Heel pain can occur at either of two places: the bottom of the heel or the back of the heel. The heel bone, the calcaneus, is the largest bone of the foot and bears our full weight during part of each stride. The painful heel, in almost all instances, is caused by excessive strain on one of the two major ligaments, and the pain occurs where these ligaments attach to the bone.
First, the Achilles tendon attaches at the back of the heel. This is the strongest tendon in the body and connects the muscles on the back of the calf to the heel. The force of contraction of the calf muscles enables us to stand on tiptoe and gives an extra thrust as we walk. Damage to this tendon attachment is called Achilles tendinitis. Frequently, there will also be tears in the tendon itself or in the lower part of the muscle.
Second, the heel spur syndrome affects the bottom of the heel. This is where the ligaments that make up the arch of the foot attach to the heel bone. These ligaments function like a bowstring to arch the foot, so they are under pressure every time we stand or step. If a problem at the bottom of the heel persists, calcium may develop in the inflamed area where the ligaments attach. The presence of the calcium spur may or may not cause additional pain. Many people have pain without visible spurs on X-ray, while others have spurs but no pain.
Usually heel pain is a simple result of a minor and forgotten injury. Unfortunately, since we strain the injured part every time we walk or stand, these problems can become a vicious cycle in which there is more injury, more inflammation, more injury, and so forth.
Rest, avoidance of further injury, and gradual resumption of activity as the pain subsides are indicated. Non-weight-bearing activities like swimming can be continued full tilt.
For Achilles tendinitis, rest the foot or feet. Use a shoe with a high heel wedge and a lot of padding, since this limits the stretch on the tendon. Warm up and stretch carefully for 10 to 15 minutes before exercise. Exercises such as tennis or walking uphill are not good; these stress the tendon. Remember that tight muscles on the back of the leg put extra strain on this tendon, so warm up with gentle toe touching or other stretching exercises for the calf muscles.
For the heel spur syndrome the activities to avoid are ones that cause pounding on the bottom of the heel. Heel padding will help, but support for the arch is even more important since this takes tension off the ligaments whose job it is to hold the arch. A strap around the foot at the level of the top eyelets on a shoe, secured firmly but not tightly by Velcro, can give good relief. Commercially made running shoes are sometimes very helpful. In most of these shoes the cushioning air cells break down after a few months, so you should change shoes even before they appear worn out. Don't worry about wearing a silly-looking shoe; forget fashion and concentrate on getting well. This kind of problem can take a year or more to resolve, or it may go away quickly. Keep trying.
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