Soleus Heel Pain often diagnosed as Plantar Fasciitis

 

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“The Runner’s Nemesis”writtenby

The Soleus and heel pain!

Heel pain can take the fun out of a lot of our activities, especially for athletes who place higher than normal amounts of pressure on their heels and arches of the foot.

Heel pain is noted as the most frequent complaint made by recreational runners.  There are dozens of diagnoses given for heel pain.  Most commonly known would be Plantar Fasciitis, Achilles Tendonitis and Heel Spurs.Myofascial trigger points can be a remarkably potent source of heel pain, especially trigger points in one particular muscle, the Soleus, whose reputation for causing heel pain in athletes has earned it the nickname “The Runner’s Nemesis.”

  

According to Dr. Janet Travell (personal physician to Presidents Kennedy and Linden Johnson and pioneer of the Myofascial Trigger Point Therapy field) symptoms of trigger points in the Soleus can include:

  • exquisite tenderness in the heel
  • pain when placing weight on the heel
  • sometimes aching pains at night
  • difficulty walking uphill
  • low-back pain when leaning over to touch your toes or pick up an object
  • tenderness in the calf
  • as well as growing pains in the lower leg

Trigger points in the Soleus can also cause swelling in the feet by interfering with the muscular venus pump in the calf sometimes referred to as the “second heart.”   Fortunately, trigger points in the Soleus can be detected with a few simple self-tests and can be treated with non-invasive self-care techniques shown below.    

*The information in this article is not intended to diagnose or treat any medical condition and does not substitute for a thorough evaluation by a medical professional.  Please consult your physician to determine whether these self-care tips are appropriate for you.

(2) Quick Self-Tests to Tell if You have Myofascial Trigger Points in Your Soleus: Follow the instructions below to get a good idea of whether myofascial trigger points might be setting you up for pain and dysfunction in your heel.

TEST 1:  Heel Down Squat 
           

 PASS                                         FAIL

Stand with your feet shoulder-width apart and your feet pointing forward.  Squat down as low as you can go without lifting your heels off the ground.  A Passing result is if you can squat all the way down without raising your heels.  A Failing result is when your heels lift off the ground before you attain a full squat (as shown in the pictures below) or you cannot attain a full squat.

TEST 2:  Soleus Palpation

As always, palpation (the medical term for pressing, feeling and squeezing to evaluate body tissue) is often the most effective test to identify myofascial trigger points in your Soleus muscles.  As in the illustration below, press your finger tips into the inside and back of the lower leg, in the muscle tissue just behind the shin bone.

Cover the shaded area on the inside and back of the calf from just below the knee down to just above the ankle, as shown.  Feel for tender spots and tight bands of muscle (trigger points), indicating a Failing result.

Take note of any Referred Pain, as well.  Referred pain from trigger points in the Soleus can can occur in another part of your leg, heel, low back over the SI joint and even in the cheek over the TMJ.  Myofascial dysfunction of your Soleus can cause problems with your heel, foot, and ankle, as well as your low back, knee and hip.


3-Step Simple Self-Care Remedies

The myofascial health of your Soleus Muscle is in your hands – literally!  If any of the tests above were positive for myofascial dysfunction, the following self-care instructions can benefit you significantly.  Spending a few minutes a day can improve the range of motion and stability of your foot and ankle, as well as relieve myofascial pain, even the prevalent heel pain caused by this “Runner’s Nemesis.”

Step 1:  Warming Up with Moist Heat (optional)

The taut bands of muscle (trigger points) in your Soleus that you will be treating may appreciate some moist heat to soften them up.  Soaking your calves in a tub of warm water for 5-10 minutes or during a shower works very well.

Step 2:  Compression

Using your hands in the same way as you palpated earlier can be a good starting point to compress the trigger points in your Soleus.  Compression allows the taut band to loosen and blood flow to increase when you release the compression.  If you own a Jacknobber, use it in lieu of your fingers for more advanced compression.

When you find a tender point, press into it with enough pressure to feel the tenderness but not cause you to withdraw from the pain.  Hold for 10 seconds while completing at least two full breaths in and out.  Continue searching for more tender areas until you have covered the entire Soleus.

A very effective technique for treating the Soleus is to combine stretching with a strap (or jump rope) while resting the leg on top of the Jacknobber, as shown in this picture below.  Runners and other athletes especially benefit from the combined stretch and compression.

Step 3:  Stretching Your Soleus and Range of Motion Exercises

Seated with a strap                    Standing

Two good ways to stretch the Soleus are seated with a strap and standing, as shown.  Use the strap with the knee slightly bent to flex the foot back until a good stretch without significant pain is felt.  Hold for 20 – 30 seconds.  Or standing as shown, stretch the back leg’s (again with the knee slightly bent) by pressing the heel down toward the floor.  Hold for 20 – 30 seconds. Repeat 2 more times with either method.

Range of Motion Exercise:  Soleus Foot Pedal

To take your Soleus through its full range of motion, alternate rolling the foot back and forth, flexing the toes back as far as you can and then pressing the toes back down and lifting the heel off the floor as far as possible.  Do the same on the other foot but opposite timing so that one heel is up while the other heel is down.  Repeat 30 repetitions per foot after finishing your stretches.

Perpetuating Factors:

In addition to performing the above self-care steps once or twice a day, it might be helpful to pay attention to the following factors that can exacerbate pain caused by trigger points in your Soleus:

  • Wearing high heels – Causes prolonged shortening of the Soleus.  Please avoid this footwear.
  • Sleeping with foot flexed downward – Heavy blankets pushing on the foot or sleeping on your stomach can create this flexed ankle position.  Sleeping with you toes propped back up by a pillow or headboard can keep your foot in neutral position (perpendicular to shin)
  • Sitting in tall chairs so toes stretch down to reach floor – Place books or other foot rest under your feet so that your ankle is in neutral position while sitting.
  • Foot Hyperpronation  –  Click here to perform a test to see if you have hyperpronation or watch this video:

 

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