Heel Pain Running with Wil Seto

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto of Insync Physio in Vancouver. Well, let's say they're one of the best physiotherapy clinics in Vancouver. Today we're gonna talk about a probably a pretty common thing, I would guess is heel pain from running that's due to tendinopathy. Is that what's causing this kind of pain typically? 

Wil: Yeah, yeah. Well, thanks Mark. That's exactly it. So quite often heel pain that starts to happen with running, you know, you can get what's called Achilles tendinopathy. So what it is, is basically an overuse syndrome or dysfunction. And it doesn't happen overnight.

So you can start to see the bigger picture like, when someone comes into our clinic, and I can think of someone that came in and saw one of our physios, you know he was telling me about this particular individual, and the picture was pretty clear how it all started.

And so essentially, you're looking at all the factors of like did you start running? And like where is the current fitness level at? And are they doing other types of activities that involve a lot of loading in the heel as well.

And then what are the previous injuries or past history of this person? Like, do they have a colourful history? It doesn't even have to be in the heel or the foot or leg. It could be even in the back, because that can add compensations into your mechanics with running. And then even just you know talking about this with you earlier, maybe the person is a little bit more overweight and if they're a beginner runner and you add that to the mix and then the mechanics are off, then with that actual little weight, that's also gonna, you know, basically cause more excessive, abnormal loading in the heel.

And giving you a lot more tightness into the calf, obviously. And then you're gonna overuse your calf to generate power as opposed to your glute muscles, which you really need that power with the extension of your hip. So then as a result, that tightness and that overuse of the achilles of the calf muscle specifically then causes the Achilles to be tight. And then usually the Achilles tendon is the weaker link, not the actual calf muscle itself.

Mark: So, when you're diagnosing this, what's most important? Is it history, to really dig into what's going on with somebody? Or is it testing? 

Wil: Well, history is a big thing in terms of like giving us a bigger picture of how this was caused and started. Cause that way we don't want it to come back. And we also want to address the ongoing mitigating factors that keep aggravating it. So that's huge. And then also as we assess, that's also gonna help with like, okay, yeah, this is what's contributing to it, these are the impairments and these are the actual things they can work on.

And then the other thing is looking at the, like assessing and looking at like, okay, so if it is a tendinopathy, you're gonna get soreness when you palpate around the area. So that's actually a really easy do it yourself home test. If you're feeling sore, when you're palpating yourself on that tendon, then it's most likely that. 

Because one of the other things that you could be getting, it could be like maybe a, what's called a bursitis in your Achilles. And so that's basically the fluid filled sac that protects the achilles tendon from rubbing on the bone. And so you might have a flare up of that. But if it's all along the tendon, like right on the superficial, like inside or outside or right on top, then usually it's most likely the tendon. But it could still be like some kind of bursitis or it could be something else, but most likely it's that. 

And then you look at, you know, other factors, even if you are an experienced runner, which we do treat a few experienced runners and you know, they take a break and then they start training again and they maybe do some hill training. And so that's gonna cause more stress and strain on that Achilles, just the overloading of that Achilles. Because you're always in that motion where it's more outstretched and lengthened and you're loading it more because you're going uphill. 

So that combined with intensity and frequency workouts and runs. And then just like, how long have you been running for? And then, well, what else are they doing? So maybe this person is doing other things like, you know, maybe they're doing a lot of other activities and sports that require 'em to be on their feet all day and then they go for a run. They don't do any recovery things. Those things are all important factors. 

Mark: So we've diagnosed it, we know what the symptoms are, the possible causes, the diagnosis. What's the treatment look like and how long does it typically take? 

Wil: Yeah, it varies. Depends on how long it's going on for, because when you're starting to have symptoms it's probably been going on well before you started to have symptoms. So you sort of reach a threshold until it becomes symptomatic. And you may sort of sub like you're below the threshold of having symptoms, but it's a problem. But you probably have noticed that, yeah, my calf muscles are a bit tight, you know, or I feel a little bit tight, but you don't really do anything about it until it's too late usually. So that's an important thing to look out for.

And so how we actually treat it, you can't actually address the strengthening of that Achilles. You wanna produce what's called collagen synthesis. And so basically what you're doing is you're promoting an increase of strength around the tendons where it's been effected. So you're reinforcing that tendon. So you're getting stronger all around it. And that's the key. So doing specific exercises that are based on research, also not just on clinical aspect of where we found successful, is like things that actually address and target specific and then strengthening. So starting off with what's called isometric strengthening.

You know, where you're putting constant tension force of the muscle where it's not moving. To then eccentric, which is basically constant tension force of the muscle while it's lengthening. And that's key because now you're working on getting more of that, what I described earlier as collagen synthesis are the building, the basic blocks of strengthening that tendon around that injured area, which will help with the full recovery. And we've seen some good success with this. 

Mark: If you're having some ankle heel pain from your running. Get in, get it diagnosed, get your gait checked. Is that a fair thing to say almost for any runner, get your gait checked regularly to see if there's any imbalances, cuz you can't see when you're running, you don't see what you're doing, you're just running. Is that fair assessment? 

Wil: Absolutely. 

Mark: Probably a good idea. 

Wil: Yeah, because there's many other factors to consider when you're getting your gait checked. Like how many steps you're taking per minute. And so that's your cadence and then how your form looks and whether or not your centre gravity forward enough and if you're getting enough power through your extensors. So it's a really good thing to do. 

Mark: People to call, the experts are at Insync Physio in Vancouver or in North Burnaby. They have two offices. You can book online either office at insyncphysio.com. Or you can call them. The Vancouver office is (604) 566-9716. North Burnaby is (604) 298-4878. Thank you, Wil. 

Wil: Thanks, Mark.