Heel pain is a common complaint that can vary in severity from mild discomfort to completely debilitating. According to the Plantar Fasciitis Organization, more than 2 million Americans are affected by varying degrees of heel pain annually. Those most likely to suffer from heel pain include athletes who perform frequent low- to high-impact repetitive activities.
Causes
The most common cause of heel pain is plantar fasciitis, according to podiatrists Stephen L. Barrett and Robert O'Malley in their April 1999 article in "American Family Physician." This condition describes the inflammation of the plantar fascia, or the thick band of tissue at the sole of the foot that serves to support the arch. The plantar fascia inserts at the inside of the heel bone, or calcaneus. When this tissue is placed under repetitive stresses, it can pull at this insertion, causing inflammation or a heel spur. Other common causes of heel pain include sciatica, Sever's disease, stress fractures and tarsal tunnel syndrome.
Anatomy
Structures that insert into the calcaneus need special consideration as tightness in these structures can lead to pain. As discussed in Dr. Frank Netter's "Atlas of Human Anatomy" book, published in 1997, the Achilles' tendon, which is the common tendon of the calf muscles, has some fibers that come down to insert into the calcaneus at the same part of the bone where the plantar fascia itself inserts. Several smaller muscles that move the foot insert into this bone as well.
Conservative Treatments
Doctors vary on their approach to treating heel pain, but most will opt for conservative treatment initially. While stretching is an important component to treating heel pain, O'Malley and Barrett point out that treatment may also include ice, nonsteroidal anti-inflammatory medication, padding in the shoe and night splinting. Always consult with a physician to determine the appropriate course of treatment, which is based on the specific cause of the pain.
Specific Stretches
Stretches to treat heel pain primarily focus on improving the flexibility of the Achilles' tendon and mobility of the plantar fascia. To stretch the Achilles' tendon, stand on a step and allow your heels to gently drop below the step. To stretch the gastrocnemius, which is part of the calf muscle, stand facing a wall, lunge toward the wall with the painful side in the back, keeping your heels on floor. The soleus, which is also part of the calf muscle, may be stretched in the same position, although the back leg is bent. According to Barrett and O'Malley, stretches should be performed three to five times each day, holding each stretch up to two minutes. To improve the mobility of the plantar fascia, perform a self-massage by rolling a firm ball under the foot while in a seated position.
References
- Plantar Fasciitis Organization: Plantar Fasciitis, Heel Spurs, Heel Pain
- "American Academy of Family Physicians"; Plantar Fasciitis and Other Causes of Heel Pain; Stephen L. Barrett, D.P.M. et al.; April 1999
- "Atlas of Human Anatomy"; Frank H. Netter, M.D.; 1997
