Heel Pain from Running

An introduction to heel pain from running

Heel pain from running is a common concern amongst the many Australians who participate in this popular form of exercise. Whilst it may be a common concern, it is not one that should be ignored. If you are experiencing heel pain from running, you should consult with a qualified sports podiatrist. Not doing so, or ignoring and pushing through pain may cause you inflict further injury, strain, or to develop other complications associated with the condition that is causing you the pain in the first instance.

What conditions can cause heel pain from running?

A number of conditions can cause heel pain from running, including strain and injury of tendons, ligaments or soft tissue structures. These conditions can be caused directly or indirectly, by structural or muscular issues, imbalances in the lower leg and foot, or improper gait pattern or suboptimal biomechanics.

Plantar Fasciitis

Plantar fasciitis is a common cause of heel pain from running. Plantar fasciitis is a condition where the plantar fascia becomes irritated and inflamed due to strain, overuse or injury. The plantar fascia is a thick and strong ligament that runs along the base of the foot, connecting the bottom of the heel to the base of the toes. Overuse from running on hard surfaces, in inappropriate footwear, or with a suboptimal gait pattern are common causes of plantar fasciitis. Patients who suffer from plantar fasciitis often describe stabbing or sharp pain in the base of their heel, which is most commonly felt first thing in the morning as they rise from bed. The pain may subside or disappear with exercise but often returns immediately following.  Sometimes, there is a sudden onset of pain, indicative of micro-trauma, or tearing, of the plantar fascia and this most definitely will cause heel pain from running.

Achilles Tendonitis – another cause of heel pain from running

Patients suffering with Achilles tendonitis experience pain in the back of the ankle, and heel pain from running. Achilles tendonitis describes a condition where the Achilles tendon becomes inflamed, particularly in the area where it attaches to the heel bone. The Achilles tendon is a very strong and fibrous cord that attaches the back of the calf muscles to the heel bone. Some common symptoms and signs of Achilles tendonitis include pain and stiffness in the morning and pain along the back of the heel that worsens with physical activity. In some cases, a bump or lump can be felt in the tendon. Sometimes redness and swelling in the affected area is visible. Achilles tendonitis may be caused by a number of factors, including tight calf muscles that limit the range of motion of the ankle joint, overweight or obesity, and generally unbalanced gait biomechanics.

Bursitis

Bursitis is another common cause of heel pain from running. Bursitis is a condition characterized by the inflammation of the bursae: the small fluid-filled sacs that are located between muscles, tendons or bones. Their job is to reduce friction between adjacent surfaces and structures, to allow movement without injury. Bursitis usually occurs when there is excessive repetitive movement and strain on the bursae. The pain caused by bursitis is usually described as sharp and shooting, and tends to be worse at night.

Heel Spurs

Heel spurs are abnormal bony projections that form on the heels, and while heel spurs are commonly misunderstood as a cause of heel pain from running, in actual fact they do not cause pain. The pain is caused by the inflammation of the surrounding tissues, where there is physical pressure or ‘digging in’ by the heel spur. When they exist, heel spurs are generally found either at the back of the heel, if associated with Achilles tendonitis, or under the bottom of the heel if associated with plantar fasciitis. Heel spurs take many months to develop, and this tends to happen in cases where there constant strain or pressure on the ligaments or tendons they form in a association with.

Diagnosing the cause of heel pain from running

In order to determine the cause of your heel pain from running, your sports podiatrist will carry out a thorough examination. This will include asking some questions about your previous and current running schedule, any other exercise history, and lifestyle questions. A physical examination will be conducted, where your sports podiatrist will palpate the lower leg and foot for abnormalities and pain responses, and comparison to the uninjured foot if applicable.

As part of the diagnostic procedure, your sports podiatrist will also likely conduct a biomechanical assessment on the in-house treadmill. This simple procedure involves placing some removable markers on the patient’s legs, and having them walk or run on a treadmill. A camera records footage of the patient’s movements, and then specialized software is used to play the footage back in slow motion. This allows for a detailed analysis of the patient’s gait pattern and allows the sports podiatrist to determine whether there are any muscular or structural imbalances or gait abnormalities that could be causing the patients heel pain from running.

Treating Heel Pain from Running

Based on the diagnosis of the cause of your heel pain from running, and the findings of the biomechanical assessment, your sports podiatrist will tailor a treatment plan for your circumstances. They will take into consideration your lifestyle, level of physical activity and the severity of the causative condition. There are many varied treatments available for the different causes of heel pain from running. Just a few of the common types of treatments that may be offered include:

• Shockwave therapy. Shock wave therapy is a clinically proven treatment for many of the causes of heel pain from running. Using a hand-held probe, high-frequency sound waves are painlessly directed into the affected area. The treatment offers almost instant pain relief, but also stimulates blood flow and tissue regeneration in the affected tissues.
• Calf stretching. Many of the causes of heel pain from running are aggravated or compounded by tight calf muscles. If this is the case for your condition, your sports podiatrist will be able to recommend a stretching routine for you to perform around 3-5 times per day for a few minutes, over a period of a few weeks. Increasing the flexibility of your calves can help to alleviate pain and prevent the issue from recurring in many cases.
• Strapping and orthotics. Your sports podiatrist can recommend whether these types of treatments are appropriate for your condition. In some cases, custom-made orthotics may be required to support the arch of the foot correctly and control it in such a way that unloads the plantar fascia and allows inflamed ligament to heal.
• Ice packs. Ice helps to reduce heel pain from running by reducing inflammation. It is a safe, easy and convenient treatment. You can safely apply ice packs for up to 20 minutes at a time, throughout the day or immediately following exercise.

Preventing Heel Pain from Running

There are some measures you can take in order to prevent heel pain from running in the first instance. These are also things that you may be advised to do whilst you are rehabilitating your injury with your sports podiatrist’s prescribed treatment plan:

• Change the surface you run on. Aim to run on grass, dirt tracks or synthetic tracks if it is at all possible. You should take advice when running on very hard surfaces such as concrete, as these mediums do not readily absorb pressure, meaning that more energy is reflected back up into your feet as you run, potentially causing trauma.
• Warm up appropriately. Making the time to warm up appropriately and stretch correctly prior to exercising is useful in reducing your heel pain from running. Your sports podiatrist will be able to advise what types of exercises are right for your condition.
• Improve your footstrike pattern when running. Your sports podiatrist will most likely have conducted a biomechanical assessment as part of their diagnostic process for your heel pain from running. With the information obtained, they will be able to tell you whether your footstrike is contributing to your heel pain. If so, they may recommend you work on changing to a more biomechanically sound running pattern.
• Maintain a healthy bodyweight. Trying to maintain a healthy bodyweight with a healthy diet and exercise will help with reducing and preventing heel pain from running. Carrying excess body weight puts undue pressure on your legs, especially on the knee and ankle joints. Maintaining a healthy body weight will not only help you feel better overall, it will assist you in gaining better balance when you exercise.
• Support your feet correctly. In some cases, your sports podiatrist may recommend custom-made orthotic inserts, a particular strapping technique, or possibly a certain type of technical running shoe to help with reducing or preventing heel pain from running. You will be advised by your sports podiatrist if this is something that you could benefit from.

Please consider that the information provided in the article above regarding heel pain from running is for educational purposes only. It is not intended for, nor should it be takes as general medical advice. If you are experiencing heel pain when running, you should consult with a qualified sports podiatrist to discuss your concerns. You can make an appointment by emailing [email protected] or by calling 03 0293883322.

Karl Lockett– sports podiatrist.