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Heel Pain

Heel pain commonly refers to pain under and around the heel.  A sharp pain under the middle of the heel is frequently called Plantar Fasciitis.  This type of heel pain is often worse when first getting out of bed in the morning or after having been off your feet for a while.  It is usually a tearing - stretching pain which can be very painful.  If the heel pain is on the back of the heel it can be Achilles Pain

If the pain is dull and typically worsens during the day it may just be fatigue from standing on hard surfaces. 

The heel is also prone to calluses that may become painful as they develop and grow thicker at which time the callus itself becomes a source of increased pressure.   
 

Common Causes   •   •   •   •   •   •   •   •   •   •   •   •   •

Pain felt under the heel is most often Plantar Fasciitis.  It is pain in the area of your heel bone where the plantar fascia (the main ligament supporting the arch) connects to the heel bone.  The pain you feel is from micro tears caused by overstretching the plantar fascia.  This pain is most commonly due to hyperpronation of the foot (fallen arches and heels leaning in).  As the severity of hyperpronation increases, the tension of the plantar fascia increases, causing these micro tears. 

Heel pain can also be referred pain from trigger points in the calf muscles and foot muscles.  Before resorting to cortisone injections, be sure that the pain is not referred from trigger points in the Soleus muscle (calf) or the Quadratus Planta (intrinsic muscle of the foot) which also refers pain to the heel in the same region where Planter Fasciitis is felt. 


Plantar Fasciitis


Achilles pain


The Soleus muscle is located underneath (deeper) the Gastroc muscle (shown) and attaches to the Achilles tendon.

How to eliminate the pain

What you have to remember about Plantar Fasciitis is that it is an injury that needs to heal.  If it is mild, stressing the ligament attachment less will suffice.  If the pain is persistent and severe, immobilization is necessary.  In a worst case scenario, you may want to give your foot a break by using crutches for a few days.  Immobilization  can be done with an arch support which will prevent the foot from hyperpronating during mid- stance and while standing.  Because Plantar Fasciitis is caused by excessive pronation, the gait must also be controlled from mid-stance to toe-off to prevent hyperpronation. 

If the pain is referred from a trigger point, you may want to see a certified trigger point therapist or a licensed massage therapist.  After eliminating the trigger point, usually through pressure and massage, the pain should resolve. 

Calluses are caused by rubbing.  Hyperpronation can cause calluses on both the inside and outside of the heel.  Calluses on the inside may be caused by rubbing of the shoe against the side of the heel when the heel is striking the ground. Calluses on the outside typically happen as a result of the heel pushing out (laterally) when the foot is hyperpronating.