Your Pain Pattern,
What Aggravates It,
The Underlying Anatomy
How to Get Relief,
How People Describe This Pain Pattern
People complain of pain on the 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. They 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 the spot, the heel pain is intense. Movement in the ankle doesn’t bother them unless they also have a trigger point in the soleus.
How You Activate and Intensify This Pain Pattern
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.
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.
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.
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Tony Preston has a practice in Atlanta, Georgia, where he sees clients. He has written and taught about anatomy, trigger points, and cranial therapies since the mid-90s.
*This site is undergoing major changes. We are reformatting and expanding the posts to make them easier to read. The result will also be more accessible and will include more patterns with better self-care. In the meanwhile, there may be inconsistencies in formatting, content presentation, and readability. Until we get older posts updated, please excuse our mess.