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Don’t let heel pain get you down this summer

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4 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:

THE 3 BIRDS 🐤 ONE STONE EXERCISE FOR YOUR PLANTAR FASCIA REHAB [Heel Pain Rehab] . In the early stages of PLANTAR FASCIA PAIN (PFP) stretching the plantar fascia is likely painful and usually not the best form rehab early on when things are super painful😥. . . For the most part annoyed and painful fascia/tendons don't want to be stretched too intensely as the compression associated with stretching could potentially be aggrevating😥. . . However as you progress through your rehab and control pain along with increasing the strength and capacity of the plantar fascia stretching starts to become more beneficial if tolerated well😊. . Here in PART 3 📽 of this PFP rehab series. We go over an effective tool for dealing with PFP. Many things are in play here which makes it a little more advanced. . In this exercise we are; . 1🐤increasing big toe extension . 2🐤stretching the plantar fascia . 3🐤loading up (contracting) the plantar fascia and associated muscles . And to even add more ammo to it you just happen to be practicing hip hinging all at the same time😮. All these things are at play with such a simple movement. 🐤🐤🐤🐤 . INSTRUCTIONS . . 🚩 Sit up and push your toes into the floor for 10s . . 🚩 Sit back for a tempo of 3s . 🚩 Get out of the position to take a break and repeat. . . 🚩Perform 3x . 🍻To happier heels everywhere🙏 . . #myofootseries #myodetox

A post shared by Dr. Kevin Marryshow (@drkev_hybrid) on

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:

THIS EXERCISE IS MISSING IN YOUR HEEL PAIN REHAB💣 [Foot Rehab] . Let's keep rolling with part 2/3 in this mini PLANTAR FASCIA PAIN (PFP) rehab series🙏. . In this 📽 we will go through an important exercise in your battle against PFP. We will cover intrinsic muscle control of the foot and toes. A combo of muscles generally control raising your big toe (extensor hallucis longus/brevis) and another combo of muscles generally control raising your other 4 toes (extensor digitorum longus/brevis). You should work on controlling both in isolation😊. . We don't think about foot muscle control as much I guess because it's our foot and we don't think of foot muscles like we think of say arm muscles💪. We wouldn't be OK with a lack of control when separating biceps contraction and triceps contraction😒 so our feet should get the same attention💞. . INSTRUCTIONS 🌄raise big toe and plant other toes hold for 3s . 🌄switch and plant big toe and raise other toes hold for 3s . 🌄 Perform 10 reps/3 sets per foot a couple days a week. . Following up on yesterday's post there is no specific research to speak to working on this😊 because it hasn't specifically been looked at as far as I know. However, when you think about it the more strength and control you have on the muscles around any given joint the more likely that joint will perform more optimally, stay out of injury and create healthy output. If you could find ways to increase your foot strength chances are you will improve midfoot control and decrease the load on your plantar fascia😏. With that being said your toes exercises await🍻. . Part 3/3 coming soon. Stay plugged🔌 . . #myofootseries #myodetox #eastruncrew

A post shared by Dr. Kevin Marryshow (@drkev_hybrid) on

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:

ACHILLES TENDON REHAB STARTS NOW⤵ #Repost @drkev_hybrid with @repostapp ・・・ [Achilles rehab exercises] . So now that you know what you're dealing with let's start mapping out how you're going to deal with it😊. . Here is PART 1/4 in the exercise phase of your ACHILLES REHAB JOURNEY. Not only is this and the next 3 posts in this exercise series effective if you are currently dealing with achilles tendon pain but it is also an amazing way to start BULLETPROOFING your achilles tendon. Especially if you are about to ramp up your physical activity..this is for you😥. . The usual suspect 🕵 when it comes to Achilles pain is too much too soon. Common example- you took all of the holidays off🎄from working out and then resumed training as if you never left😔. This will give you a regimen to start incrementally increasing your physical activity to avoid this common mistake and ramp up the load safely😏. . [The literature suggests that going up higher in insertional Achilles tendinopathy takes out the likelihood of dorsiflexion compression🤓. Cook et al 2002] . INSTRUCTIONS . 👟Go back to the last post and get a breakdown on if you are more likely mid Achilles tendinopathy or insertional Achilles tendinopathy . 👟 Hold the heel raise for 8-10 secs (or less if that's what you could tolerate) . 👟 Repeat 3 times for 3 sets . . In the next post phase 2/4 is coming right at you. Stay pluggeedddd🔌🔌. . . #myoachillesseries #myodetox #futureproofyourbody #imfi #imfi_wilayah2 #fisioterapia #fisioterapimuda #fisioterapi #physio #physicaltherapy

A post shared by IMFI Wilayah 2 (@imfi_wilayah2) on

 

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

 

 

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