Posterior heel pain can be caused by several things. The Achilles tendon is the strongest tendon of the body and attaches to the calcaneus at the back of your heel. Damage or tightness of the Achilles tendon can be a cause of posterior heel pain. A bone spur known as a "pump bump" located in that area can rub on the back of your shoes and become extremely painful. You may notice redness where the shoe rubs on the foot and even feel a bony bump there.
Plantar Heel pain is most commonly caused by a condition called plantar fasciitis (fashee-EYE-tiss). The hallmark of this condition is a sharp shooting pain at the bottom of the heel. Many say that the first step out of bed in the morning is excruciating and almost feels as though there is a knife in their heel. The pain can also begin when you start walking or standing after a long periods of rest like sitting at your desk at work. This is because the band of fascia tightens or constricts at rest, when you stand you are putting tension on the fascia and potentially straining it. In the past, many doctors felt that a bone spur was causing the pain. However, after many studies, it has been shown that the pain is mostly caused by a tight plantar fascia, a thick band of tissue similar to a ligament that holds up your arch. Over night or during times of rest, this band becomes tight. When you stand or begin walking, you are putting stress on this tightened band and causing strain or micro-tears, which will lead to swelling or inflammation which causes pain. Standing all day on hard surfaces may also cause the pain to increase as the day progresses this is due to fatigue of the fascia and surrounding tendons that support your arch.
This theory of the tightened fascia is why the stretching part of therapy is so important. The cornerstone of all plantar fasciitis therapy is stretching. The most vital exercise is done prior to standing in the morning, it is like a warm up for the day. To perform this stretch, place a bed sheet or towel across the widest part of your foot (were your toes meet the rest of the foot) with legs extended and straight back pull your toes toward your nose. Hold the stretch for 3-5 seconds. Relax and repeat 10 reps on both sides, even if both sides are not hurting you. You will feel the stretch behind your heel and calf as well as at the bottom. There are many other stretches for plantar fasciitis but this one has proven to be most effective.
It is important to see a foot doctor to identify the cause of your heel pain before engaging in any therapy. Misdiagnosing yourself can potentially delay proper treatment and create further injury. An X-ray can offer a lot of information in pinpointing the cause of your heel pain so be prepared if the doc suggests it. Beyond stretching, there are many options for treatment of plantar fasciitis and perhaps we will discuss those in Heel Pain 102.
Also a slightly taboo point that your doctor may not feel comfortable mentioning is that your weight plays a significant role in heel pain, as well as increased activity. Many times this goes hand in hand. You may have added a few extra pounds and are now ready to exercise and try to slim down. Just as you are getting into the groove of your work out this crippling heel pain puts an end to your routine. This is a common scenario. Don't throw in the towel! Do the stretches and decrease the activity level just a bit until you can make an appointment to confirm your self diagnosis. And most important !! Wear the proper shoe gear when exercising, this is a whole topic in itself but remember, quality goes a long way and worn out shoes do not offer the same support they once did.
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- Danielle McNeil, DPM