What Causes Arch And Heel Pain

Arch & Heel Pain & Scar Tissue

Scar tissue is a major cause of arch & heel pain

There are 2 types of scar tissue in life. Scar tissue that comes from major injury events – and scar tissue that develops slowly due to repetitive strain mechanisms. Both types of scar tissue can contribute in a big way to stubborn arch & heel pain.

When we injure ourselves in the traditional sense, deep tracts of scar tissue are often left behind. This scar tissue a very common cause of longer term pain. Old tracts of scar tissue are a major contributing factor to many cases of arch & heel pain. Sometimes even when the scar tissue is in the calf and knee.

When repetitive strain impacts soft tissues plays out over long periods of time; a type of scar tissue forms in the key areas of tissue stress. This type of scar tissue is the mess left by all the body’s failed attempts at repair. The final outcome is a painful degenerative mixture of scar tissue and incomplete wound healing. If you have arch & heel pain there is a high probability that you have some of this going on !!

There can be great value in acknowledging the role that old injuries play in arch & heel pain, and it can be complex. Old injuries can easily contribute to pain in the arch and heel.

Happily most scar tissue is easy to break down as long as you have the right tools and the right professionals at your disposal. At Featherston St. Pain Clinic for example, relieving stubborn pains by breaking down scar tissue is our bread and butter!

Arch & Heel Pain & Muscle Wasting 

If you have chronic pain (of almost any type) it’s vital to know that muscle weakness is almost certainly part of the issue. Strong body parts seldom hurt, no matter what other complex  factors are involved. 

Most modern humans engage in less than 10% of the activity our hunter gathering ancestors did. As a result our bodies are extremely prone to muscle wasting. In fact, compared to our ancestors,specific patterns of muscle wasting are the norm for us; and it’s due to our profoundly sedentary lifestyle patterns.

The most obvious role of muscle is movement, muscles pull on our bones and enable important life preserving activities like tennis and Zumba afterall. The role muscles play in injury prevention is less obvious but just as important.

When there is a threat of injury muscles intervene and assume their role as a highly effective suit of armour. Patterns of protective muscle contraction also prevent repetitive strain in our legs and feet. Muscle performs this trick by maintaining even weight distribution when we are on the move.  When these muscles weaken we are far more susceptible to developing arch pain and heel pain.

Arch & Heel Pain & Repetitive Strain

Straight forward overuse is the most obvious and natural cause of arch & heel pain. The list of life’s tasks that don’t involve using our arches & heels is short after all. 

Your body can do far more repetitive work than any machine without the need for new parts,  because it is engaged in constant repair. Consider that an active person loads their entire body weight through the soles of their feet more than 800 million times every 10 years without any need for replacement parts. This feat is only achievable for a system that constantly repairs itself.

Repetitive stress injuries occur when the body cannot keep up with the repair needed to sustain high levels of activity. Our arches & heels are extremely vulnerable to this for obvious reasons.

Overtraining is the most easily understood cause of true overuse repetitive strain type arch & heel pain pain. You might be incredibly strong and have perfect lifting technique but if you do the same intense crossfit workout every day for 3 years the damage you do will massively over-exceed your limbs ability to carry out growth and repair processes. 

Obviously, occupational overuse is a very common cause of arch & heel pain. Work tasks that require a certain amount of strength, tasks performed in huge numbers of repetitions or are performed at an awkward angle can all lead to arch & heel pain.

Arch & Heel Pain & Lifestyle Choices 

Our body’s muscles and soft tissues were designed for a very different life from the one most of us lead; a far more wild and active life. Imagine the difference  work your feet do if you need to find your own food and water, and build your own shelter; in bare feet in the big outdoors.

Road running is excellent for the heart and lungs but does not do any favours for feet that evolved for soft natural ground. Wearing high heels during office hours 5 days a week doesn’t do any favours for the soft tissues in your feet. Walking around bare foot at home can effect your heels, especially if you are a bit ‘stompy’. And there are many more examples besides.

One of the main lifestyle factors that can impact arch and foot pain is the question of ‘how much’ we do. Those who overtrain endlessly tend to be more exposed to plantar fasciitis . Those who are extremely sedentary also tend to be more prone to plantar fasciitis .

Like so many things in life the prevention of arch pain and heel pain through lifestyle choices is a question of balance. It may be okay to wear high heels for example, but perhaps just ‘at’ the office and not walking to and from the office. There is almost always a way to manage the impact lifestyle has on our feet, but sometime some professional advice is necessary.

Arch & Heel Pain & Alignment Issues

A wise woman once said ‘It ain’t what you do it’s the way that you do it’ and she was right, at least when it comes to preventing arch & heel pain.

Tasks performed in an efficient way put a tiny fraction of the strain on the body’s tissues than tasks that are performed inefficiently and with poor alignment.

Many sufferers of arch & heel pain are people who have developed inefficient, misaligned or overly hurried ways of doing things. Our habits of posture and movement have a way of  sneaking up on us and it is all too easy to develop habits of working/living that cause strain without us realising. Much in the same way that we are able to slowly lose 20/20 vision without realising.

For many sufferers of stubborn arch & heel pain, improved ergonomics and biomechanics are major factors in the eventual elimination of their pain. Happily, any pain clinician who knows their stuff should be able to help you take the guesswork out of making the necessary changes. 

