So why did you develop your pain? Heel and arch pain are due to an overuse syndrome. What does that mean? Basically, because we are on our feet so much, we are walking and standing on so much concrete, we are overloading our feet! It doesn't help that we Americans are a little too fond of "over-storing" our food intake as well. The amount of force our feet must endure is a result of our body weight times the length of time we are on those feet. Concrete, being such an unforgiving substance, adds to our feet's stress, even if we hide the concrete with linoleum, terrazzo, or a thin layer of carpet. The pain you are experiencing in your heel is due to a "stress reaction" in your heel bone (calcaneus). This is like a "stress fracture". Stress is good. It keeps your bones healthy and strong. The old saying "use it or lose it" applies very well to your bones. But, too much stress is bad; it causes our bones to fail.

Why is your calcaneus susceptible to stress? The calcaneus has three forces acting on it. All three contribute to a stress reaction. The first force is the impact force against your heel, the force transmitted to the calcaneus when your heel strikes the ground. The harder your shoes' heel the stronger the transmission of force to your calcaneus. This is why your heel pain is usually worse when you walk on hard floors and wear hard soled shoes. Your heel pain is usually better when you walk in a running shoe due to its softer energy absorbing heel. You may not know you are stressing your heel too much the day you are overdoing it, but you will the next morning.

Two other forces work in tandem. They are the forces of your heel cord tendon contractions and the pull of your plantar fascia (ligament). Usually people with heel pain have a very tight heel cord. This magnifies the problem by the constant over pull of this powerful tendon.  The plantar fascia's role in this syndrome is why some people call heel pain plantar fasciitis.

Patients often have heard of heel spurs and "worry" if they have them. Heel spurs develop at the site of our arch muscles and planar fascia ligament attachments to our calcaneus. They face forward into the muscle, not down. Heel spurs do not cause your pain. They arise for the same reason you get your pain, the traction of the muscle and ligament on the calcaneus. Even those doctors who operate on people with heel pain don't remove the spur, but cut the plantar fascia ligament. Your x-ray, therefore, never changes except your arch can drop due to the lack of support from this important structure.
   
So, how do you treat this stress reaction? Well, If too much stress caused the injury, then decreasing the stress will help the healing process. This will require modification of activity. Decreasing your impact sports or decreasing the amount of time you spend on your feet is helpful. If you went on crutches or wore casts for several weeks your pain would go completely away. Unfortunately, as soon as you started overdoing it again, your pain would return. The reason for this is that your bones would soften due to the lack of stress. Some stress is good, too much is bad, and a happy median must be met. Once you have no morning or start up pain after following our protocol, we recommend slowly increasing your activity. The best program is a walking program where you start mile a day then slowly increase the distance over 3-4 weeks until you are walking 3 miles per day. I usually have you walk a mile per day for three days in a row, always waiting until the next day to see if you did too much. You will know because your first steps in the morning will once again hurt if you walked too much! If the pain returns, you have to ease up once again and start at a less stressful level of activity. Too much stress too soon will send you back to square one so take it easy.

HOME PROTOCOL INSTRUCTIONS

  1. Look for ways to get off your feet. If you have the opportunity to sit versus stand, sit. It is not so much as how much you are on your feet at any given moment, but how much your are on your feet during the day.
  2. Exercise is good for the heart, body, and soul (or sole if you prefer). However, during this time, we recommend cross training such as cycling, swimming, elliptical machine instead of the high impact exercises and instead of walking or running. As your heel pain improves then you can gradually, repeat, gradually increase your activity level.
  3. Contrast bathing. Take a heavy metal can such as a soup can, put it in the freezer, and allow it to freeze. Then take a tub of hot water, soak your foot in it for 10 minutes, and then roll your foot over the frozen can for 10 minutes. 10 minutes heat followed by 10 minutes cold. The heat relaxes the tissues and the cold can massages nature's anti-inflammatory into the deep tissues of the plantar fascia. Do this at least once a day, primarily at the end of the day because of the stress you have placed on the tissues. If you can do this periodically during the day, especially after exercise, that is best.
  4. Stretch. Stretch. Stretch. Stretch your calf muscle 5 to 6 times a day periodically. You almost can't stretch too much. This is accomplished by doing the classic runner's stretch. This is done by standing away from the wall, but facing it. If you were given orthotics, wear these while performing your stretch as they will keep your foot in a neutral position. Bend your opposite knee and place your involved leg behind you with your knee straight and your heel touching the ground. Make sure the toes of your involved leg are facing the wall at all times throughout the stretch. Then lean into the wall by supporting yourself with your arms, bending your elbows and bending your opposite knee more.  Make sure you drop your hips to maximize the stretch. Do not let your heel lift off the ground or your back knee bend. You should feel a steady burning or pulling sensation in your involved calf. Hold this position for a count of 10. This should be a slow steady stretch; do not bounce back and forth with your arms. 
  5. Wearing an orthotic in your shoe. By wearing an orthotic in your shoe, you off-load the plantar fascia and therefore it does not have to work as hard. There are several over the counter orthotics that are available. Look for one that has a good arch support and is cushioned for shock absorbing value. Hard orthotics can work, but they can be uncomfortable for day to day wear or exercising. We have several over the counter orthotics in our office that work well and are designed for this condition. Additionally, we have a pedorthist on staff who can modify them to fit your needs or create a custom set for you. This is important for those who run or work on their feet. 

UNDERSTANDING YOUR HEEL PAIN
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