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Heel Pain
by Dr. Simon Small
Whether you've
been playing tennis for 4, 24 or 40 years, you may at some point
experience heel pain. This article is the first in a series that I hope
will be helpful to athletes who want to better understand what problems
they may experience in their feet, which ultimately affect how they feel
both on and off the court. By taking a few moments now to understand the
origin of your discomfort, you may prevent it from reoccurring. Don't
despair-your game is only temporarily kaput!
Heel pain is
uncomfortable and annoying because it interrupts your ability to play, but
the good news is it is treatable without surgery. It is an overuse injury,
like a muscle strain, ligament tear or ankle sprain. It starts suddenly
and you have to deal with it, because the sharp, burning pain rarely goes
away on its own. Since your foot has been compensating, each time your
heel touches the ground it uses muscles that should be at rest, not
stretched.
Heal pain can be caused by sudden rigorous or prolonged
activity without sufficient training.
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There are several
reasons why heel pain occurs. If you suddenly become active after a
prolonged period of time, or if you haven't sufficiently trained for a
rigorous workout, you may feel pain immediately. Heel pain also stems from
a mal-alignment of the foot that causes increased stress in the heel area
during walking or activity. This underlying structural abnormality won't
allow your foot to absorb shock normally. An example of this is flat feet,
meaning you have a flattened arch that causes an increased stretch of the
plantar fascia ligament. Heel pain can also result from other conditions
such as gout, arthritis, psoriasis, collagen disorders, nerve injuries and
tumors.
Don't Delay Treatment
It's difficult to
get rid of heel pain without professional care. If you wait weeks or even
months before seeing a podiatrist, the soft tissue of the heel can become
inflamed leading to stress on the heel bone itself. If your foot has a
structural abnormality, your podiatrist might recommend physical therapy,
cortisone injections, or a pad or orthotic (custom designed foot support
placed in the shoe to add balance, support, and bio-mechanical control to
the foot) in your shoe. Your doctor might prescribe oral non-steroidal
anti-inflammatory medications and tell you to ice down and take some time
off from training. When you resume, at first you'll train less
aggressively and incorporate stretching of about 30-45 seconds in
duration. Then on the court you will slowly increase the amount of time
you play to enable your muscles to feel as comfortable as possible.

After Your Workout
The basic regimen
to follow is one you've heard over and over - rest, ice, compression,
elevation (RICE) and then more ice. After play, as soon as possible, use
ice cubes on your feet to vigorously massage the area for three-five
minutes. For a chronic problem, warm water soaks are more effective in the
morning. Before play, make sure to wear thick-soled shoes at all times to
cushion the heel area during activity. Above all, avoid vigorous activity
until your doctor or trainer says you're healing (no pun intended),
because a workout places far more pressure on the foot.
Full
contact supports can cushion the ball of the foot and enable
the foot to meet the floor at a position that does not stress the
heel.
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A Support Could Help
Depending on your level of play,
you may need a subtle balance enhancement for your shoe. A "full
contact support" is a combination foot liner and arch support. It
cushions the ball of the foot and enables the heel to meet the floor at a
position that does not stress the heel. The support creates a better
neutral position of the foot to leg relationship so the heel won't drop,
which is what causes strain by stretching the muscles in the back and
bottom of the foot. A full contact support also keeps the heel from moving
side to side.
Time needed for recovery varies,
depending upon how well you follow your podiatrist's guidelines and how
diligently you do the exercises mentioned later in this article. Surgery
is rarely done because the full contact support or orthotics can often
correct the problem. Surgery is usually a last resort for those whose
symptoms have existed for quite some time. Your specialist may also
temporarily tape or strap your foot in position while your orthotics are
being made.
As an athlete, if you are unable to
straighten or bend your knee, the contact point becomes greater on your
forefoot. The overuse occurs when the muscle has to stretch. Gravity tries
to bring the heel to the ground but your muscles try to resist the
stretch. Yet gravity will win out causing the heel pain trauma, that can't
be undone quickly.
The following exercises done
several times weekly, will help minimize overuse injuries to the feet:
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Stretch the ligaments in your
ankles by doing "figure eights"
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Extend your left foot in front
of your right one: stretch the Achilles tendon of the rear leg by
bending the front leg with hands on knee. Force your weight back
toward the ground through the back heel.
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Face a flight of stairs,
placing both forefeet parallel to the front edge of the same step.
Without bouncing, relax and allow gravity to pull your heels downward
for about 20 seconds.
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Face a wall with both heels on
the ground; place your hands on the wall at shoulder height and width
apart; extend your chest, back and waist straight so that they and
your nose touch the wall. Keep your heels on the ground and your body
straight, except for bending at the ankle joint.
Whether you're nine or 90, a social
player or a competitor, you can take steps toward avoiding heel pain.
Treat your feet well, stay flexible, and enjoy your game.
As
a Diplomat of the American Board of Podiatric Surgery, a Fellow of the
American College of Foot Surgeons and the American Academy of Podiatric
Sports Medicine, Dr. Small brings the expertise of twenty years of
experience in this field. Dr. Small serves as a consultant to the
football, baseball, tennis, and basketball officials, as well as the
Sports Medicine Department of Villanova. His patients include many
professional athletes.
As a member of the Medical Advisory Committee of the United States
Squash Racquet Association and Director of Education for Pro Support
Systems, he has traveled all over the country and Europe giving lectures
at various facilities, screening and evaluating athletes for lower
extremity preventive sport injuries at different squash and tennis
tournaments, including the U.S. Open, Copperbowl Junior Tennis Tournament,
The Easter Bowl Tennis Tournament and in Europe, at the French Open and
Wimbledon. |