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Questioning The Use Of Negative Heel Stretching

A vital part of treatment for Achilles tendonitis and plantar fasciitis is stretching of these structures. There is a very powerful Achilles and plantar fascia stretch that is often used in an eccentric Achilles strengthening program. This stretch involves the person lowering one or both heels off of the edge of a stair or curb. Although patients have said this stretch feels great, this negative heel stretch or negative heel position can actually be damaging to the tendon and/or fascia.

I do not recommend this stretch at all but I realize many practitioners out there do. Think about the logic of the maneuver. With the heel in a vulnerable, unprotected position, one lowers that heel into a position that it is not used to being in. If you think about heel position in life activities (functional activities), our heels are either at the same height as the front of the foot or elevated above the front of the foot as in a normal heeled shoe. Negative heel stretching places the heels in an uncustomary and often stressful position. 

Almost one’s full body weight goes into the Achilles attachment and that of the plantar fascia into the calcaneus. One “Golden Rule of Foot” for me is to avoid negative heel stretching. I implore patients to not take a chance on overloading the weakened areas, leading to even greater damage to the tissues. My best examples of this are patients with Achilles tendonitis or plantar fasciitis who improve in rehabilitation, only to have their problem flare up when introducing “heel drop” exercises. The first patient I treated in private practice with bilateral Achilles tendonitis ruptured one of his Achilles tendons doing negative heel exercises. 

There are many other ways to stretch these areas. It is important to be very cautious even with no prior pain history in these areas. Eccentric Achilles training can still involve lifting the heel off the ground as much as possible and slowly lowering the heel to a stable level ground position. This is still eccentric.

I strongly encourage you to critically evaluate the recommendations you give patients, even if you have done so for years. We all want our patients to improve but let us consider the mechanics of these exercises, the benefits and potential pitfalls thereof.

Dr. Blake is in practice at the Center for Sports Medicine, which is affiliated with St. Francis Memorial Hospital in San Francisco. He is a past president of the American Academy of Podiatric Sports Medicine. Dr. Blake is the author of the recently published book, “The Inverted Orthotic Technique: A Process Of Foot Stabilization For Pronated Feet,” which is available at www.bookbaby.com

Editor’s note: This blog originally appeared at www.drblakeshealingsole.com. It is adapted with permission from the author.

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