Heel clicking is a specific gait deviation defined by the audible and physical contact between the medial sides of the heels or ankles during walking. This phenomenon indicates that the legs lack the necessary lateral clearance during the normal walking cycle. It signals an underlying biomechanical issue that forces the lower limbs into an unnaturally narrow pathway.
Understanding Gait Deviation
Normal walking involves the gait cycle, divided into the stance phase (foot on the ground) and the swing phase (foot lifted and moving forward). For the body to move efficiently, the swinging leg must clear the ground and the stationary leg with sufficient lateral space. Heel clicking typically occurs during the mid-swing or late-swing phase as the leg advances past the standing leg, requiring the foot to track a path wide enough to avoid contact.
The collision results from the foot or entire leg swinging too close to the body’s midline, a pattern known as reduced step width. The limb exhibits excessive adduction or inward movement instead of maintaining lateral distance. This narrow tracking forces the medial heel or ankle of the advancing leg to strike the standing leg, creating an audible sound and localized friction.
Anatomical and Muscular Causes
The root causes of heel clicking stem from structural alignment issues and muscular control deficits that force the legs into a narrow gait. Excessive foot pronation (flat feet) is a common structural contributor, where the arch collapses too much during the stance phase. This over-pronation causes the lower leg, or tibia, to rotate internally, which brings the entire limb closer to the midline and reduces swing phase clearance.
Another structural factor is genu valgum (knock-knees), where the knees angle inward toward each other. This positioning mechanically forces the lower legs and feet into a closer path. Additionally, a functional or anatomical leg length discrepancy can trigger compensatory movements, causing the body to shift and rotate, which introduces the inward swing that leads to striking.
Weakness in specific hip muscles, particularly the hip abductors and external rotators like the gluteus medius, is a major muscular cause. These muscles stabilize the pelvis and prevent the femur from rotating internally during the weight-bearing phase. When weak, the pelvis can drop, and the femur rotates inward, driving the foot closer to the center of the walking path and increasing the risk of collision.
Physical Consequences of Heel Clicking
The repeated physical impact of heel clicking leads to localized issues on the medial side of the ankle and heel. Friction and microtrauma from collisions cause skin irritation, including chafing, redness, and blisters. Constant striking can also lead to chronic bruising or thickening of the skin and underlying soft tissue at the point of contact.
The underlying gait deviation places abnormal stress on the entire kinetic chain beyond the immediate site of impact. The rotational forces required to compensate for the narrow walking base increase strain on the knee and hip joints. This compensatory movement pattern, driven by internal rotation, can contribute to issues like patellofemoral joint stress or chronic hip discomfort, as the joints are repeatedly subjected to forces outside of their optimal alignment.
Strategies for Correction and Prevention
Correction strategies focus on addressing biomechanical faults, particularly excessive pronation and lack of hip stability. For issues stemming from foot mechanics, custom or over-the-counter orthotics are highly effective by controlling the rate and extent of pronation. These shoe inserts provide support to the arch, which helps prevent the excessive internal rotation of the lower leg.
Footwear choices also play a supportive role, with stability shoes offering features like a firm medial post to resist the foot’s tendency to roll inward. If a leg length discrepancy is identified, a simple heel lift placed in the shoe of the shorter leg can restore better pelvic symmetry and reduce compensatory gait patterns.
Physical therapy interventions aim to strengthen the muscles responsible for lateral stability and external rotation. Exercises specifically targeting the gluteus medius are important, as increasing the strength of this muscle helps stabilize the pelvis and control femoral rotation. Gait retraining is also employed, allowing a person to consciously practice a wider, more controlled step pattern that ensures sufficient lateral clearance during the swing phase.