Answers for Your Heel Pain
Since about March of last year, I've been suffering through some intense heel pain. After about a month, it got to the point where I couldn't run and even cycling was painful. After long days of walking, it would throb like a beating heart. No matter how much I iced, taped, or rested - it wouldn't go away. Without time or thought to go to a podiatrist, I left for my summer in Europe where I froze plastic water bottles in hostel fridges and elevated my foot on rungs of bunk beds after walking upwards of 20 miles a day. By the time I got back to the States, I assumed I would be in physical therapy for months before I could run again. I planned out a spinning and lift schedule that would accommodate for the absolute worst-case scenario. Essentially, I was ready for the doc to tell me I needed a wheelchair. I scheduled an appointment with a podiatrist entirely regretting not having done so before leaving for the summer. I went in prepared for the worst.
I don't like doctors. As a fitness professional well-versed in physiology and structural anatomy and a proponent of homeopathic remedies, I tend to avoid medical attention until urgently necessary. Take that as you will. However, this podiatrist was the answer to my prayers. After a quick x-ray and examination of my debilitated heel, he concluded that it was plantar fasciitis which flared up so bad to start the growth of small heel spurs. Let's go back a little.
Although heel pain can be caused by a variety of health conditions - arthritis, stress fractures, tumors, bone deterioration, etc. - it's most commonly experienced in the forms of tendonitis or plantar fasciitis. Tendonitis usually results in pain through the foot and ankle while plantar fasciitis tends to be isolated in the heel and middle foot. It makes sense anatomically. A tendon connects muscle to bone which in this case is the achilles tendon whereas the plantar fascia is a ligament which is fibrous tissue connecting bone to bone.
Plantar fasciitis is the most common form of heel pain especially that which comes from physical activity. The pain comes underneath the heel and can extend down the foot. Plantar fasciitis can be acute or chronic - the difference being in how long the pain persists. In most cases, acute pain lasts fewer than six months. With acute plantar fasciitis, the solution is to ice and stretch which I will dive deeper into later. If the pain persists longer than six months, it becomes chronic and can lead to other problems.
After persistent plantar fasciitis, heel spurs can develop. Plantar fasciitis is essentially micro tears in the ligament connecting the sole of the foot to the ball of the foot. After a long period of inflammation where the body tries to repair the ligament, it begins to repair it by growing bone. Unfortunately, this bone spur can cause additional pain, and it doesn't really go away. The pain subsides when the actual fascia repairs itself.
This is the typical trajectory of heel pain in most people, but as we know - every body is different. That said, this is the general advice for plantar fasciitis from acute to chronic. Luckily, I was only at six months of my plantar fasciitis and had only developed a small heel spur by the time I got the right treatment. My podiatrist taped me up, sent me with some anti-inflammatory medication, and told me to heat. Heat? I had been icing religiously the entire summer!? Apparently, heat is most effective for chronic pain because inflammation is less of a problem causing the solution to be found in repairing the tissue itself.
Heat allows the blood vessels to expand bringing more blood to the affected tissue facilitating the transport of nutrients and the ridding of waste in the cells. Okay, okay, so I got my heat pack and was all taped up with my anti-inflammatory meds. I was not a believe. I followed the instructions hopefully but knowing I would probably be let down by a return of that end-of-the-day throbbing pain. A week later, I felt like a new woman. Or at least the same woman with a new foot.
The throbbing pain was gone. There was certainly still pain, but after months of being constantly reminded of the torn tissue in my right foot, I would frequently forget about it. I went back for a follow up appointment where my podiatrist recommended a few stretching exercises to facilitate healing and also prevent more tears from my workouts. I was running within a month. With new insoles in my shoes with more sturdy arch supports, I was back out running.
I have many takeaways from this experience, but the main one is - ask a specialist. This is not always the answer and is not always necessary. However with months spent in agony and too much time spent asking Google and friends who work at shoe stores for the answers, I certainly wish I would have gone to a podiatrist sooner. I have two other important lessons: ice vs. heat and stretching.
In general, you ice injuries and heat muscles. As always, seek medical attention when needed, but often ice helps reduce swelling and inflammation while heat actually helps repair the tissue. Additionally, stretching is really important for everyone. Stretching is important to maintain balance in the body. When a muscle on one side is tight, and you go one to perform repetitive movements, you're asking for an injury. Stretch, stretch, stretch. I enjoy restorative yoga on a regular basis in addition to my problem-area specific stretches. Below is a video of the best stretches for heel pain and preventing heel pain which should be held for 20-30 seconds on each side and repeated multiple times throughout the day.
As we've learned time and time again, every body is different, so make sure you're doing what's right for you. Try different things out and tune in to what's helping and what's not. Most importantly, prioritize healing and take care of yourself. As always, I'm happy to suggest guidance and other options. Just shoot me an email.