Heel Pain & Injury
What Causes Heel Pain?
Heel pain is a prevalent foot complaint and may involve injury to the bone, fat pad, ligaments, tendons or muscles.
Common Causes of Heel Pain
The most common cause of heel pain is plantar fasciitis. This is a condition where your main arch ligament (fascia) becomes inflamed and causes pain.
More info: Plantar Fasciitis
Plantar fasciitis can develop into a heel spur (calcaneal spur) when your fascia healing is delayed and bone is laid down in response to excessive load through the injured soft tissue. Heel spurs are often related to flat feet or pes planus.
The attachment of your Achilles tendon can cause Achilles heel issues onto your heel. This can be due to tendonitis or a related Achilles tendinopathy. While not necessarily painful, a ruptured Achilles tendon causes functional limitation such as an inability to rise on your toes, walk or run.
Peroneal tendonitis is a common lateral heel condition due to altered foot biomechanics or hind-foot control issues. Medially (inside your heel), another tendinopathy known as tibialis posterior tendinopathy can cause heel pain.
More info: Retrocalcaneal bursitis
Posterior Impingement Syndrome
Heel pain can also be associated with posterior impingement syndrome conditions, common in dancers or athletes who need to plant their foot, e.g. cricket fast bowlers. It can also occur in any athlete with a relatively unstable ankle, e.g. poorly rehabilitated sprained ankle.
More info: Posterior Impingement Syndrome
Your heel pain can arise from osteoarthritis affecting the subtalar joint or talocrural (ankle) joint.
More info: Heel Arthritis
Bone injuries such as fractures can occur from a trauma such as a fall from a height onto your heel. Athletes, especially runners and landing sports, can also suffer overload fractures known as a calcaneal stress fracture.
More info: Stress Fracture
Children’s Heel Pain
Sever’s disease is a ubiquitous source of children’s heel pain. Sever’s is related to overactivity and overloading of the calcaneal growth plate.
More info: Sever’s disease.
It is important to have you thoroughly assessed to ensure an accurate diagnosis and subsequent treatment. Heel pain can also be referred to by a pinched nerve in your lower back, e.g. sciatica. This can be tricky to diagnose and requires the professional opinion of an experienced spinal health care practitioner such as your physiotherapist.
Who Suffers Heel Pain?
Anyone can suffer from heel pain, but certain groups seem to be at increased risk, including:
- Middle-aged men and women
- Active people, e.g. running sports
- People who are very overweight
- Children aged between 8 and 13 years
- Pregnant women
- People who stand for long periods of time.
Common Sources of Heel Pain
Some of the many causes of heel pain can include:
- Abnormal walking style (such as rolling the feet inwards)
- Ill-fitting shoes, e.g. narrow toe, worn-out shoes
- Standing, running or jumping on hard surfaces
- Recent changes in an exercise programme
- Heel trauma, e.g. stress fractures
- Bursitis (inflammation of a bursa)
- Health disorders, including diabetes and arthritis.
FAQs about Heel Pain & Injury
6 Post-Run Recovery Tips
Are you planning on running a marathon, half marathon, participating in a charity run or just running for fun? How about dreading the post-exercise soreness and fatigue? When you push your body to perform an intense exercise or exercise it may be unaccustomed to, it is beneficial to know what to do to assist recovery after the event.
Here are six tips to assist you in recovering after a running event.
1. Post-Run Nutrition
After exercise, it is paramount you replenish the energy stores (glycogen/carbohydrates, electrolytes and protein) and fluid stores you lost during activity. This nutrition will help the body recover from intense exercise and assist your immune system damaged by the practice.
When glycogen synthesis is highest within the first-hour post-exercise, consume a carbohydrate-rich snack/meal that provides 1-1.2g of carbohydrate per 1kg of body weight.
Intense exercise causes a breakdown in muscle tissue. Protein helps restore tissue and assist muscle adaptation. Essential amino acids from high-quality protein-rich foods in the hour post-exercise promote protein rebuilding. Commonly 10-20g of protein in the first hour post-exercise is recommended.
It is essential to replace the fluid lost during exercise. Electrolytes, particularly sodium, lost through sweat are required. Sodium helps to increase your fluid balance post-exercise by reducing urine loss. To check, please weigh yourself before and after your race. A guideline to fluid replacement is 1L for every 1kg lost during the event.
More info: Sports Dietitian
2. Cool Down Exercise
Low-intensity exercise can help remove lactic acid build-up and promote blood flow to relieve tight and sore muscles. This exercise can be performed as a light jog or walk after your event or the day following. This cool down exercise can be followed by a brief 5 to 15-min period of stretching to assist with tight muscles.
