Heel Pain In Baseball Players: The Causes & Treatment Plan Beyond Rest & Gel Heel Cups!
Heel pain is a common problem in any “cleated” athlete population. This essay will focus on the most common cause of heel pain in baseball players. Differential diagnoses includes Achilles tendinitis, stress fracture, recurring ankle sprain, nerve entrapment, and plantar fasciitis. Please do not assume that your Google degree has enabled you to reliably determine Sever's disease from a stress fracture or achilles tendinitis. This problem is most often a condition known as apophysitis of the calcaneus (heel bone) or Sever’s Disease. This label describes a repetitive overuse injury, with inflammation of the growth area of the calcaneus which has not completely closed. It is most commonly seen in boys and girls between the ages of 10-15 who frequently participate in sports that involve running and jumping. The pain is usually present in the back and bottom surface of the heal.
CAUSES OF SEVER'S DISEASE INCLUDE:
1. Training Errors
The issue often occurs abruptly after a period of inactivity, when the athlete resumes running, cutting, and jumping activities too frequently or intensely. Other times, the condition develops gradually as the athlete continues to pound their joints with insufficient time for recovery between games and practices (especially tournaments played on very hard ground).
2. Footwear
Athletic cleats are intentionally created to minimize interference with foot feel and function. This is great for speed and precision, but leaves very little between the foot and the ground. Cleats that are too small are often a culprit, as are shoes with less than four cleats in the heel area. Make sure the rear of your cleats has some surface area to it!
3. Foot Structure and Function
Biomechanical imbalances such as high or low arches, or very stiff or loose joints, can be the root cause of the abnormal strain across the Achilles tendon insertion point on the heel bone. The details are beyond the scope of this writing, but you should realize that the heel may be overloaded due to too much or too little movement in other areas of the leg.
TREATMENT: BEYOND REST AND GEL HEEL CUPS! The most effective treatment usually includes not just rest and then going back to the exact same mechanical factors that caused the problem in the first place. You should take measures to address some combination of the above problems.
1. Systematically apply stress to the body
Plan ahead to gradually apply more stress to the foot and ankle before jumping into a lot of repetitive agility and sprint work. At least initially, apply a limited number of high impact activities to build resiliency in the foot and ankle.
Wear cleats around the house for “everyday life” and lighter practice before using them for more intense training.
2. Address issues with foot structure
The details of foot structure and function are beyond the scope of this essay. This is highly individual, and demands a thorough orthopedic evaluation of the entire athlete (not just the foot). Not all “low arch” feet need orthotics. They may respond well to a few exercises and shoe modification. But some athletes certainly do require an appropriate off-the-shelf or custom orthotic device.
3. Modalities
Applying ice and massaging the calf muscles and the area around (but not directly to) the tender area often helps. I’ve found Ultrasound treatment to be worthwhile to decrease pain and inflammation. While these do indeed help manage the symptoms, they don’t address the root cause.
4. Taping Techniques
There are a few flexible- (K-tape) and traditional taping techniques that effectively reduce the overload of the heel bone. Sometime this is enough to get the athlete outside of the threshold of injury. Which technique and type of tape may work best depends on the static and dynamic (movement) patterns the athlete displays.
5. The quick fix
I’ve hit upon a quick fix (of sorts), and suggest waiting on use of orthotics and prolonged periods of rest. I usually have my clients try a 3/4th length heel lift in combination with a few targeted exercises and temporary activity modification. This combination seems to do wonders for athletes who are stuck in a rut of heel pain. The 3/4th length piece is semi soft and gradually tapers to the ball of the foot. This works far better than Dr. Scholls type insole because they don’t take up room in the toe box area where the athlete is accustomed to a form fitting shoe. And unlike gel “cushion” heel cups, they don’t slide around in the shoe. They also provide more lift than squishy gel. A quarter inch is usually enough to lift the back half of the foot and lessen the Achilles tendon pull on the heel bone (calcaneus).
Try these tips and as always feel free to reach out to me at bobg@fullrepstraining.com or visit our website at www.fullrepstraining.com to schedule an assessment today!!
-Bob Gorinski
