Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the normal walking pattern. As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward. Excessive pronation—excessive flattening of the foot or lowering of the arch—can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom and back of the heel bone. The posterior tibial tendon helps holds the arch up and provides support during step-off on the toes when walking. If this tendon becomes inflamed, over-stretched or torn, pain can radiate to the bottom of the heel as well as inner ankle, and a gradual loss of the inner arch of the foot can occur. Without treatment, this condition can create dysfunction and the foot can eventually become rigid, changing the way you walk or making it difficult to wear shoes. Excessive pronation may also contribute to strain on the hip, knee, and lower back.
The most important thing you can do to avoid injury and foot pain is to gradually work into your new activity. We recommend following a formula called the “Rule of 2”. This says that if you are starting a new walking or running program you should start with just than 10 minutes for your first session and increase by 2 minutes each session.
At any point if you have some pain or discomfort then decrease your time the next day to what you had done the previous day. Stay at that level for at least 2 pain free sessions. After that you can start increasing your session time by 2 minutes again.
A common cause of heel pain is an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar) surface of the foot, from the heel to the ball of the foot. The inflammation is called plantar fasciitis. It is common among athletes who run and jump a lot, and also those who stand for prolonged periods. For example, teachers or factory workers may be more susceptible to this injury. The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length, leading to inflammation, pain, and possibly the growth of a bone spur where the plantar fascia attaches to the heel bone. The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area; by walking barefoot; and by the chronic irritation that sometimes accompanies an athletic lifestyle.
Resting provides only temporary relief. When you resume walking, particularly after a night’s sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest or extensive walking.
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