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Heel pain can occur at either of two places: the bottom of the heel or the back of the heel. The heel bone, the calcaneus, is the largest bone of the foot and bears our full weight during part of each stride. The painful heel, in almost all instances, is caused by excessive strain on one of the two major ligaments, and the pain occurs where these ligaments attach to the bone.
First, the Achilles tendon attaches at the back of the heel. This is the strongest tendon in the body and connects the muscles on the back of the calf to the heel. The force of contraction of the calf muscles enables us to stand on tiptoe and gives an extra thrust as we walk. Damage to this tendon attachment is called Achilles tendinitis. Frequently, there will also be tears in the tendon itself or in the lower part of the muscle.
Second, the heel spur syndrome affects the bottom of the heel. This is where the ligaments that make up the arch of the foot attach to the heel bone. These ligaments function like a bowstring to arch the foot, so they are under pressure every time we stand or step. If a problem at the bottom of the heel persists, calcium may develop in the inflamed area where the ligaments attach. The presence of the calcium spur may or may not cause additional pain. Many people have pain without visible spurs on X-ray, while others have spurs but no pain.
Usually heel pain is a simple result of a minor and forgotten injury. Unfortunately, since we strain the injured part every time we walk or stand, these problems can become a vicious cycle in which there is more injury, more inflammation, more injury, and so forth.
Rest, avoidance of further injury, and gradual resumption of activity as the pain subsides are indicated. Non-weight-bearing activities like swimming can be continued full tilt.
For Achilles tendinitis, rest the foot or feet. Use a shoe with a high heel wedge and a lot of padding, since this limits the stretch on the tendon. Warm up and stretch carefully for 10 to 15 minutes before exercise. Exercises such as tennis or walking uphill are not good; these stress the tendon. Remember that tight muscles on the back of the leg put extra strain on this tendon, so warm up with gentle toe touching or other stretching exercises for the calf muscles.
For the heel spur syndrome the activities to avoid are ones that cause pounding on the bottom of the heel. Heel padding will help, but support for the arch is even more important since this takes tension off the ligaments whose job it is to hold the arch. A strap around the foot at the level of the top eyelets on a shoe, secured firmly but not tightly by Velcro, can give good relief. Commercially made running shoes are sometimes very helpful. In most of these shoes the cushioning air cells break down after a few months, so you should change shoes even before they appear worn out. Don't worry about wearing a silly-looking shoe; forget fashion and concentrate on getting well. This kind of problem can take a year or more to resolve, or it may go away quickly. Keep trying.
Running with heel pain can be an agonizing experience. For those with active lifestyles, it's hard to adjust and limit your physical activity and routines once you encounter heel pain. This makes it important to know the symptoms and treatment methods for some of the most common types of heel pain that develop among runners.
The bones of the feet are protected by dense fibrous tissue called plantar fascia, which extends from the heel to the toes. This cushions the feet whenever we walk or put weight on them. If, for some reason, tears or inflammation develop in the heel pad due to constant tension from running, jogging or dancing, the planter nerve becomes irritated and inflamed. This is plantar fasciitis or the painful heel syndrome, which is marked by mild to intense pain at the back of the foot, especially when weight is placed on the heel.
Plantar Fasciitis usually develops gradually. Heel pain may only occur when taking the first steps after getting out of bed or when taking the first steps after sitting for a long period of time. If the plantar fascia ligament is not rested, the inflammation and heel pain will get worse. Other conditions or aggravating factors, such as the repetitive stress of walking, standing, running, or jumping, will contribute to the inflammation and pain.
The traditional remedies for plantar fasciitis include stretching the calf, massaging, decreasing one's training, losing weight, purchasing better-fitting shoes (with a raised heel and arch support), icing the sore heel, and taking ibuprofen. Another treatment option, also known as one of the easiest, is using heel seats in your shoes. Heel seats pick up and re-stretch the plantar fascia, redistribute the heels natural fat pad, provide structural reinforcement to the foot, and apply acupressure to relieve the pain while your feet heal.
Climbing up and down stairs, walking or running on hills, squatting, carrying heavy items and walking on uneven terrain all place excess stress through the feet. Decrease these activities by asking your spouse, significant other or friend for help with the kids or carrying heavy items. Avoid multiple trips up and down the stairs at work and home. Limit gardening to flatter more even terrain. Stop running and walking for exercise and try biking or swimming. Avoid the stair stepper, the treadmill and the elliptical machine at the gym.
Keeping up aerobic activity is important and cross training can help. Try biking or swimming. Most walkers hate the stationary bike at the gym, but this isn't forever. Don't drop your heel when you bike and try to avoid standing and climbing steep hills if you cycle outdoors. If you participate in spin classes, you may need to modify the class to avoid further injury to the foot. The recumbent stationary bike may place excess stress through the arch because of the position. The classic stationary bike may be more appropriate.
The Lunge exercise is suitable for stretching both calf muscles. The gastrocnemius (the main muscle in the calf region) is stretched by keeping the heel of the back leg on the ground. The front leg goes well forward, keep your balance; stay tall and in this upright position, lean forward until the stretch is felt on the straight back leg. "Placing the front foot flat on a chair, the soleus (the smaller muscle in the calf) can be given an extra stretch. Push the bent knee forward with the hands until the muscle starts to feel a little tight.