Heel pain and the calf – a simple strategy for improving the pain!

The plantar fascia is a broad band of connective tissue spanning across the bottom of the arch. It connects to the bottom of the heel bone (calcaneus) and extends to the joints at the base of the toes. Its two primary functions are to protect the muscles in the arch and to support the arch; about 25% of the arch support comes from the plantar fascia. Contrary to what some may think, the fascia does not stretch. Instead, the plantar fascia resists stretching and flattening of the arch. It is under tension with every step and even during weight bearing when the foot is loaded. 

Plantar fasciitis means inflammation of the fascia. But, this term is a bit deceiving because the fascia itself never really becomes “inflamed.” Rather, inflammation develops around the fascia, in the arch muscles, and on the surface of the heel bone. Research is not clear on how long the fascia remains inflamed, but best estimates are 4-6 weeks on the short side and a few months on the long side. If this inflammation does not resolve, then the plantar fascia will eventually become damaged. When this occurs, the term we use is plantar fasciosis rather than fasciitis. Scar tissue begins to develop in the fascia and replace the normal collagen matrix. As this damage worsens, the fascia thickens – I commonly see fascia two to four times thicker than normal under the heel bone. Consequently, many people with long-standing heel pain describe the feeling of stepping on a rock. 

Causes of heel pain are multi-factorial, meaning several problems tend to congregate together and cause the pain. One factor that appears to be the most prominent cause is reduced flexibility in the calf muscles. Research has shown that tight calf muscles are present in 80-85% of patients with heel pain. Consequently, one simple method for treating – and preventing – heel pain is to improve calf flexibility through stretching. 

So, how do they become tight? Most of the tight calf muscles I see are related to lifestyle. We spend a lot of our days sitting with the knees bent. Because the gastrocnemius muscles cross the knee joint, bending the knee relaxes the calf muscles. Spend most of your day like this and the muscles naturally shorten. In addition, as we sleep at night we naturally point our toes downward under the covers thus shortening the calf muscles. (Ever wonder why heel pain is so common when standing up after resting or getting up in the morning? There you go.) There are genetic variances as well with some individuals lacking flexibility for most of their lives.

If you find yourself suffering from heel pain, or just want prevent heel pain, then try stretching your calf muscles. Chances are you’ll find a significant improvement your pain. There are two primary muscles you’ll need to stretch: gastrocnemius and soleus. Two different stretches should be performed twice each day. These are called static stretches and are ideal for improving flexibility. As a general rule, however, static stretches should be avoided prior to exercise. Why? Research has shown static stretching reduces muscle force output (not what you want to do before a run.) Dynamic stretches prior to exercise are ideal. We’ll cover that subject in a future blog. Here are two videos demonstrating stretch techniques for the calf muscles. Now, run safe and run smart!

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