To relieve the stress of living in lockdown many of us have dramatically increased our level of exercise. Exercise is a fantastic outlet for reducing anxiety and improving our overall health. It can help reduce blood pressure, kick our metabolism into high gear, and help us sleep better.
Unfortunately a rapid increase in our mileage when walking or running can also lead to foot and ankle problems such as back of heel pain. If you've increased your exercise distance by more than 10-20% a week you're doing too much. Reducing your level of exercise may be all you need to relieve your pain.
However, an increase in exercise is only one factor in causing back of heel pain.
Low or Flat Arches
Your foot type can play a major role in developing foot pain. People who have flat feet or low arches are at greater risk for developing Achilles tendonitis one of several conditions that results in back of heel pain. The Achilles tendon is the largest tendon in the body. While it's able to withstand forces of 1,000 pounds or more, it can become inflamed.
People who have flat or low arches tend to roll their feet inwards or over pronate, increasing the pull on this tendon. People with this foot type also tend to develop a related condition--plantar fasciitis. Instead of feeling pain in the back of the heel, patients with this condition experience pain in the bottom of the heel.
Old, worn out, or poorly fitting athletic shoes can also increase the likelihood of developing Achilles tendonitis and plantar fasciitis. This is particularly true for patients who have flat feet or low arches. A person with this foot type often needs more supportive shoes to keep their feet stable and pain free.
Tight calf muscles
Another factor in development of back of heel pain are tight calf muscles or equinus. Tight calf muscles limit range of motion and make it much more likely for a person to roll inward or pronate causing strain and inflammation on the heel cord.
Other Types of Back of Heel Conditions
Other types of back of heel conditions can result from too much exercise or other factors.
Heel spurs are osteophytes on the bottom or back of the calcaneus, or heel bone. These result from conditions such as plantar fasciitis or Achilles tendonitis, in which additional stress is placed on the plantar fascia ligament or Achilles tendon. The bone grows in response to the tight ligament or tendon as the micro-tears in these structures repair themselves. Heel spurs may not cause pain by themselves but may be associated with back of heel pain.
Bursitis occurs when the bursa located at the back of the heel becomes irritated and inflamed from excessive walking or running. Initially the fluid-filled sac develops as a protection from micro trauma that occurs from the repetitive movements, but eventually the sac also becomes inflamed leaving the person with bursitis.
A special type of bursitis can be caused by Haglund's deformity or "pump bump". The back of the heel bone or calcaneus enlarges as a result of wearing shoes that are too tight or stiff in the heel. This condition can also develop as a result of a tight Achilles tendon or having a high arched foot.
Insertional Pain of the Achilles Tendon
Insertional pain of the Achilles Tendon occurs at the site where the Achilles tendon inserts on the back of the heel bone. The tendon and its covering become inflamed, and a spur may form at the back of the heel. This condition is commonly caused by chronic overuse of the Achilles, a flatfoot deformity, or an acute injury.
Athletes and others can also develop an overuse injury called a stress fracture on the back of the heel from a rapid increase in exercise. Stress fractures can also develop by changing the exercise surface (going from running on a soft track to concrete), poor running technique (i.e. compensating for a blister or bunion), and/or poor bone health (women who have low bone density due to menopause or low weight due to dieting or eating disorders).
Sever's disease is a condition that affects children between the ages of 8-14. Pain can be felt at the back or the bottom of the heel as a result of inflammation of the growth plate. Sever's disease or calcaneal apophysitis is most commonly experienced in youth athletes, particularly those involved in soccer, track, or basketball. Unlike adult heel pain it doesn't subside immediately once the activity stops.
Treatment for Back of Heel Pain
To treat and prevent back of heel pain it's important to properly diagnose the condition and the factors that contribute to it. The following modalities and suggestions are part of a comprehensive plan to resolve back of heel pain
Build Up Your Exercise Slowly
As mentioned earlier back of heel pain can result from rapid increases in exercise. Therefore it's best to increase your time and distance by no more than 10-20% per week. You’re much more likely to get a repetitive injury if you’re body and feet aren’t ready.
While limiting or reducing exercise may be enough to prevent or stop some back of heel pain, curtailing exercise altogether is necessary with a someone with a stress fractures or Sever's disease in order to heal.
Shopping for Shoes
The type of exercise you engage in should dictate the type of shoes you purchase. Supportive shoes designed for your sport can make a big difference in preventing back of heel pain and other painful foot conditions. Be sure to follow these tips when shopping for shoes:
- Go to a reputable store - go to a store that specializes in the sport you engage in.
- Replace the insert that comes with your athletic shoes with an over-the-counter insert like Powerstep.
- Go shopping later in the day when feet are more likely to swell.
- Get your feet measured and buy shoes to fit your larger foot.
- Test your shoes for stability - shoes should bend at the toe not in the center, be difficult to twist when you try to wring them out like a rag, and have a stiff heel counter that you can’t move easily.
- Replace worn out shoes every 500 miles.
Stretching for Tight Calf Muscles
While everyone should stretch before engaging in exercise, this is essential for people with tight calf muscles. For many people standing stretches may be sufficient, but for those with very tight calf muscles I recommend using an Achilles splint for 30 mins during the day while watching television or reading a book. This needs to be done daily for a least three weeks.
To resolve and prevent flare ups of most back of heel pain, custom orthotics are often necessary. This is particular true for those with a diagnosis of Achilles tendonitis and if your back of heel pain is worse because you have flat feet or low arches. Custom orthotics will correct faulty foot mechanics and relieve pressure from the Achilles tendon.
MLS laser and other cold lasers can greatly help reduce back of heel inflammation and pain. The MLS laser uses dual wavelengths of infrared light to penetrate deep into the tissue and stimulate regeneration at the cellular level. Patients often experience relief with as few as 2-3 treatments.
As with any inflammatory condition, a return to exercise must be gradual.
If you're experiencing back of heel pain, call us today at 206-368-7000 for an appointment. Often same day for emergencies and less than 2 weeks for chronic foot pain. You can also request an appointment online.