HEEL PAIN AFTER RUNNING: POSSIBLE EXPLANATIONS & WHAT TO DO

Runners are generally familiar with the aches and pains associated with this high-impact form of exercise. Muscle pain in the legs or joint pain in the knees or hips are fairly common by-products of a long run. 

Pain in the feet, particularly the heels, can be common too. But understanding the cause of heel pain after running may be less easy. That’s because the human foot is a complex structure composed of many bones (26, to be exact), 33 joints, muscles, tendons, 100 ligaments, and nerves. 

Think about it: Our feet carry our weight every day. And when we run, we ask so much more of them. No wonder, then, they sometimes let us know we’ve been hard on them!

What to do if you experience heel pain after running? It depends…

What you should do about heel pain depends on its familiarity and severity. But following the RICE rule is always a good default step for treating heel pain. For those not familiar, RICE therapy breaks down as:

• Rest: Rest is important for allowing the injured area to heal properly and to immediately relieve pain. This means taking a break from activities that aggravate the injury (such as running or jumping) and avoiding putting weight or pressure on the affected area.
• Ice: Applying an ice pack to the affected area can help reduce pain, swelling, and inflammation. Ice should be applied for 20-30 minutes at a time, several times a day, and should be wrapped in a towel or cloth to prevent direct skin contact.
• Compression: Wrapping the affected area in a compression bandage or brace can help reduce swelling and provide support for the injured tissue. Compression should be firm but not too tight and should be adjusted as needed to ensure comfort and proper circulation.
• Elevation: Elevating the affected area above the level of the heart can help reduce swelling and promote drainage of fluids from the injury. This can be done by propping up the affected limb with pillows or cushions.

While rest is recommended, you will still have to move around. Wearing shoes is important here as going barefoot may exacerbate the pain. It might be a good time to check out those Recovery Shoes you’ve been thinking about.

However, if the pain is sharp and sudden/unfamiliar or it lasts for many days, you can’t go wrong making a doctor’s appointment. Because the foot is so complex, there can be many explanations of what’s causing heel pain (we’ll go over some of the most common concerns next.) And the tests required to identify the cause can range from a physical examination/palpation to an X-ray, MRI, or Ultrasound. 

If you’re a serious runner, you want to take care of your feet, so don’t depend on Dr. Google to diagnose a foot pain problem, leave it to the medical professionals to help both prevent heel pain and treat heel pain.

The most common culprit: Plantar fasciitis (inflammation of the plantar fascia)

Depending on your medical history and athletic background, you may already be familiar with some of the common explanations for heel pain after running. Plantar fasciitis is usually top of the list.

Plantar fasciitis is a common condition that causes pain in the heel or arch of the foot. It occurs when the plantar fascia, a thick ligament that runs along the bottom of the foot, becomes inflamed or irritated. The plantar fascia connects the heel bone to the toes and helps to support the arch of the foot (think of it like a shock absorber.)

Plantar fasciitis is typically characterized by pain that is worst in the morning or after periods of inactivity and improves with movement. The pain is often described as a stabbing or burning sensation in the heel or arch of the foot. Certain movements, like climbing stairs, can be more difficult with this condition.

Risk factors for plantar fasciitis include:

• You guessed it: Running
• Being overweight (it is generally advised to maintain a healthy weight)
• People who stand or walk for long periods
• Those who have fallen arches (flat feet) or very high arches
• Wearing inadequate running shoes

Heel spurs

Heel spurs are bony growths that can develop on the underside of the heel bone that may cause heel pain after running. Heel spurs are often associated with plantar fasciitis.

In runners, heel spurs are most commonly caused by overuse and repetitive stress on the plantar fascia and heel bone. This can occur as a result of running long distances, running on hard surfaces, or wearing running shoes that do not provide adequate support and cushioning for the feet.

Other causes of heel pain in runners

Tendinopathy or tendonitis

Tendons are fibrous cords that attach muscles to bones, and they play an important role in supporting the foot and ankle during movement. When those tendons are damaged or degenerate, pain occurs. While tendinopathy and tendonitis are sometimes used interchangeably, they are different:

• Tendinopathy is a degeneration of the collagen protein that forms the tendon 
• Tendonitis is inflammation of the tendon

These conditions are more common in athletes and people who engage in activities that put stress on the tendons, such as running or jumping.

