The heel is one of the most important parts of our amazing body. The value of this part of your foot just under the ankle has a value that extends far, far beyond its diminutive size. If you think about it, it is this area smaller than the size of your palm (whichever palm/Palm you want to relate to) that first strikes the ground with every step you take, absorbing so much of your body weight, and helping to direct the rest of the foot as you walk and run.
The heel is also akin to your teeth in this way: just a slight disturbance in either can alter the way you feel and affect your whole outlook. Heel pain (like tooth ache) can really spoil your day. Some of the conditions that cause heel pain can be considered sports injuries, while others may be a result of your body structure, leg flexibility, work needs, and shoe choices. Here are some common conditions that may help you to get to grips with your heel pain and get you taking literal steps towards less pain … for more gain.
Pain under the heel
- How it feels: Pain occurring under the heel may be related to high impact activities (eg basketball, netball, high impact aerobics, martial arts). When you land on your heels, there is a sharp pain. As the condition gets worse, you may even feel this pain from the pressure of walking or even standing.
- What it is: The pain you are feeling comes from a bruised heel, a common sports injury. This pain may result from too much pressure being placed on the heel pad which is a fat pad that protects the underside of the heel. There may also be some small dark spots appearing on the skin at the back or side of the heel. These are small blood vessels called capillaries which have burst as a result of repeated or heavy impacts that you have been taking on your heels.
- Treatment: the best way to heal this condition is to literally give the heel pad a rest. That does not mean stopping your sports (which would cause you heart ache in addition to your heel pain…). It does mean reducing the amount of impact forces you subject your heel to (that means the number of times you land hard on your heels, and how hard you land on them). When in doubt, a visit to the sports injury clinic may help to get you healing that heel faster.
- More treatment: Another very important check is to see if your sports footwear has started to lose its shock-absorbing feature. This may because the mid-sole of the shoe has started to break down both as a result of repeated heavy impacts as well as just plain old aging. You should consider using a shock-absorbing heel insert in your sports shoes as well as your normal work shoes. And remember to give those heels a break when you are at home: avoid walking around barefoot on hard tiled floors: a simple and inexpensive pair of soft slippers will bring your heels a very welcome padding as you, well, pad around your, uh, pad…
More pain under your heel …
- How it feels: This heel pain is not as dramatic as the first heel pain I talked about earlier. As a sports injury of the heel, it affects runners as well as those of you who spend a lot of time on hard surfaces (courts) or use hard shoes on hard ground (eg. soccer, rugby, hockey). But it is also very common in people who are not physically active as well. You feel the heel pain most commonly as soon as you wake up and take those first few steps of the day. The pain under your heel may be so bad that you have to walk rather carefully to avoid stressing the heel. As the day goes on, the pain recedes. But it comes again with a vengeance after physical activity or sometimes even during the exercise. The pain is more frequent in those of you who have pronated or slightly/very flat feet (click here to read more about pronation and what this is) link to article on foot types .
- What it is: This condition is called plantar fascitis. The pain arises from an overstretching of a ligament under the arch of your foot, called the plantar fascia. This is attached to the heel bone and extends forwards to the toes. The overstretching causes inflammation to occur and this is most common just near the attachment of the fascia to your heel bone. With pronated or flat feet, or if you have very tight calves, the fascia is placed under even greater tension.
- Treatment: You should see your sports doctor to have this checked out properly. This condition is sometimes associated with a heel spur, which is an outgrowth of the heel bone. There may be a need to take some medication to lower the inflammation, and in advanced stages, a steroid injection may be required. Apart from this, you will do well to change the mechanical factors that make this condition worse: stretch those tight calf muscles, use shoes with a slightly higher heel as well as slippers at home (this reduces the tension on the tense fascia), and use insoles that help to support those tired and flattening arches (read more about insoles here) link to insoles article..
Pain behind the heel
- How it feels: If you feel the back of your heel and ankle, you will be able to put your fingers around a tough tendon that runs from your calf muscle downwards to your heel bone. This is the Achilles tendon (named after the Greek mythological god, Achilles) and it may sometimes get irritated and inflamed – a true and common sports injury. This gives rise to pain in the tendon itself (squeezing the tendon is not an enjoyable sensation at those times) or its attachment to the heel bone. The pain is worse when you wear flat shoes, or when your exercise causes you to have to push off from the front of your foot (jogging, step aerobics, tennis, etc). The pain seems to be better when you wear shoes or sandals with slightly higher heels.
- What it is: This condition is commonly called Achilles tendinitis or tendinopathy The inflammation of the Achilles tendon is caused by it being overstretched too often, too much, or very suddenly. This is often the case when you play sports that use a flatter shoe on hard surfaces (eg. hard court soccer, badminton, volleyball) or when your favorite running shoes are starting to show their age. The aging of the shoes results in a breakdown or hardening of the inner cushioning of the shoe (called the midsole), and this allows your heel to sag more when you run, slowly over-stretching the tendon. And very commonly, this sports injury occurs when you have increased your exercise levels too suddenly or, if you are a runner, changing your running routine (eg. running hills, speed work on the track).
- Treatment: Apart from doing your best rest and apply ice to the sore area, this is definitely sports doctor-time again !! Some medication can bring prompt relief, but do bring your running shoes along for him to check the condition of the shoes. He will also check if your calf muscles are overly tight as well as this contributes to chance of you getting this condition again. Stretching of your calf muscles, strengthening exercises, and advice on shoes will help prevent this sports injury from happening again.
Finally, if you do decide to see your sports doctor for your heel pain, do remember to bring your sports footwear with you (running shoes, hiking boots, tennis shoes, football boots, etc). If you have just changed to a new pair of shoes, bring along your old pair with you too. This is so that an assessment of your shoes can be made, telling the sports doctor a lot about your feet and how you run or walk, and possibly revealing problems in the footwear that may have caused the heel pain.