If you are suffering from pain at the bottom of your heel, you will probably see a podiatrist who will most likely take an x-ray and inform you that you have a heel spur. You will probably be given a cortisone shot and/or have an orthotic added to your shoe. I have treated innumerable patients who went this route and still had pain at their heel.
The answer to why they still had pain after being diagnosed with a heel spur is because in most cases the heel spur found was not causing the pain. The heel spur was there before the pain began and will be there long after the pain is resolved.
This is another example of finding something on an x-ray and automatically assuming this is the cause of pain even when the circumstances don't fit. I have treated women with heel pain after they wore high heels for a sustained period of time. I have treated people with heel pain that resulted from performing a specific activity like a sporting event. In these cases, if the cause was a heel spur, then the heel spur must have grown just at the time of the event that initiated the pain. Doesn't sound very logical, now does It?
Pain experienced at the underside of the heel in most cases is the result of an inflamed plantar fascia. The plantar fascia is a connective tissue attachment that runs from the balls of the feet to the heel. Its purpose is to help support the arch of the foot. The plantar fascia works in conjunction with two muscles called the anterior tibialis and posterior tibialis to support the arch.
There are two types of abnormal forces which can cause increased pressure on the arch which can jeopardize the plantar fascia and the anterior and posterior tibialis. The first is called forward center of gravity. When standing a person should have their ear over their ankle when viewing them from the side. This means that you are being supported through the ankle which is the proper position during stance. If there is a muscle imbalance between the front thigh muscles (quads) and the back thigh muscles (hamstrings), the quads can shorten. In doing so, they can pull your body weight forward so that your ear is now over the balls of your feet versus over your ankle.
This increased load puts more pressure through the arch of the foot causing the anterior and posterior tibialis' to overwork and strain. Once strained, they weaken and support of the arch is lost. This can cause an increased separation of the balls of the feet and the heel. This causes the plantar fascia to be overstretched which creates irritation and pain at its attachment to the heel. The resolution of this situation is to strengthen the glutes (buttock muscles) and hamstrings, the anterior and posterior tibialis'. The exercises to be performed are straight leg deadlifts, hamstring curls, dorsiflexion and inversion. Presentations of these exercises can be found in my book; Overpower Pain: The Strength Training Program That Stops Pain Without Drugs Or Surgery.
The second abnormal force relates to when someone has plantar fasciitis in just one foot. A muscle called the gluteus medius (hip abductor) sits just above the hip joint. It is responsible for keeping the pelvis level when single leg standing which is part of the walking cycle. If the glute med is weak, the pelvis on the opposite will drop toward the floor. This causes a person to lean toward the opposite side. When single leg standing, instead of weight bearing through the midline of the foot, the person is now weight bearing more through the inside portion of the foot.
This creates an excessive load on the arch of the foot causing the anterior tibialis and posterior tibialis to overwork and strain causing a separation of the balls of the feet and the heel. This causes the plantar fascia to be overstretched and strain creating irritation and pain at the heel. The solution to resolving this problem is strengthening of the glute med, anterior and posterior tibialis. The exercises to be performed are hip abduction in sidelying, dorsiflexion and inversion.
Plantar fasciitis is one of the best examples of a situation in the body where the cause of pain is substantially far away from where the pain is being experienced. This is a very hard concept for most of the medical establishment to accept. Take it from me. Hold off on getting the cortisone shot and orthotic when you experience pain at the underside of the heel. Try my method first. I have shown that in most of the cases I have treated where heel pain was the symptom, the cause was plantar fasciitis and the resolution of the heel pain came through strength training.
