Understanding Trigger Points – Pain in the heel when walking

This trigger point creates pain on the bottom of the heel that may extend slightly into the back of the arch of the foot. It is associated with the trigger point in the quadratus plantae muscle, in the bottom of the foot, just in front of the heel.

referral - quadratus plantae - TPPeople complain of pain on bottom of the heel of the foot, especially with pressure on the heel and while the foot is being twisted. It is worse when walking on uneven surfaces. The often get some relief from a padded heel cup or supportive shoes that have a stiffer outer sole and reduce movement of the foot within the shoe. This problem is frequently not addressed until the joints of the ankle have become stubbornly fixated.

With further examination, there is stiffness or swelling in a sensitive spot just on the front edge of the heel. When I press into  spot, the heel pain is intense . Movement in the ankle doesn’t bother them unless they also have a trigger point in the soleus.

Although this often comes from stepping on protruding or twisted terrain, it can also come from a poorly fitted shoe or a blow to the foot. I’ve had this in my own heel from over-tightening the laces in shoes before lunging in the gym. The overly tight lace around the front of the ankle displaced joints as my foot slid forward in the shoe with each lunge. Here is a great video about how to tie your shoes with a “heel-lock” to prevent that.trail runner

This pattern can be easily confused with several other trigger points that produce pain in the heel. The soleus trigger point is very similar but tends to extend up the Achilles tendon and produces stiffness in the ankle. Soleus and quadratus plantae are often active at the same time and both need to be addressed. The tibialis posterior trigger point produces pain across the same areas but tends to focus on the Achilles tendon and the foot pain is broader across the bottom of the foot, focusing on the arch. The sacrotuberous ligament also produces heel pain but the focus of pain tends to be in the center of the calf.

You may get relief by freezing a plastic bottle of water and rolling your foot across it for a few minutes with gentle pressure. The ice temporarily diminishes the pain response and releases muscles that are held tight with trigger points. The movement across the uneven surface often breaks up minor joint fixations. Ice plunges are also helpful and, when done with consistency, can make big differences quickly. If it has gone on for a while or you don’t get relief from this self-care, you probably need direct work from your Neuromuscular therapist to decompress the ankle joints for lasting relief.

Tony Preston has written and taught about neuromuscular and craniosacral since the mid-90s. He teaches Integrative Bodywork, (including cranial work) in Atlanta, Georgia. If you would like to get bodywork from Tony Preston, contact The Body Guild.

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