor digiti minimi (moves the little toe outward) and extensor digitorum and hallucis brevis (extend the toes upward).
Several ligaments that stabilize the foot and ankle attach to the calcaneus on either side and from beneath the foot. The plantar fascia, a thick fibrous band of tissue that runs longitudinally along the bottom of the foot from the base of the heel up toward the toes is also an important structure when it comes to heel pain. It plays an important role in the biomechanics of the foot during walking and standing and in shock absorption. As you can see, there are quite a few places where heel pain can develop.
AM I AT RISK FOR HEEL PAIN?
While heel pain is a fairly common complaint many people will never experience this condition. Certain factors and activities, though, can increase one’s risk for developing heel pain. Lifestyle factors like participating in activities that involve a lot of running or jumping may increase the chance of heel pain or discomfort developing. Similarly, spending a lot of time on your feet, especially on concrete floors or while wearing unsupportive or uncushioned footwear may increase the risk. Finally, intrinsic risk factors like being overweight or having foot arthritis or flat feet may also increase the risk for heel pain. Having any one or several of these factors does not guarantee you will develop heel pain but identifying the risk factors can help provide targets for treatment or prevention.
WHAT MIGHT BE CAUSING YOUR HEEL PAIN?
While there are many potential sources of heel pain, here are some of the more common causes:
Heel spurs: Heel spurs are bone spurs or osteophytes that form on the calcaneal (heel) bone of the foot. These areas of excess bone can cause pain, inflammation, tenderness and joint stiffness in the area.
Sever’s Disease: The most common cause of heel pain in growing children, Sever’s Disease occurs when the growth plate at the back of the heel becomes inflamed and painful.
Plantar fasciitis: When inflamed or irritated pain can be felt in the bottom of the heel, along the arch or at the ball of the foot.
Achilles tendinitis: Achilles tendinitis is one of the most common causes of heel pain felt along the back of the heel. Injury or irritation at the attachment site or distal end of the achilles tendon which connects the calf muscle to the calcaneus is a hallmark sign.
Tarsal Tunnel Syndrome: Entrapment of the tibial nerve where it runs beneath a band of ligaments along the inner ankle can cause pain, numbness, tingling or burning along the sole of the foot, including the heel.
Stress fracture: Calcaneal stress fractures can occur in persons participating in high volumes of weight bearing activities like running or marching.
IDENTIFYING THE CAUSE OF HEEL PAIN
Identifying the cause of heel pain is helpful in developing an effective treatment plan. There are several tools that physical therapists and other medical professionals use to pinpoint the possible causes of heel pain. Some of these tools include:
Subjective interview: Don’t underestimate the importance of describing your symptoms to your healthcare provider. Providing information like where the pain is located, when it started, what provokes and relieves the pain and the characteristics of the pain can be very helpful to healthcare professionals in developing a list of possible causes.
Movement analysis: Watching the way your foot, ankle, knee and hip move while you stand, walk, jump and run can give clues as to what may be provoking your pain. Problems with form and biomechanics during repetitive movements can lead to pain or discomfort in areas that are experiencing higher levels of stress or strain than normal.
Palpation: Gently palpating or pressing along the heel can help your provider locate the exact location of your pain. By identifying the location they can more easily identify the anatomical structures that may be involved in your symptoms.
Imaging: When necessary, imaging studies such as X-rays, MRIs or CT scans may be warranted to look for structural issues and injuries like bone spurs, fractures, ligament tears, tendon inflammation and so forth. It is important to know that while imaging can sometimes be very helpful in locating the source of your pain, other times imaging may reveal what we would consider to be “abnormal” findings that don’t actually cause any symptoms at all. They may be a red herring, so to speak.
While living with heel pain can be quite frustrating, you don’t have to figure it out on your own. Our physical therapists can help you identify the underlying cause of your pain and develop a plan to reduce your discomfort and minimize the risk of recurrence in the future.
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About EvolveNY-
Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!
First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.
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