Heel Pain Part 1 – Pain under the Heel – A Practical Self Help Guide

The three most common areas of heel pain will be looked at over a 3 part blog series:

Part 1 – Pain under the heel, where the muscles of the foot attach (this post)

Part 2 – Pain at the back of the heel where the Achilles Tendon attaches, found here, and

Part 3 – The Achilles Tendon itself, found here (coming soon)

For a brief Introduction and Overview of Heel pain, see our previous post on Heel Pain, found here.

Pain felt under the Heel typically occurs where the Fascia, or Tendon attaches to the bone. Pain occurs because the attachment is too weak, and strains to hold onto the bone. Tendon fibres breakdown, leading to inflammation and pain.


Things you’ll need:

A massage ball – this is simply a solid rubber ball. We highly recommend getting one these as they can be used for a couple of other common areas of pain found in runners (and even walkers). Alternatives include: a golf ball, or even a frozen water bottle to roll the foot over. Massage balls are the most effective though.

A Foam Roller – A great self massage tool that can be used for many common ailments, as well as a terrific preventative of injury. Alternative: Massage Gun.

A Step (not pictured)

An Ice Pack.


What you need to do:

To get over Heel Pain, you’ll need to firstly back off on the load – running/walking/training, and then focus on restoring mobility, followed by flexibility, and finally strength. As the symptoms settle, you can then slowly start to up the load again towards your previous level. There’s a table outlining the rehab protocol at the bottom of this post.


Mobility:

Massage Ball

Soften and loosen the muscles of the foot, and lower leg.

For pain felt under the heel, start with Massage Ball to the muscles of the foot:

Do it in standing, seated, or in the lunge position, depending on how painful it is. Painless? Move on to the Foam Rolling.

You’ll be able to control and add a bit more pressure when seated:

To add even more focused, controlled pressure, try it in the lunge position:

Foam Roller

Soft tissue self massage of the lower leg muscles, especially the bottom half of the lower leg – the Soleus muscle.

Start here. If you can’t feel too much discomfort (foam rolling isn’t meant to feel pleasant!), put your other leg over the top to add a bit more pressure.


Foam rolling isn’t meant to feel pleasant!

Flexibility

To get the best effect, stretch the muscles of the feet, and lower legs after some gentle mobility exercise, like walking for 5-10 mins. If the heel pain is severe, stretching cold (without walking beforehand) can make the protective spasm worse. Feeling pretty good? – carry on below

Stretch the calf while leaning against a wall:

Then, add a bit extra to the stretch by hanging the heel off the back of a step:

Also, stretch the lower calf by bending at the knee to really loosen things up towards the heel:


Strength

Before you start the strengthening process, we must first address a common technique mistake when performing a heel raise – Flaring the Ankles:

Learning the art of ‘Toe Yoga’ will help direct the force through the Big Toe, without scrunching up and clawing with the other toes – another common error we see when people are doing a simple calf raise. Especially noticeable when doing a single leg calf raise.

OK. On to the strength work!

Inflamed Tendons and their bony attachments don’t heal with rest and time. The cure from heel pain comes from increasing the muscular and tendon strength.

Feet and calves need high volume to create strength and endurance. So, we’re going to do a few sets.

The aim is to build up to 15 repetitions. But! Remember – The body needs time to adapt to a new exercise regime. Start with 10 reps, or even fewer if you’re struggling, and add 1 rep per day to your workout till you get to the magical 15 mark.

Feel free to put your runners on to make these exercises more comfy.

The warm up – Heel Raises off the ground:

After a 60 second rest, fold a small towel, so the toes (and especially the big toe), bends further as you come up to the top of the movement. This is important to bias the strength work through the correct muscles. Once again slowly build up to 15 reps as previously mentioned.

Now do the calf raises off the edge of a step. Once again, build towards 15 reps.

Once you’ve been doing 15 reps for a week or 2, (see table below), progress to doing these last two exercises on one leg. Once again, try and start at 10 reps and build slowly to up to 15.

Feet and calves need high volume to create strength and endurance.

Well done!

Now finish with the foot resting on an Ice Pack for 20 minutes.


