Video and Transcript: Healing Heel Pain

Hi, everyone! Dr. Orit Hickman here from Pain Science Physical Therapy.

This is a short video to address one of the most common symptoms and pains that we see in the physical therapy clinic which is pain in the back of your heel. So, a lot of times, patients will think that this is, or call it, plantar fasciitis. It is not. It’s typically achilles tendon irritation or achilles tendinopathy. If you have an acute episode of this pain, it’s-it’s called achilles tendinitis. That means that the tendon, which is the attachment of the achilles to the back of the heel, has gotten inflamed. If this has been going on for many, many months or even, sometimes, many years, it’s called achilles tendinopathy. 

The treatment of achilles tendinitis, acute inflammation of the achilles tendon, is different than achilles tendinopathy, which is more chronic and persistent. This video is specifically going to address the achilles tendinitis, something that has been occurring for maybe several weeks or even several months, but not pain that’s been occurring for several years. We usually have a lot of other things that we need to assess and address with that type of pain. So, again, this is for [a] more acute, more recent onset of achilles tendon irritation.

So, the big mistake that a lot of patients will make is not moving at all, and the challenge with that is that it tends to keep things pretty irritated and pretty inflamed. So, sometimes, if you need to, you can use a little bit of ice on the back of the heel. But, this can occur because you’ve done maybe an excessive amount of walking on uneven surfaces, up and down hills, up and down ladders, up and down stairs, which is a lot more than what you typically do. So, it’s usually [that] the onset is due to a change of the activities that you normally take care of or do on a day to day basis.

So, the-there are a few different things that you can do for this. The most common [thing] that patients will do is try to stretch the tissue. Gentle stretching is really all [that] you want to do at this point. You don’t want to get in there and do really aggressive stretching on this tissue. If it’s inflamed, it’s trying to heal. So, a gentle stretch would be something where you use a strap, for example. I’m going to show you how I would do this on my right foot. So, if my right heel is irritated, I could grab a strap or a towel. I would put that around the top of my foot, and then I would gently pull my toes towards my nose. This stretch is supposed to be gentle, so it’s not supposed to be a really aggressive, deep stretch. And, I would hold that stretch for about 15 to 20 seconds, and then I would release it. So, there should be some discomfort, but it shouldn't be very painful when you do this. If it’s too painful, hold off. Again, we’re talking about an acute episode of pain. We’re not talking about something that’s persistent or chronic. So, this tissue needs to heal if it’s gotten very irritated.

The other thing that I would recommend that you do is some gentle strengthening exercises. And, this is actually really good stuff to do when the heel has gotten kind of irritated. The first strengthening exercise, believe it or not, is just balancing on one foot. You get all of the muscles in and around the foot and the ankle activated with this activity. Holding onto something for balance is also very helpful. As you can see, my balance is a little off. I’m recovering from some recent heel pain. It is not the same type of heel pain that we’re talking about today. If you check my last video, you’ll see that one. But, again, you try to balance on just that one foot. That’ll work all the muscles around the foot, the ankle, and the heel. 

Finally, I would have you-my patients do a very gentle heel raise. And, I’m hoping that I've got the camera positioned properly so that you can see this. But, using both feet, I would come up on my toes on both sides. Then, shift the weight over to the one side that hurts. And, if possible, I would have my patient lower slowly down on that affected side. So, this is called an eccentric loading activity. So, I would have the patient lift up with both feet, come over onto one side, if possible, hold the weight on that side, and then slowly lower down on that affected side. The joy-the real nice thing about this exercise is that by using the unaffected side, so, in this case, I’m using my left foot to help support my right foot when I do the exercise. The lift up phase is going to be maybe three seconds. The lowering down phase is about six seconds, so it really is supposed to be a very nice, slow, controlled motion. And, I would recommend that you do this about five or ten repetitions, maybe one to two times a day as the tissue is healing on that heel on that right side. In this case, this is the right foot we’re talking about. Again, it doesn’t matter which foot you're doing this on. So, if you have pain on your left heel, you would lift up with both feet, shift your weight over to the left side, and then slowly lower down on the left side. Again, it’s up for a count of three, down for a count of six.

So, again, a little bit of ice would be great in the back of that heel, some gentle stretching [for] maybe two, three times a day, holding for about 15 to 20 seconds, and then that nice eccentric lowering activity on the side that is affected, again, five to ten repetitions [for] two to three times a day. After a few days, that heel should start to feel better. If, for some reason it doesn’t, there may be something else going on. You may want to get with a physical therapist to have them fully evaluate the heel to see what’s happening. And, again, this is for an acute episode of heel pain. This is not for that more chronic episode of heel pain. That’s got to be a whole other video all in and of itself. 

I hope this was helpful. If it was, I’d love a thumbs-up. Any comments below, I’ll feel free-get a chance to answer those. And, please subscribe for more videos, just like this one.