“Doc, why do my heels hurt?” I
hear this question at least once
a day in my office. When I think
about it I wonder why I don’t
hear this complaint more often
than I do. It is estimated that
the normal person takes 1
million steps per year. With
each step, each foot is required
to hold one to one and a half
times body weight. When you run
you put two to five times body
weight on each foot. Then when
you add the force of impact the
load sky rockets. So it is
really amazing how much stress
is put on the heels and how well
they hold up under all this
stress.
The short answer to “Why do my
heels hurt?” is inflammation.
Heel pain is usually due to
inflammation where the plantar
fascia attaches to the heel. As
with all inflammation the proper
initial treatment is rest to
allow healing and then correct
the problem to prevent it from
happening again. However for
most people this simply is not
practical. You need to walk
around. You just can’t put your
feet up for a few days. Who
among us in our busy lives can
take a couple of days off our
feet. Even if we could rest for
a few days if the problem that
caused the pain is not
corrected, the pain will return.
The key is to correct the
problem. In order to correct the
problem we have to know the
cause.
Causes of heel pain
While it is possible to bruise
the fat pad of the heel by
stepping on a stone, this is not
the kind of heel pain I
typically see in the office. The
(why do my heels hurt?) type of
heel pain I see in the office is
usually from a condition called
plantar fasciitis (plant-tar-fass-she-eye-tis).
The heel pain from plantar
fasciitis is usually worse in
the first few steps in the
morning and also when you get up
and take those first few steps
after sitting for a while. In
the early stages, the pain
subsides as you walk for a while
and everything gets stretched
out. However as the condition
progresses the pain lasts all
day long and may get worse
throughout the day.
The plantar fascia is a band of
fiber tissue that connects the
heel to the bones of the toes.
The plantar fascia acts like a
spring and it is the tension in
the plantar fascia that creates
the arch of your foot. As you
take a step, the plantar fascia
stretches out a bit to allow the
arch to flatten out and allow
the foot to pronate (rotate
toward the floor) This action of
pronation allows the bones of
the mid- foot to unlock. The
loose, unlocked bones of the
mid-foot allow the foot to adapt
to uneven surfaces. The spring
action of the plantar fascia
also allows the foot to act as a
shock absorber. At the end of
the step the plantar fascia
helps reverse the process. As
the weight is transferred from
the mid-foot to the fore-foot
the plantar fascia tightens up
again and allows the foot to
supinate (rotate away from the
floor). Supination relocks the
bones of the foot and the foot
becomes rigid so it can push-off
from the floor and propel you
forward.
The pain associated with
plantar fasciitis comes from
inflammation where the plantar
fascia attaches to the bottom of
the heel. This area of
attachment becomes inflamed if
the foot over-pronates and
stretches out the plantar fascia
too much. The over-stretching
causes the plantar fascia pulls
away from the bone. The body
protects itself by building-up
the bone where the plantar
fascia attaches to the heel. The
resulting build-up of bone is
called a heel spur. On x-ray the
heel spur looks like a hook
shaped piece of bone coming out
of the heel. However the
heel-spur itself is not what is
causing the, why do my heels
hurt, type of pain. The heel
pain comes from the inflammation
of the fascia where it attaches
to the bone.
Another cause of heel pain is at
the site of attachment of the
Achilles tendon to the back of
the heel. The pain from this
condition is bursitis. Bursitis
is inflammation of the bursa. A
bursa is a pillow-like sac of
fluid that is found anywhere a
tendon comes in contact with or
curves around bone. The bursa
acts like a cushion to protect
both the tendon and the bone.
Too much pressure or friction on
the bursa causes the bursa sac
to become inflamed and painful.
Thus bursitis is usually the
result of over-use and this type
of pain in the back of the heel
known in medical terms as
retrocalcaneal bursitis (retro
means behind, the calcaneus is
the medical term for the heel
bone). Usually this is caused by
excessive running but can also
be caused by the shoe being too
tight and putting too much
pressure and friction on the
area.
Now that you know the answer to
“Why do my heels hurt?” the next
question you may ask is “What
can I do about it?” The
treatment for these conditions
is usually relatively simple and
straightforward, seldom requires
surgery and may not even require
a visit to the doctor. Continue
on for Part II of “why Do My
Heels Hurt? For a simple
solution.
Since the cause of plantar
fasciitis is usually due to over
pronation and excessive
stretching of the plantar fascia
the treatment is to limit the
amount of pronation and
stretching. This is most easily
accomplished thru the use of a
simple arch support. However the
arch support must do precisely
that, support the arch. Some
people use the term arch support
to refer to the cushions you can
but over-the-counter in the drug
store but this is not what you
need. The over-the-counter arch
supports seldom provide enough
support to correct the problem
of over-pronation. An arch
support with the rigidity to
support the arch must be custom
fit to the contour of the foot
or it will cause pain. That is
why the over-the-counter arch
supports are soft. If they are
soft they do not need to match
the exact contour of the foot.
However if they are soft they
will also not support the foot.
Therefore the proper treatment
requires a custom arch support.
Fortunately custom
arch supports
no longer have to cost an arm
and a leg. New technology allows
custom arch supports to be made
that are only slightly more than
what you would pay
over-the-counter.
The pain from retrocalcaneal
bursitis (pain behind the heel)
is treated by rest,
anti-inflammatory medications
such as ibuprofen and a simple
heel insert that lifts up the
heel slightly to put a little
bit of slack in the Achilles
tendon and allow the
inflammation to subside. However
if a heel insert is put in one
shoe it is important to also put
the same size insert in the
other shoe to balance the leg
lengths.
Proper stretching is an
important part of any treatment
plan. Click this link for
stretching
techniques.
Pain in the heel is your body’s
way of telling you that
something is wrong with your
foot biomechanics. If you have a
problem with your foot
biomechanics you could also have
a problem with knee, hip and
low-back biomechanics. Therefore
it is important to have this
condition diagnosed and
corrected as quickly as
possible.
