Heel Pain In Cyclers

Cyclists do not commonly experience heel pain, but if they do have it, it is mainly because of over straining while pedaling. During a typical two hour cycling ride, a cyclist will be to make 83 crank revolutions per minute and that’s a total of 10,000 cranks revolution in two hours. This puts a considerable amount of stress to the calf muscles and feet while pushing against the pedal, especially when going uphill. 

The most common type of heel pain a cyclist can encounter is a strain to the Achilles tendon. The Achilles tendon is the largest tendon in the body. It attaches behind the calcaneus or heel bone and attaches to the calf muscles above. The pain commonly occurs at the attachment of the Achilles tendon to the heel bone. Commonly referred to Achilles tendinitis, this is the inflammation behind the heel causing pain, swelling, tenderness and heat when the touched.

Another common cause of heel pain among cyclers involves the plantar fascia. This fascia runs underneath the foot and also attaches at the bottom portion of the heel bone to the balls of the foot. It is responsible for the arch of the foot and is very important for its biomechanics. This too is a strong tendon and is constantly under stress when walking and running. This is a particularly common among runners but it too can occur among cyclist.

The reason why cyclers experience heel pain is due to erroneous training, failing to do stretching exercises before bicycling, wrong positioning, poor equipment, random peddling and improper footwear.  Error in training is a result of apply too much intensity too soon. Stretching is an important pre training measure in preventing injury. Foot positioning while pedaling is important, so as not to strain any muscles or tendons. Using worn out shoes do not provide much support and cushioning, and can irritating the plantar fascia.

Treatment primarily involves identify the specific foot problem. Visiting a podiatrist is best for these situations and they can also assist and give advice in of the do’s and donts of proper foot care whether in training or not.

Treatment Modalities in Managing Peripheral Neuropathy

Peripheral neuropathy is condition where the nerves of the peripheral nervous system get damaged. There are different signs and symptoms of peripheral neuropathy, but the more common ones are numbness, sensitivity to touch, tingling sensation, or muscle weakness on the arms, legs, hands and feet. In some cases, patients experience paralysis or burning pain.

Fortunately, there are ways to effectively control and manage these symptoms. There are many treatment modalities that neuropathy patients choose and seek out the right treatment that works for them.

Thiamine 

Thiamine deficiency is a very common cause of peripheral neuropathy. Thiamine or vitamins B1 have various roles in keeping the body working properly. Lack to thiamine can cause tingling sensations, burning sensation, sharp pain or numbness to the hands and feet. To counter this, a neuropathy supplement with thiamine and other nutrients and vitamins are needed like cobalamine (vitamin B12), DHEA and alpha lipoic acid.

Medications

Over the counter pain relievers can sometimes relieve mild symptoms of peripheral neuropathy. For nerve pain, physicians usually prescribe anti seizure medications like garbapentin and phenytoin. Some anti depressants like amitriptyline has also properties to relieve pain. Lidocaine patches can be applied to the painful area. Tramadol is an opiate based painkiller reserved for patients who do not respond to any other treatment.  All drug based medications might have side effects so be aware if any of these products have serious adverse results.

Injection Therapy

This involves injecting a numbing agent like lidocane to the affected area. This technique provides instant but temporary relief. Lidocane or other anesthetic agent blocks the nerve impulses from reaching the brain. Injection therapy is usually done with other treatment modalities like physical therapy.

Physical Therapy

Physical therapy is essential to improve blood circulation, strength and function in areas affected by peripheral neuropathy.  This involves active and passive exercises.  Stretching and passive range of motion exercise are done to maintain range of motion. Muscle strengthening includes active and resistive and isometric exercise.

Surgery

Surgery is done for certain conditions that may cause peripheral neuropathy. Carpal tunnel syndrome and a nerve compressing tumor are good examples that cause peripheral neuropathy and the only effective treatment is to surgically remove the compressing entity. In this case, the carpal ligament is permanently cut and the tumor is removed both of with relieve pressure to the nerves.

Reversing thiamine deficiency with thiamine supplement  is a well known and often highly successful way to nutritionally manage peripheral neuropathy.

What’s Causing Your Heel Pain

The most common condition that affects the foot is heel pain. The characteristic pain affecting the heel is variable. It could be burning pain, slow progressing pain, or striking pain when the affected heel is used. In some cases, especially when a patient has chronic heel pain, the pain can occur even at rest.

In most cases of heel pain, the plantar fascia is involved. There could be a pathologic finding or damage to plantar fascia or irritation and inflammation to the surrounding tissues at the heel bone where the plantar fascia attaches.

The plantar fascia is a strong band of fibrous tissue found underneath the foot. It attaches to the calcaneous or heel bone to the balls of the foot. It is responsible in maintaining the arch of the foot which is very important in the biomechanics of the foot.

The plantar fascia is constantly under tremendous pressure when walking, running, lifting weights, or anything that involves using the foot. For this reason, it is not surprising that this structure develop tiny tears that can accumulate over the years. These tiny micro tears can cause mild to severe heel pain. This is the reason why the elderly commonly develop this type of foot pain. Younger individuals also develop premature fascia tears, especially people who are active in sports like runners. Plantar fasciitis is the medical term which means irritation and inflammation of the plantar fascia.

Heel pain is a very common condition. About 10% of the human population will experience at least one episode of heel pain at some point in their lives. Individuals mostly affected by heel pain are:

•  The elderly around the age 40 to 60 years old.
•  Active individuals who regularly run or jog.
• Athletes especially runners, basketball players, volleyball players. 
• Obese or overweight
•  Diabetics

Treatment of heel pain caused by plantar fasciitis focuses on alleviating the inflammation and irritation of the plantar fascia. The easiest way to treat heel pain is by following the R.I.C.E. method.

•   Rest. Immobilizing and allowing the foot to rest promotes wound healing. Resting alone can treat the acute or early stages of heel pain.  This heals the micro tears and damage done to the plantar fascia
•  Ice. Cold stimuli help reduce inflammation and can also decrease pain
• Compression. Compression bandages help immobilize the foot and also reduce further swelling of the foot
• Elevation. Elevating the foot above the heart prevents pooling of blood. This significantly reduce swelling therefore also a great way to reduce pain

Other treatments include calf stretches, steroid injections, devices that support the foot like orthoses or shoes that provide cushion and support for the foot.

If the above treatments still do not alleviate pain, then other modalities like ESWT or minimal surgery is required especially for chronic heel pain.