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Tender heel when running or sleeping

People complain of pain on the bottom of their heel. It may be when they are still or active. They may talk about pain when they step onto the heel or when resting but are almost always stiff and protective when moving the ankle. They may have been told that they have heel spurs. They don’t usually complain about pain along the back of the heel and Achilles unless they have a shoe that presses into it or they have pressed into the area with their fingers. They are more likely to refer to the pain up the Achilles as tightness.

When I press them for more details, they are more likely to have pain when they are very active (running) or still for long periods (sleeping) than when they are gently active (walking). Examination usually reveals that the lower calf is much stiffer than the other side. Runners and cyclists, who have more constant movement than, say, basketball players, and complain more of chronic tightness than pain.

This problem often created by ill-fitting shoes in combination with unexpected vigor. A recent client had a problem with this after trying to dash across a busy street in high heels that had ankle straps that wrapped around her instep and up her lower leg.

This is a common story where and ill-fitted shoe or unusual terrain is part of the onset of the problem. The tarsal bones become displaced and the muscles around them tighten to protect compromised joints.

Self-Care

Padded heel cups and more supportive shoes usually don’t offer relief from this heel pain. A little lift in the shoe or heels can offer relief during the day as it accommodates the short soleus while walking.

For temporary relief:

Use these when you’re on your feet. Put it right where that green asterisk is in the picture. It is right where the muscle slims down into a tendon. It will be tender if you squeeze it.

You can wear one at night to stop the heel pain but will still need to sleep on your side or in a position that doesn’t point the toe until you can get this stretched out.

These are available at most drug stores and grocery stores as well as here on Amazon.

For longer-lasting relief:

from Allyson Sunderman, DPT

This is the stretch for the soleus. Ice the back of the calf when using Ice-and-Stretch.

Use the AIS Guidelines and this produces great relief in the hell and the low back. I did this stretch while alternating feet for 30 minutes while watching my favorite sitcom. I was amazed at the difference in my low back. This muscle ties to the low back through the hamstring.

Therapy Notes

This pattern is very similar to the pain pattern created by quadratus plantae but is more likely be sore during moderate exercise and twisting of the foot. This pattern can also be similar to the pain pattern of tibialis posterior, which is usually more focused on the Achilles tendon than the heel. This referral pattern is also similar to the pattern of the sacrotuberous ligament, which focuses pain more in the center of the gastrocnemius and does not produce the same restrictions in range of motion.

Padded heel cups and more supportive shoes usually don’t offer relief from this heel pain. You can often get relief from this trigger point by stroking the back of the calf in strips from the heel to the fold of the knee while gently bending the toe back toward the knee. Follow the guidelines for Ice-and-stretch. Ankle decompression may be key in breaking up joint fixations in this area that perpetuate . See a bodyworker for lasting relief.

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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.

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