A pain in the heel

Pain in the heel can be debilitating and hard to get rid of, so seek treatment early, advises Jane Banting.

When people complain of heel pain, it is useful to ask them to indicate which specific part of the heel hurts. They may point to the Achilles tendon, the sides of the Achilles tendon, the heel pad or the edge or side of the heel pad. Between them, these areas cover a multitude of conditions, but the risk factors and causes are very similar.

Risk factors

The predisposing causes of heel
pain are:

– repetitive activity (e.g. years of
running)
– increased recent activity (e.g.
increased speed, increased distance
travelled, running on an incline)
– reduced recovery time between
training sessions
– change in exercise surface (e.g. to a
hard surface such as concrete from a
soft surface such as grass)
– change in footwear (e.g. lowerheeled
shoes)
– poor biomechanics, including
excessively flat feet or a rigid midfoot
region
– calf weakness
– poor flexibility of the calf muscles
or reduced lunging ability of the
ankle joint (e.g. because of a
previous injury)
– poor footwear (e.g. heels too low, lack
of support, old shoes that are worn
out and need upgrading).

Causes of heel pain

Achilles tendon pain can be caused by:
– Achilles tendinopathy, an irritation of the
Achilles tendon that attaches the calf
muscles to the heel (calcaneus) bone
– inflammation of the bursa (cushioning
tissue) between the heel (calcaneus)
and the Achilles tendon
– an acute tear of the Achilles tendon.
Pain in the heel pad can be caused by:
n plantar fasciitis, which is inflammation
of the tissue that attaches to the heel
pad and the base of the toes
– fat pad syndrome, or ‘bruised heel’,
caused by a fall onto the heel from
a height.

Seek help at once
A common indication of damage to
either the Achilles tendon or the heel
pad is to find yourself limping when you
wake. If this persists, you need to seek
the assistance of a physiotherapist and
podiatrist. If you ignore these symptoms,
your condition is likely to deteriorate as
a pain/weakness cycle develops.

Managing the pain
1. Reduce pain and swelling/oedema
with the use of ice, shock wave
therapy and anti-inflammatory
medication (including a cortisone
injection if appropriate).
2. Reduce the load on the Achilles
tendon by resting from aggravating
activities and utilising such remedies
as taping, soft-tissue massage and the
heel drop exercises shown here. The
massage and exercises will also help
you to strengthen the Achilles tendon
and calf and regain calf flexibility.
3. Improve the biomechanical stability of
the foot/ankle with the use of orthotics
and wedges.
4. Use heel cups and good running
shoes to reduce the degree of shock
absorbed by the heel.

Exercises

1. Heel drop with knee straight. Stand on the edge of a step, feet apart and knees straight. Raise both heels for the count of 5, then drop the heels below the level of the step for a count of 5. Repeat 10 times, twice daily. When you’re pain free, progress to single leg raise/ drop, i.e. raise one leg off the step, bent comfortably at the knee as shown, then raise and drop the heel of the other leg as described above.

2. Heel drop with knee bent. Stand on the edge of a step, feet apart, knees bent. Raise one leg off the step, bent comfortably at the knee as shown. Then raise and drop the heel of the other leg as described in exercise 1, but keeping the knee bent. Repeat 10 times, twice daily. If you have difficulties balancing with any of these exercises, hold on to a rail.

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