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. 

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.

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:

• Stretch the ligaments in your ankles by doing "figure eights"

• 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.

• 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.       

• 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.

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