Why is my heel pain back?
Many of my patients ask me will my heel pain come back. Some people come to my office after years of not keeping their regular checks and wonder why their heel pain returned. Before I answer that question, let’s revisit why you got the heel pain in the first place.
There are many causes of heel pain but the most common cause is a condition called plantar fascitis. This is an inflammation of a band of tissue, or ligament, which attaches to the heel bone and runs to the ball of the foot. The ligament gets inflamed because of a extreme pulling of this structure against the heel bone. This is usually due to poor biomechanics, or the way one walks. When you over-pronate, or turn your heel out excessively, the ligament is put under tension.
Treatment is usually conservative in nature and surgical intervention is only necessary in less than five percent of the cases. Icing, stretching, shockwave therapy, and orthotics usually take care of the problem. At times, the use of a night splint might be needed. Most cases of plantar fasciitis can be eliminated in 6-8 weeks or within 3 weeks with the use of shockwave therapy. Now that the condition has been resolved, let’s look at the reasons why plantar fasciitis can recur.
As I mentioned, the main cause of the plantar fasciitis is due to poor biomechanics. An orthotic is used to control the over-pronation. Even though most orthotics are very sturdy, they can change shape over time. There are several components to an orthotic. The orthotic refers to the shell, which can be made from different grades of plastic, ranging from flexible, semi-flexible, to rigid.
A lot of orthotics have a plastic heel, known as a post. The post provides stability and maintains your foot in a neutral position, which is where all the bones and joints are aligned. It is like a built-in chiropractor for your feet. This post can become wobbly over time, thus your foot is not maintaining the corrected position that the orthotic was intended. This is why it is important to keep your twice a year orthotic check ups.
The second reason, is that you stopped wearing your orthotics because you feel great. Orthotics are like eye glasses. If you put your glasses on, you can see, but once you take them off, your vision is blurred. The same goes for orthotics. When you wear them, they maintain the proper position of the foot, but the foot goes back to functioning improperly when you stop wearing the devices. The difference is with eye glasses, you know immediately that you are not wearing them. With orthotics, it can take days, weeks or even months before you start to feel the difference.
A lot of people stop wearing the orthotics in the summer since they want to wear sandals. So, it is common to have a recurrence of the heel pain during this period. You can combat this problem by wearing shoes with the orthotics only when you are doing a lot of walking. If you are going to a pool or to someone’s house, then by all means, wear your comfortable sandals. When walking in the malls or the super markets, you should be wearing your orthotics.
Another reason your heel pain can recur is the too much, too fast, too soon syndrome. This is when you have decided that you are going to start exercising or you are going to increase it. You go all out, right away. You forget that your health is a journey, not a destination. You went from the couch to running a couple of miles, or you went from running a ten minute mile to an eight. It can just be that went from sitting at your desk, to going to NYC and walking like a New Yorker. You increased your stride and your speed. Your body needs to time to adjust to the new activity. Take your time and enjoy your new activity.
Another reason you still have the dreaded heel pain is your shoes. Worn out or improper shoes will make your feet unstable. Is the outside of your heel worn down? Are the sides of the shoes stretched out? Are the shoes so flexible you can bend them like a ballet slipper? Then these shoes are not providing the support that you need. If you wear the same shoe every day, then you need to change them every six months or at least refurbished. It is best to alternate shoes, in order to allow them to breathe and regain their shape.
The last reason why your plantar fasciitis has recurred, you have gained weight. Extra weight will put a lot of pressure on your heels. So, get off the couch and start stretching and icing and visit your podiatrist. Then, when your heel pain dissipates again, start a gradual walking program and of course, get rid of the bad snacks in your house.