3. Soft Tissue Recovery
Ways to assist soft tissue recovery at home include foam rolling and wearing compression garments. Foam rolling on your back, ITB, hamstrings, quads and calves dramatically helps your soft tissue recovery. Spend 2x 1-minute intervals in each area. You may wear compression garments for 24-hrs post-exercise. Both techniques can assist in reducing post-exercise muscle soreness and may enhance recovery of muscle performance.
More info: Foam Rollers
4. Recovery Massage
A post-run recovery massage can reduce excessive post-exercise muscle tone and increase muscle range of motion. Massage also improves circulation and nutrition to damaged tissue, deactivate symptomatic trigger point, reduced post-exercise soreness and delayed onset muscle soreness (DOMS). Soft tissue therapy has also been said to aid in psychological recovery alongside music, warm baths and showers to enhance muscle relaxation and allow healing.
More info: Recovery Massage
There is often debate whether ice baths (cold water immersion) is beneficial after exercise. In regards to running, ice helps to decrease inflammation resulting from intense activity. Ice can help to reduce post-activity muscle soreness.
The day after intense activity, you can use heat to help relax tight muscles. Heat also promotes blood flow to an area, promoting the recovery of lactic acid build-up.
More info: Ice therapy
A good night’s sleep consisting of around 8 hours is essential for muscle recovery, among other biological functions. As mentioned above, compression garments can be worn to bed to further assist with healing. You can achieve a good night’s sleep by ensuring the room is cool, dark, quiet, and free of electronic distractions. Ideally, one should have a well-developed sleep routine that consists of the strategies mentioned earlier and avoids caffeine and excessive fluid intake before bed.
More info: Running Injuries
Article by John Miller
What is Barefoot Running?
Barefoot running is a term that means either running either without shoes or with minimalist shoes. Barefoot running has gained popularity over the last few years to return to pure running and proclaims to help reduce the rate of running injuries. But is this accurate?
To gain a more scientific basis on whether barefoot running is advantageous or not for you, let’s look at what researchers have discovered.
Who is Suited to Barefoot Running?
When you run without shoes, you tend to land on the front part of your foot. This impact is called a forefoot strike. Landing through the centre of your foot is called a midfoot strike.
If you were to land barefoot on your heel, it's called a rearfoot strike, the ground shock would be excessive, and you would develop heel pain or injury, plus some other injuries further up your leg. That's why most barefoot runners tend to have a forefoot or midfoot strike. When you put on a traditional jogger with rearfoot cushioning, this cushioning allows you to land on your heel without damage. This heel is why a lot of shoe runners become rearfoot strikers.
Ground Reaction Forces
Generally, the higher the force, the greater the risk of injury. Research tells us that ground reaction forces are higher in the forefoot strike. Surely this would mean that you would get more injuries running with a forefoot strike technique. Not exactly. As well as considering the ground reaction force, it would help if you also looked at the vertical loading rate.
Vertical Loading Rate
The vertical loading rate is a measure of how quickly the ground reaction forces increase.
The steeper the curve, the greater the risk of injury. Running with a rearfoot strike produces a steeper force curve and makes some leg injuries more likely, but not all.
Running Shoes vs Barefoot Running
Does this mean you should toss away all of your running shoes? Maybe hold on to them just a little longer. The evidence is not clear yet about whether a forefoot/midfoot strike reduces your injury rate. What appears to occur is the barefoot running reduces loads in one area only to increase loads in another. And, since you are probably running on firm or rough surfaces such as footpaths, roads or gravel, you'll need some form of cushioning and protection for your feet. Don't you hate landing on those little stones!
What Should You Do?
If you are running without injuries at present, you would probably be silly to change. Changing footwear and technique may add another increase in loading and create new injuries elsewhere. Indeed, at PhysioWorks, we see more forefoot injuries in barefoot runners, which makes sense given the load charts. Plus, most of these injuries occur within a few weeks of changing your running style.
However, if you have been suffering injuries from running, barefoot may be a consideration for you. Changes to your running technique, such as reducing your stride length or your shoe style, could help you. You may also have some muscle control issues in another part of your body that could be altering the way you adapt your running style. So, before you toss your running shoes, it may be in your interest to consult with a running physiotherapist, a sports podiatrist or a running coach. They can analyse your running style, assess your body for weakness or tightness, check your leg and foot biomechanics or help you to retrain your running technique or some slightly weak muscles.
Most problems that cause running injuries are simpler to fix than you may think.
More info: Running Injuries