Heel Pain When Walking? Top 3 Areas You Should Check and Why

Heel Pain

Heel Pain

Heel pain is so debilitating because every step serves as a constant reminder. We rely on healthy feet to get around the house, get to work, exercise, and play with our kids. But when all of that is painful we may get depressed, irritable with our kids, and can even gain weight because we can’t exercise the way we want to.

The only way to treat heel pain successfully is to get to the source of the problem. I don’t just mean identifying where the pain is and what tissue is damaged causing the pain. I mean the breakdown that occurred to cause the pain in the first place.

The concept is often overlooked in physical therapy treating things like plantar fasciitis and Achilles tendinitis. I have seen too many patients and, honestly, too many physical therapists, stop care when the heel pain is “under control”. As if now the pain is gone the problem is solved. That is just like sweeping the dirty kitchen floor and pushing that pile under the living room floor rug. This mentality of “pain gone, problem gone” is what has contributed to the opioid epidemic and the overutilization of preventable surgery. (you heard me, preventable surgery). Unless you fell off a ladder and landed on your heel, the source of your pain is from a mechanical breakdown of tissue instead of a sudden one.

If you are suffering from heel pain be sure you have these 3 areas checked to get lasting relief.

Check Your Hips

Your hips and pelvis area play a very important role in transferring energy from one leg to another. But what they also do is help to stabilize your foot as it contacts the ground. Many people overlook this fact and will only focus on the muscles of the ankle. When your hips are stiff or weak it changes the way the load is transferred to the foot and can wear down different structures of the foot, like the plantar fascia.

Ankle Mobility

How well the ankle moves also plays a big part in how the load is transferred from the ground up and from the hips down. The important movement to measure when treating heel pain is called dorsiflexion, or when your toes are pulled up toward your shin. The amount of movement in the ankle is affected by things like footwear, activity level, and prior injuries. The most common reason for stiff ankles is the type of shoes you’re wearing. This is true since so many will put their feet in a mild high heel position with the toes staying lower than your heel. This causes tightness in the calf and stiffness in the ankle and causes a tug of war between the plantar fascia and the Achilles tendon. Your heels may be in the middle getting pulled in opposite directions.

Check Your Shoes

And that is why your shoes and footwear become so important. You want to look for comfortable shoes with a neutral or zero-drop sole. Meaning the height difference from heel to toe is nearly the same and not like high heels. If you MUST wear high heels you do so sparingly and regularly work on calf stretches. Check the tread of the shoes that you wear most often and look at the wear pattern of your heel. It’s easy to wear out one side before the other. Is one worse than the other? Listen to our podcast episode where they talk about the perfect shoe.

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Nick Hunter, PT, DPT

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