October 2


Heel Pain with Wil Seto

By Wil Seto

October 2, 2023

foot pain

Mark: Hi, it's Mark Bossert. I'm here with Wil Seto of Insync physio in Vancouver, and today we're talking about, you know, what's the latest body and fender work that we want to work on? Heel pain. We're going to talk about inner heel pain you said, what is this all about? 

Wil: Well it's interesting because like quite often when people have heel pain and I don't know if it's more common now, and people are more aware of it, but they think of this term called plantar fasciitis. And some people are more aware of it than others. But then there's more to it. Like, if you actually diagnose it, or if you actually assess it properly, you can determine, well, is it really that, or is it something else that's going on.

So the more common, like the plantar fasciitis, basically what that is, it's an overuse issue, there's connective tissue on the bottom of your foot. And it usually happens more in the heel, and it can happen kind of around the inside of the heel too but there's other things that can actually be that's not plantar fasciitis, but can also be pain in that area.

You have padding in that heel, kind of like, you know, your butt, so we call it the fat pad. So that's sometimes getting irritated, and it's not necessarily the actual connective tissue. So it's just an irritation of that. And there's a lot of nerve endings there. And so that can be caused from the improper, like motion or mechanics of, like, if you're a runner and you may have really stiff hips and then it's causing you to not really transfer your load into your whole foot properly. And so then you end up heel striking harder. And running, you shouldn't be heel striking. Walking yes, you do. But not in running. So there could be like changes in that that are happening. 

The other interesting one. Actually, someone came into the clinic with this issue and they came in and saw one of our physios and they had this inside ankle heel pain. And it only happened after like longer walks and no pain in the morning or evening or sleeping or anything like that.

And it was interesting because usually with plantar fasciitis, you get worse symptoms in the morning and your first few steps kind of thing. And so with this person, it was more like after they've been walking for a while. And so when we assessed their gait, well, actually, when we first assessed even the person standing, the foot was fully collapsed.

And I was like, Oh, that's interesting. And so we measured the length of the legs. And that didn't seem hugely off, like it was like maybe a very minimal, you know, in terms of leg length differences on the left and the right. But when we actually started to look at the stability and what was going on in the ligaments, because when she was lying down, it looked fairly normal, it was only collapsed looking and looked really off when she was standing.

And then she started walking, it was like, Oh, well, if I had an issue like that, I would be getting foot pain too. Turns out that her ligaments on the inside of her ankle were torn. Now, it was funny because when we asked her about it, when the physio asked her about it, she didn't say anything about having an injury.

And then she just suddenly remembered, that she twisted her ankle about 15 years ago. And the thing about those kind of, so this is an eversion, which is basically not the most common type of ankle ligament injury sprain, which is on the inside. And so she had this eversion sprain, and typically like when it's a really bad one, and she said it swelled up, but it wasn't too bad, but usually when you tear all the ligaments, then there's other stuff that potentially can happen, like a fracture or something like that.

Because the ligaments are so strong, they attach more to the bone. But it was a little bit loose, definitely. And then she had like all this collapse and all the muscles that have compensated. In terms of like for this injury and nothing was working properly. So all those muscles that were supporting the arch before and she was getting the inside heel pain, was the whole sort of inside of that arch area because it was collapsing. So there was nothing supporting it.

And her arch was was collapsed because everything around there was insufficient. And so she came in to see us with this sort of chronic issue that just started like a couple weeks ago. But it probably would have been ongoing and she had been taking up a lot more hiking just recently this summer.

So the antidote or I guess the treatment for this is really looking at trying to stabilize. So we look at the mobility. She's got good mobility there. In fact, it moved too much and where she's really lacking is strength and really looking at what to activate. And how to activate it and then really ultimately get it giving her more of that stability that she needs. So whether it's like as we get her stronger and maybe she also needs a little bit more of a revision in her orthotics, that she's not getting that support anymore.

Mark: What sort of exercises would that involve? 

Wil: Yeah, so depending on what we find, like usually in that area, there's certain muscles that kind of stabilize that whole inside of the ankles and prevent it from collapsing. And so, I mean, I can name off a few, it's like big names, like the tibialis posterior muscle is a big one. You know, that can be really helpful. Because for her, especially, it was not activating at all. Like when we started and here's the interesting thing. She would just stand, her normal stance would just be like in a collapsed position. That's her comfortable stance to try and get her to activate that muscle, it was really hard. 

But when we did like, Oh, that feels different. And then you can see like when we did it was supported. So the challenge is keeping her supported while she walked. And so ultimately, the thing that we would do is taping it and supporting it physically in that way. Her orthotic may be helpful later on in the revision in that, but doing things is supported or braced or something that just really helps to keep that medial arch more supported. And lo and behold, you know, that taping did help a lot.

And that's how we know that there's not other things that are bigger going on either. Because when we can really look at, Oh, yeah, hey, that really helps. Oh, my gosh. 

Mark: Is there an aspect of the taping that brings someone's attention to that part so that they maybe it triggers that muscle reactivation after it sort of you know, been dormant for 15 years?

Wil: Yeah, that's a good question. So the taping that we do specifically is a little bit more rigid because we want to help support that. But also there's an aspect of taping that we can do that's a little bit more facilitating sort of the nerve muscle connection. So that can help with that. And then combined with doing specific retraining and rehab for that system is extremely helpful.

Mark: Yeah. And does that make her walks a little bit more pleasant so she doesn't run into so much pain? 

Wil: Well when we taped her up, it was definitely night and day. It was funny because she said, yeah, I only get pain with when I do longer walks. But then when we got her in a clinic, just literally doing like walking for like 10 feet.

Yeah, I feel that. So it's like sometimes we just ignore the, you know, until it gets. So if it's like a two out of 10 pain, we ignore it. Until it becomes like oh, yeah, now I feel pain. So even like she was like two out of ten from two out of ten to zero out of ten and feeling supported. I think that that's definitely gonna help 

Mark: if you're encountering some sort of heel pain instability with your heels, fat pad pain, where the bottom of your foot kind of feels funny, and you're in Vancouver or North Burnaby, you want to see Insync Physio. They can help you diagnose exactly what's going on and get you on the path to recovery. Insyncphysio.com to book your appointment. Or in Vancouver, you can call (604) 566-9716 in North Burnaby (604) 298-4878 to book your appointment. Thanks Wil. 

Wil: Hey, you're welcome.

Wil Seto

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