Arch & Heel Pain & Genetic Factors

High arches are inherently unstable and can cause chronic strain and pain in the feet if they are not properly supported over time. At the other end of the spectrum, having low arches is like having poor shock absorption, which can lead to  scar tissue build-up in the feet. Tissues that are chronically scarred or strained are far more likely to suffer with pain.

Wearing modern custom orthotics and making wise footwear choices can help greatly with arch issues over time. This is one of the most accessible and simple ways we can care for our arches and heels.

Having one leg longer than the other can load excess strain on a foot, usually on the longer side. The longer leg will tend to take more weight and do more work which may lead to repetitive strain and pain in the arch and heel. Only a small percentage of leg length discrepancies are ‘true discrepancies’ however and most are caused by a tilt of the pelvis.

Distinguishing between true leg length discrepancies and false (pelvis is tilted) leg length discrepancies is the key to troubleshooting these issues, and the impact they can have on stubborn arch and heels pain.

Arch & Heel Pain & Psychological Stress

Increasingly science is unpacking the intense links between our psychological well being, our emotions and the stubborn health issues we suffer from. These days it is more or less common knowledge that stress can influence pain in a big way.

A modern view of pain hinges on one relatively simple concept. Pain does not just happen in your body’s tissues, it also happens deep in your central nervous system. When we experience stubborn pain it is happening both in the tissues but also within the ‘pain pathway’’. The pain pathway is the set of nerves and nerve clusters that manage the pain signals.

Pain can be amplified by physical stress in the body’s tissues, we all know that one. But pain can also be amplified by the effects of psychological stress on the central nervous system.

An excellent piece of research carried out on behalf of Boeing highlighted the effects work related stress can have on pain. Boeing spent a huge amount of money trying to unpack what causes so many of their staff to suffer debilitating back pain. Cutting a long story short it turned out that it wasn’t heavy lifting or repetitive work that predicted back pain in workers; the workers who experienced the worst back pain were the ones who felt chronically under-appreciated!!!

In practical terms: a mild injury in the foot of a person suffering a huge amount of psychological stress can lead to more ‘physical pain’ than a major issue in someone who is enjoying their life situation.

Arch & Heel Pain & Surgery

Surgery is great, but there can be complications and chronic pain is one of them.

We are truly blessed to live in an age of modern surgical procedures and technologies. The right surgery at the right time can be nothing short of life saving after all. Then there are all those non-life & death procedures that can relieve nerve compression and all sorts of other nasty’s. Surgery is great.

As wonderful as it is, surgery remains the most risky and invasive of all healthcare paradigms. For your body’s soft tissues  getting cut open by a surgeon is an injury like any other. And like all injuries, surgery can leave the body with longer term issues that may predispose it to pain.

Sadly very few of us are given sufficient rehab after surgery due to the pressure on our healthcare systems, and the need to discharge patients in a timely fashion. A history of surgery anywhere in the leg and persistent arch & heel pain can be a sign that there is some residual scar tissue or muscle wasting.

The happy news is that many cases of post-surgical arch & heel pain related to poor surgical recovery are an absolute piece of cake to treat as long as you are willing to put in the necessary rehab work.

Arch & Heel Pain & Tendinopathy 

Tendinopathy is an integral part of almost all persistent arch & heel pain, and is pretty much an inseparable part of the underlying problem. It is valuable to understand what tendinopathy is and what we can do about it.

Up until recently we used a different term for tendinopathy.. Tendinitis! Until it turned out that tendonitis is a completely inaccurate and unscientific term for what really happens in painful tendons.

The term tendinopathy reflects what we now know scientifically about tendon pain. When you look down the microscope at chronically painful tendons you see degenerative changes. This means that tendinopathy is just as degenerative in nature as conditions like osteoarthritis. Happily though tendon degeneration can be reversed due to its rich blood supply.

Many arch & heel pains are tendinopathy by another name. Using treatments like extracorporeal shockwave therapy combined with a tailored strength exercise program for the tendons is an excellent way to manage these types of problems both in the long and short term. 

We now know that the body can reverse degenerative type changes when it is given the right care.. 

Arch & Heel Pain & Fascial Adhesions

Fascia is the whitish/ silvery connective tissue that neatly wraps up all your body’s internal structures. We now understand that the skin is a very large and very important organ system; and we are also beginning to understand fascia as an organ. Previously it was thought of as nothing more than the boring stuff that you cut through during surgerys and autopsies. 

Fascia is really important stuff. It binds interdependent sets of muscles, bones, nerves and blood vessels together in a way that enables them to work together effectively. Fascia assists movement between tissues too, structures like tendons need to move smoothly against bone, and even against the overlying skin.

‘’Fascial adhesions’ are sticky thickened sections of connective tissue that contribute to pain by preventing normal movement between neighbouring tissue structures. If you are not a lifelong vegan you have probably seen what fascia looks like on a lamb shoulder. The fascia is the silvery connective tissue between the muscles. If you can picture what it would be like if that silvery membrane thickened and ‘sticky’ you understand fascial adhesions.

Fascia adhesions are a very common part of the body’s response to physical strain, and they are a major part of the mess that needs to be tidied up in most cases of arch & heel pain.

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