Now for the answer to the question everyone wants to know…

How long will this take to get better!?!

Heel pain typically occurs at the tendon attachment to the bone. Pain occurs because the tendon attachment is too weak, and strains to hold onto the bone. Tendon fibres breakdown, suffering a series of repetitive microscopic tears, leading to inflammation and pain.

The problem, however, is that inflamed tendons and their bony attachments don’t heal with rest and time. The cure comes from increasing the muscular and tendon strength so it can handle the stress you are applying to it with walking and exercise.

The inflammatory part of the healing process can take up to 6 weeks to settle right down in the most severe cases. And another 6 weeks to strengthen.

Before you get too caught up in that total 12 week recovery period, most people notice a significant loss of symptoms after as little as 2-3 weeks, with a complete loss of symptoms over that 6 – 12 week period.

Recovery from this, is by no means easy. It takes persistent and consistent effort on a daily basis.

To get over Heel Pain, you’ll need to firstly back off on the load and then focus on restoring mobility, followed by flexibility, and finally strength.

Here’s a typical program for the average person, who’s being suffering from a moderate amount of pain for a few weeks:

Weeks 1 – 2Do the following exercises: Once per day in week 1
Twice per day by week 2
MobilityMassage Ball to the arch of the foot2 mins
Foam Roller with as much pressure as tolerated2 mins Soleus
2 mins Calf
Toe Yoga10 reps
FlexibilityStretch against a wall (1 leg at a time)Straight Knee3 x 20 seconds
Bent Knee3 x 20 seconds
Stretch off the edge of a step (both legs at once)Straight Knee2 x 20 seconds
StrengthHeel Raises off the ground (both legs at once)Straight knees10 reps (in week 1)
Straight knees15 reps (by week 2)
Heel Raises with a folded towel off the ground (both legs at once) Straight knees 10 reps (in week 1)
Straight knees 15 reps (in week 2)
Ice pack20 minutes
Weeks 3 – 4Twice per day
MobilityMassage Ball to the arch of the foot2 mins
Foam Roller with as much pressure as tolerated2 mins Soleus
2 mins Calf
Toe Yoga10 reps
FlexibilityStretch against a wall (one leg at a time)Straight Knee1 x 20 seconds
Bent Knee1 x 20 seconds
Stretch off the edge of a step (both legs at once)Straight Knee1 x 20 seconds
Bent Knee 1 x 20 seconds
Stretch off the edge of a step (1 leg at a time)Straight Knee 1 x 20 seconds
Bent Knee 1 x 20 seconds
StrengthHeel Raises off the ground (both legs at once)Straight knees15 reps
Bent knees15 reps
Heel Raises, with a folded towel, off the ground (1 leg at a time)Straight knees 15 reps
Bent knees 15 reps
Ice pack20 minutes
Weeks 5 – 6Twice per day
MobilityMassage Ball to the arch of the foot2 mins
Foam Roller with as much pressure as tolerated2 mins Soleus
2 mins Calf
Toe Yoga10 reps
FlexibilityStretch against a wall (one leg at a time)Straight Knee1 x 20 seconds
Bent Knee1 x 20 seconds
Stretch off the edge of a step (1 leg at a time)Straight Knee 1 x 20 seconds
Bent Knee 1 x 20 seconds
StrengthHeel Raises off a step (both legs at once)Straight knees15 reps
Bent knees15 reps
Heel Raises off a step (1 leg at a time)Straight knees 15 reps
Bent knees 15 reps
Ice pack20 minutes
Weeks 7 – 8Twice per day
MobilityMassage Ball to the arch of the foot2 mins
Foam Roller with as much pressure as tolerated2 mins Soleus
2 mins Calf
Toe Yoga (should be mastered by now – no need to do them)0 reps
FlexibilityStretch against a wall (one leg at a time)Straight Knee1 x 20 seconds
Bent Knee1 x 20 seconds
Stretch off the edge of a step (1 leg at a time)Straight Knee 1 x 20 seconds
Bent Knee 1 x 20 seconds
Strength Heel Raises off a step (1 leg at a time) Straight knees15 reps x 2 sets
Bent knees15 reps x 2 sets
Ice pack20 minutes

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