Heel pain can strike unexpectedly or can creep up on you over time. It can make you grab your most cushiony shoes or buy every gel pad available on the shelf at Walgreens. You can feel it with every step, forcing you to walk onto your forefoot only to cause calf strain.

It may be obvious how it started. Perhaps you jumped down onto a hard surface, landing firmly on your barefoot heels. Or, maybe you took on a new activity like running on concrete and wore some crappy shoes.

More often than not, the onset of your heel pain may not be apparent. Are you scratching your head because you have no idea what led to this? You swear you didn't do anything, and it seemed to come on overtime. You thought it would go away, and it is still nagging you. If this is you (or a friend), read on.

Gradual onset of heel pain is prevalent. A quick google search will tell you that you have Plantar Fasciitis. Even a visit to your local MD will often lead you to the same diagnosis. Then, you are given a plethora of options, from arch supports to frozen water bottle rolling techniques and even night splints that are a nightmare to sleep in. Yet, six months later, you STILL have that darn heel pain.

Unfortunately, this is the story we repeatedly hear at Juniper Physical Therapy. Our frustrated clients with heel pain are desperate for one final option to rid them of their probable "plantar fasciitis." They soon learn that the reason for their heel pain is something no one has yet mentioned to them.

We look at your heel differently. We see everything that connects to it. We understand what needs to happen elsewhere in your body for your heel to work optimally. We hear you say "heel pain," and we immediately look beyond your heel for the root cause of that pain. Unless you experienced an apparent injury to your heel, our minds search for an issue nearby or further away from your pain.

We are the masters of understanding your body's kinematics (physics of movement) and have 5 reasons for heel pain that your MD or Dr. Google didn't tell you:

1. Loss of fat under your heel - Everyone is born with a natural cushion of fat under their heel. This cushion starts out well hydrated and provides adequate shock absorption even during our most impactful activities. Over time, your fat pad can diminish, become thin, or atrophy. You can begin to lose your natural shock-absorbing cushion for many reasons, such as:

• Age - the natural aging process results in a loss in elasticity of the soft tissue structures in the body.

• Poor foot mechanics due to joint stiffness and/or intrinsic foot muscle weakness.

• Poor core and hip strength lead to faulty leg mechanics and more significant pressure on your heels.

• Too much direct impact on your heels, such as walking, running, or jumping barefoot on hard surfaces

• Obesity - creates greater prolonged pressure and impact on your heels over time

2. Weakness or tightness in your lower calf and foot muscles - Muscle weakness or tightness can lead to muscle strain and trigger points. Suppose you get trigger points in one of these lower leg muscles: Soleus or Posterior Tibialis, or one of these foot muscles: Abductor Hallucis or Quadratus Plantae. In that case, you may be feeling the referred pain from them in your heel. This means that your heel is actually okay. It is one of these muscles that need treatment.

3. Gluteal Weakness - Your Gluteal muscles (located in your butt and hip area) help to stabilize your pelvis and hips. If they are weak, the center of your body loses stability. Your brain is always searching for stability and control. Therefore, if your core is slacking, your foot and lower leg work harder to achieve this controlled balance. This can cause more tremendous pressure on your heel and strain on your intrinsic foot muscles. Both of these situations can lead to heel pain.

4. Ankle & Foot Joint Stiffness - You can develop ankle and foot joint stiffness for various reasons, including prior injury history, lack of movement, arthritis, faulty mechanics, improper footwear, active lifestyle without proper self-care, and many more. If these joints are stiff, you lose shock absorption with every step. This creates greater force upon impact leading to heel pain over time.

5. Lack of Big Toe Extension - Your big toe is designed to bend backward when you walk. It provides stability and control as we move. If this joint is stiff and cannot bend backward enough, the rest of your foot and/or ankle needs to compensate. This compensation changes how your foot and heel hits the ground, potentially causing more significant impact and stress to your heel.

Did any of these 5 reasons surprise you? Do you think one or more of them are causing your heel pain? If you or a friend suffer from heel pain and want some solutions, stay tuned for next week's blog post. I will be sharing our favorite treatment strategies for these conditions!

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