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Why Does My Heel Hurt?

Updated: Nov 30, 2023

Plantar Fasciitis is one of the most common causes of heel pain. It is usually described as a sharp or stabbing pain in the bottom of your foot close to or on the heel. The pain is typically worse in the morning and may get better once you start moving around. However, it could get worse with long periods of standing.

The plantar fascia is a thick taught band of tissue that runs the entire length of the foot. It connects the calcaneus (heel bone) to the toes. It helps support the arches of the foot. The medial longitudinal arch is comprised of 5 bones, the first metatarsal, the medial cuneiform, the navicular, the talus, and the calcaneus.

Lateral view of the foot
From Kapandji Volume Two

The medial longitudinal arch is supported mainly by the configuration of the bones, however, the ligaments and muscles around the joints help control the motion of the foot. The only two points of support are the head of the 1st metatarsal (point A) and the calcaneus (point C). While the height of the arch is fairly important, having control of the arch is more important. We should be able to both flatten and raise the arch. Many times with plantar fasciitis, we are stuck in either a flattened position or raised position. Restoring control of the arch is a major component in the treatment of plantar fasciitis.

The arch should act as a spring as we walk, run, or lift. The goal is to absorb some of the shock of the foot making contact with the ground. When this happens the arch should fall in a controlled manner as the knee and hip stay relatively facing straight ahead.

Explanation of the windlass effect
From "Influence of the windlass mechanism on arch-spring mechanics during dynamic foot arch deformation" Welte

There can be many different causes of plantar fasciitis. The main contributors to symptoms are an active job that requires you to be on your feet often, obesity especially if the weight was gained rapidly, repetitive activities such as running or wearing soft-soled shoes or high heels. Finding the contributing factor is the main goal of treatment. Changing the environment you are in can be the best option for reducing and abolishing your symptoms.

At around 6 months of infant development, we see a combination of the glutes beginning to work more in a triplanar (3 direction) function as well as the beginning of the arch development. By the time the child is 3 years old, the arch should start to look like what adults consider an arch. This is due to the many of the bones along the arch ossifying or hardening at 3-4 years of age. The connection from the hip to the foot stays with us for the rest of our lives. Having control and stability at all of the joints in the leg is necessary for good daily function, but also making sure that the foot is not being overloaded and then causing the plantar fasciitis.

Lower body compensations from anterior pelvic tilt
From Google Images

Side Note: The low back must be completely ruled out in a case of plantar fasciitis. The referral pain from the low back can cause the same symptoms as plantar fasciitis. With low back pain referral, we also see pain that is worse in the morning and better with movement.

Treatment for plantar fasciitis

After ruling out the low back, the treatment is focused on controlling the arch of the foot and making sure the ankle has full free range of motion. This would start with learning how to form the arch. Typically people that do not have control of the arch also have poor control of the hips specifically the glutes. Incorporating a progressive, full-body rehabilitation program is a factor in returning to full function.

Along with correcting foot function, modifications to your daily activities may be necessary. If you are a runner that gets bouts of plantar fasciitis, modifications to your weekly mileage or changing the activity to swimming or rowing may need to happen until the pain is under control. If you are not a runner, finding the daily activity that is driving your pain will be necessary along with finding modifications for that activity.

Step 1 is always get assessed by a professional, they will be able to help you figure out where the pain is coming from and give you a plan to get started in the right direction.

If you need help finding modifications for painful activities or want to get out of pain reach out to dr.kopp@kalamazoochirorehab

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