Fitness, Personal Training, & Exercise Science

Ouch!! My Heels Hurt!!

By: Barbara Mellens


When a client complains of heel pain should you dismiss it as whining? Or, should you ask questions that help define the problem?

Where Is The Pain?

The pain is usually centered just in front of the heel and on the bottom of the foot towards the arch.
It can also be on the entire bottom of the foot. Or, one might experience heel pain with the first few steps taken in the morning. If your client describes any of those situations, they may have Plantar Fasciitis, the most common cause of heel pain. Approximately two million cases of Plantar Fasciitis are reported in the U.S. each year. The vast majority of people with Plantar Fasciitis are over thirty years old.

The pain is a result of tension, inflammation or scar tissue in the “fascia”… the flat layers of fibrous tissue separating layers of tissue in the foot. The fascia, along with plantar ligaments connects the heel bone to the base of the toes, forming the arch. The inflammation places pressure on the tissue and nerves in the area, resulting in pain. People who stand for a day (like at a convention), exercise on hard surfaces and go barefoot are susceptible to Plantar Fasciitis.

Runners who up their intensity or distance suddenly, or take to running hills are susceptible. Also, sports that cause the athlete to push on the ball of the foot can cause Plantar Fasciitis. Some examples are volleyball, basketball, tennis, and hiking.

Not all heel pain is due to Plantar Fasciitis, though. The symptoms of Plantar Fasciitis and heel spurs are very similar. The heel spur differs from Plantar Fasciitis in that it is excess bone growth on the heel. Some of the symptoms of Plantar Fasciitis are similar to symptoms of other conditions such as arthritis, stress fractures, and nerve damage. Consequently, when a person experiences heel pain, the cause may be difficult to diagnose. The hurting individual should seek medical attention and professional diagnosis promptly. X-rays, MRI, and blood tests may be used to test for the condition.

What Causes Plantar Fasciitis?

Arch failure: People with high arches or no arches are susceptible due to inadequate balance of weight and stress on the sole of the foot.

Weak foot muscles: Foot muscles absorb some of the impact that is otherwise placed on the fascia. Weak muscles cause the fascia to absorb the impact. This cause often surfaces when someone starts a new activity.

Tight muscles: Tight calf muscles place more strain on the fascia. Increasing workout intensity or duration without proper stretching of the Gastrocnemius can induce this.

Shoes: Worn shoes may be too flexible in the middle of the arch causing increased tension on the fascia.

Increase in intensity or duration of exercise: Increasing running distance, length of a workout, or intensity can put more stress on the fascia, and cause Plantar Fasciitis.

Weight: Increase in weight can add tension to the fascia.
What Can I Do About It?

The first step is to seek medical attention. The longer a person waits, the more the plantar fascia can become irritated. The five most effective treatments, based on a survey of 1300 patients:

1. Rest.

2. Shoes. Most of the time, investing in a good pair of shoes can control plantar Fasciitis or orthodic inserts.

3. Stretching/strengthening: Gently stretch the calf muscle. Strengthen the foot muscles.

4. Decrease activity: Decrease the workout intensity. Switch to water exercise or bicycling. Don’t do anything that causes pain!

5. Lose weight.

The bottom line: take a client’s complaint of heel pain seriously. Teach them why pain occurs and how to avoid a problem like Plantar Fasciitis! And, of course, urge clients to seek medical attention and back off on exercises that cause pain.

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