Achilles Tendinopathy

The Achilles tendon, which is the largest tendon in the body, connects the calf muscles to the heel bone. Achilles tendinopathy can be:

• Insertional Achilles tendinopathy: This affects the lower part of the Achilles tendon where it attaches to the heel bone (calcaneus). It may be caused by repetitive stress, degeneration, or inflammation in the tendon, or by a bone spur on the calcaneus.
• Non-insertional Achilles tendinopathy: This occurs in the middle part of the tendon, away from the attachment to the heel bone. It is often caused by overuse or repetitive stress and may be associated with aging, poor blood supply, or a sudden increase in activity level.

The pain of tendinopathy or tendonitis may worsen with activity and improve with rest. As such, following the aforementioned RICE protocol is advised as a direct step. Non-steroidal anti-inflammatory drugs (NSAIDs) like Aspirin or Advil may also be used to manage the pain.

Bone stress fractures

Bone stress fractures are a common overuse injury in the feet, especially in athletes and runners. Stress fractures occur when there is repeated micro-trauma to a bone, leading to tiny cracks or fissures in the bone. 

Symptoms of a stress fracture in the heel may include pain, swelling, and tenderness in the back or bottom of the foot, as well as difficulty walking or putting weight on the affected foot. It is important to seek prompt medical attention for a stress fracture.

Common stress fractures that may cause heel pain include: 

• Calcaneal stress fracture
• Navicular stress fracture
• Medial Malleolus stress fracture

Ways of preventing stress fractures in the feet include gradually increasing the intensity and duration of exercise, wearing appropriate footwear, and maintaining good overall bone health through adequate nutrition and calcium and vitamin D intake. 

The treatment for stress fractures in the heel and foot may depend on the severity of the injury. It typically involves the following RICE therapy plus:

• Crutches, night splints, or a walking boot may be recommended to reduce weight-bearing on the heel and foot.
• Pain management
• Physical therapy

It is important to consult with a healthcare professional for proper diagnosis and treatment of any injury, including stress fractures in the feet. In some cases, more aggressive treatment may be necessary, such as immobilization with a cast or surgery.

Nerve irritation

Several nerves pass through or near the heel, including the tibial nerve, the sural nerve, and the medial and lateral plantar nerves, which can be affected by injury, compression, or inflammation.

• Plantar fasciitis: We already covered plantar fasciitis, but the inflamed tissue can compress the nerves in the area, leading to heel pain, tingling, and numbness in the heel and bottom of the foot.
• Tarsal tunnel syndrome: This occurs when the tibial nerve, which runs through a narrow tunnel on the inside of the ankle, becomes compressed or irritated. 
• Baxter's nerve entrapment: This is a rare condition that occurs when the lateral plantar nerve, which runs along the inside of the heel, becomes compressed or trapped. This can cause pain, numbness, and tingling in the heel, as well as weakness and muscle wasting in severe cases.

Arthritis

Arthritis is a condition that causes inflammation and degeneration of joints throughout the body, including the joints in the feet. In particular, the heel can be affected by two types of arthritis: osteoarthritis and rheumatoid arthritis.

Arthritis in the heel can significantly impact a person's ability to walk, stand, and perform daily activities. Treatment to relieve heel pain caused by arthritis may include medications to manage pain and inflammation, physical therapy to improve joint mobility and strength, and in severe cases, surgery to replace or repair damaged joints.

In children: Sever’s disease

Sever's disease, also known as calcaneal apophysitis, is not actually a disease (this name just appears to have stuck.) But it is a common cause of heel pain in children and adolescents, typically between the ages of 8 and 14 years old. It occurs when the growth plate in the heel bone, known as the calcaneus, becomes inflamed due to repetitive stress and overuse.

The condition is often associated with physical activities that involve running, jumping, and other high-impact movements that put stress on the heels. Children who are active in sports, especially those that involve running and jumping, are at increased risk of developing Sever's disease.