HEEL PAIN DIAGNOSIS - OFTEN EASY FOR YOU TO SORT OUT

Your heel is sore? Exactly where is it most tender on firm pressure? The heel pain devil is in the detail.

The back of the heel, the middle, or the front and edge of the heel pad – indicate three different conditions.

three places to check for heel pain

Your heel cord - the tendo Achilles

Our calf muscles attach to the heel bone by a flat tendon (Tendo Achilles.) There is a flat balloon containing a little fluid (a bursa) between the tendon and the bone.

The Achilles tendon gets sore and swollen (achilles tendinitis) an inch or two further up usually, but the bursa can become inflamed.

Pinch the tendon lightly between index finger and thumb, and run up and down it to feel for any localized swelling. It is likely to be quite tender if you pinch a little more tightly over this swelling.

An ultrasound examination is in order if you do find such swelling.

Sometimes there is a partial tear within the substance of the tendon. There is then a very real possibility of a complete tear, which is even more disabling.





Press very firmly, right in the middle of your heel pad.

Your heel pad is a very tough structure designed to take the constant pounding of our heel on the ground. Nothing much goes wrong with it.

If You've heel pain and this is the site of the maximum tenderness, your pain is coming from somewhere else! Press deeply all over your calf muscles to find the culprit (a tender area.)

Calf muscle stretches should then relieve your heel pain.



Calf muscle stretching

calf  muscle stretch

Lean on a bench facing something you can watch (TV?) Take the foot concerned back as far as you can while still keeping your heel on the floor. Ensure both your feet are pointing directly forwards.

Now bend your other knee, keeping the knee on the stretched side quite straight. Lean forward until you feel tension in the calf muscle.

Hold this position until the tension relaxes, then bend the other knee a little more and repeat the process until the calf no longer feels painful on stretch.

Another way to do this is to stand facing a kitchen chair, put the other knee up on it and steady yourself with your hands on the back of the chair, as you do the stretch.

The proof of the pudding is in the eating. Is your heel pain better now?

I prefer this method to standing on an 30 degree inclined surface, toes up and heel down. You are using your full body weight then, which is much more likely to cause damage.

While you are at it, try your other leg, and stretch if it hurts.



Plantar fascia

The Plantar Fascia stretches across the sole from the heel bone to the bases of the toes, to help maintain the arch of the foot.

Its' narrow attachment to the heel bone is where plantar fasciitis develops if it's over worked. This is likely to happen if we put on weight or spend long unaccustomed hours on our feet, or become weak from illness.

Muscles become weak very quickly from disuse. I've seen other painful foot problems rapidly lead to plantar fascia attachment strain from the leg muscles not being used normally.

A heel spur is a bony growth at the attachment of the plantar fascia to the heel bone (Calcaneus.) This develops from long standing inflammation at the attachment (enthesis.)

The spur is not the cause, but a result of the plantar fasciitis. Surgical removal does solve the problem, however. The plantar fascia is cut from the bone in the process, which relieves the abnormal tension causing the inflammation.

A very extensive discussion of various treatments for plantar fasciitis, can be found at http://heelspurs.com/_intro2.html



Use of heel raise to temporarily relieve heel pain

A first aid measure to relieve your pain is to wear a higher heel.You can easily test how high a heel raise you need.

Sit well forward on a kitchen chair, with bare feet flat on the floor. The test is done by standing up using equal weight on both feet and equal weight on forefoot and heel.

This last point is very important. Repeatedly shift your feet forwards and back and stand up, until this feels to be the case.

Does this standing up hurt the affected heel?

If it doesn’t, have someone hold your hands to steady you, and stand up putting most of your weight on the affected side, still with equal weight on heel and forefoot.

If you can make it hurt even slightly, you can use this test.

Keep your feet in the same positions. Now repeat the process after sliding books under the affected heel to lift it different heights from the floor.

Determine the minimum height which stops it hurting as you stand up.

When the heel is raised the foot has to bend in the middle for the forefoot to reach the floor. This shortens the distance between the heel and forefoot, reducing the stretch on the plantar fascia and so the pain.

It also takes some tension off the calf muscles.

Wearing footwear with the same height heel, is a good way to get immediate relief.



(Adhesive) tape application for plantar fascitiis

Viewed from behind, your heels should appear vertical as you stand with your weight evenly taken by both. If a heel slopes down and out to the side, this is called heel pronation.

On the foot pain page, I talked about weakening of the foot arch as the first stage of weak muscles causing flat foot. Overpronation is another part of the picture, and it is a bit of a chicken and egg situation.
Overpronation puts more strain on the big toe, so could help speed up the flattening of the medial longitudinal arch.

Taping is a way of giving temporary relief. It can be applied down the length of the sole to reduce stretching to the fascia attatchment, or up from the inside of the heel bone to the instep to reduce overpronation.



Heel pain from cracks in thickened skin.

The skin of our heels can thicken up, where it rests over the edge of the heel platform of our footwear. If our skin is dry as well, deep painful vertical cracks can develop here.

A simple first aid measure is to put 1" wide inelastic tape around the heel. Leukoplast by BSN medical is suitable.

Cut a strip with rounded corners at the ends, to avoid it being easily peeled off when dressing.
Apply on retiring and carefully lift on a sock over it to wear that night, as it takes some time to stick well.

This prevents the crack opening up every time we put our heel to the ground, and allows the crack to heal. It relieves the pain immediately.

Regular attention with removal of thickened skin and creams is obviously better than waiting for a heel fissure to occur.

The way we walk is important too. We swing a leg forward and then come "heel strike." This technical term describes it well. The force with which our heel strikes depends on our coordination and how much we are using the toes of our other foot.

If you're waking along with nothing else to occupy your mind, a really good exercise is to dig in the toes of the other foot until it leaves the ground.

An off label use of prescription tretinoin (vitamin A acid) or OTC all-trans retinol, may be useful for helping bad cracks to heel. This may help by anti-inflammatory effects or stimulating collagen formation. I've been told about this use, but can't find reference to it on the net.

Pretreatment of skin with all-trans retinoic acid (tretinoin) has enhanced wound healing in experiments.

There are stacks of other suggestions on the net on how to deal with this cause of heel pain.



Calf muscle tight and sore? Look further up your leg to help explain heel pain

Needing to treat a sprained ankle?

The other end of your foot - painful conditions of...


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