Four questions you should be asking about your heel pain

“What exactly is going on with my heel when it feels like I’m walking on egg shells?”

That’s honestly a great question and to be even more honest the most knowledgeable of healthcare professionals isn’t even 100% sure. However, there is a lot that we do know about it that could at least steer us in the right direction and understand more as there are a few things that are pretty consistent. So what we do know is that heel pain is most often the result of plantar fasciosis. I know it looks like a spelling error and even my macbook wanted to correct me for grammar. This is not a typo folks there is a distinct difference between what we commonly know as plantar fasciitis and plantar fasciosis. 

  Fasciitis implies that there is chronic inflammation which was something we once thought to be true. We now know that   there is actually very little inflammation when it comes to this type heel pain. This is important to know because it will help with the question of “what should I do about my heel pain?” but we’ll talk about that later.

There are a couple of consistent theories that exist when it comes to this type of heel pain. One is that people commonly ramp up their workouts/runs to fast which is typical when the weather gets better right around this time of year. We go from running for small distances on a treadmill to 10k outdoor runs. This is the easiest way to make your heel angry. Another theory is that flexibility can be an issue. If your ankle and toe movement is limited this can cause increased stress to the heel by way of the plantar fascia which is just a fancy word for all the tendons, muscles and “stuff” that runs along the bottom of your foot and inserts into your heel bone. Lastly, strength is another major key factor. If your foot, calf or glute strength is sub par your heel will let you know soon enough.

    “So now that I know what it is how long is this thing going to stick around for?”

I wish I had better news and had a smaller window but the research is what it is at the moment and it is said that it could last 3-6 months. But at the end of the day it is dependent on so many factors. Every single one of these factors is crucial:

a) Will you relax and let it heal?

Everybody wants to keep doing the exact thing that lit their heel on fire but in the same breath wants the heel pain to go away. In the case of heel pain you unfortunately can’t have your cake and eat it too.

b) Will you be diligent with exercises?

Heel pain loves controlled low grade load. What I mean by that is that good exercises will put happy stress on your heel and allow the muscle tissue to get stronger and become more resilient.

c) Will you resort to just rest?

Although rest is important in healing it has to be combined with exercise. Rest alone will never heal heel pain. It may feel really good since you haven’t been challenging it. But as soon as you get back into what brought on the heel pain to begin with soon enough the pain will come back.

d) What are you eating?

Nutritional changes are so important in this process. We often talk about rest, what to avoid, drugs, exercises etc. What we often overlook is food. There are many ways to use food as a vessel for healing. I’m not going to get into food details as that could be a whole blog post in itself. Just know what you eat could make all the difference.

“Can this even be avoided?”   

For those of you out there who have never experienced heel pain before consider yourself lucky as anybody suffering could tell you it’s not a party by any stretch. The same ways one could manage and overcome heel pain is the same process by which one can avoid heel pain. It involves exercise and movement education and an understanding of training intensity and volume all of which the next question you probably have will address.

“I think I’ve heard enough. What could I start doing to deal with my heel pain?”

There are so many ways approach this. All you need is a bucket of tools at your disposal that addresses these 3 important things;

a) Increase big toe extension

The flexibility of your big toe is so important in controlling heel pain. Here is a video where I breakdown toe extension and its importance:

b) Improve toe strength

The more control you have of your toes the better off your heel will be. Here is an amazing drill to start working on that:

c) Calf and plantar fascia (muscle tissue under your foot) strength

Strength plays an important role in managing heel pain. Here is a drill where you could start improving all of the above:

Hopefully we have started to paint a clear picture for you on the many intricacies of heel pain management. Heel pain is very common and at the same time very debilitating. If you take anything from this remember that complete rest isn’t the answer. You need to introduce exercises early and often. The only thing you should be resting from is the very thing that brought your heel pain on to begin with.

Sullivan et al. 2015. Musculoskeletal and Activity-Related Factors Associated With Plantar Heel Pain

Hossain and Makwana. 2011. “Not plantar fasciitis”: the differential diagnosis and management of heel pain syndrome.

Riel H, et al Is ‘plantar heel pain’ a more appropriate term than ‘plantar fasciitis’? Time to move on