Heel Pain After Running: 5 Possible Causes

Many people take up running as a form of exercise and fitness. According to Sports Australia, around 4.4 million Australians either jog or run.[1] While it has many benefits, such as improving heart health, strengthening the body and helping mental wellbeing, it can be stressful on the body. Physiotherapists routinely see patients with heel pain after running.

According to the Australian Family Physician, around 900,000 Australians experience heel pain.[2] There are several reasons why running can cause heel pain.The earlier causes get discovered, the better the outcome and the higher likelihood you can start running without discomfort. Additionally, there are also treatment and prevention strategies that are readily available to help sustain your fitness.

This article will discuss several reasons why you may be getting heel pain after running and what you can do about it.

Causes of Heel Pain After Running

According to Australian researchers from La Trobe University, there are several causes of heel pain after running.[3] Two of the most relevant causes of heel pain are

1. being overweight in inactive people, and

2. having spurs (bony growths) on the heel(s)

While not as definite, other causes may also include:[3]

• Recent weight gain in inactive individuals

• Ankle stiffness

• Older age

• Having a stiff big toe

• Standing for long periods

• Foot posture when still and/or moving.

Risk Factors for developing Heel Pain after Running

1. Plantar Fasciitis

Plantar fasciitis is a condition where the plantar fascia begins to break down, tear and thicken. The plantar fascia is a long piece of connective tissue that starts from the heel and spreads out along the foot to the base of the toes. As a result, it can lead to heel pain that extends along the arches. Its role is to support the arches in the foot and absorb shock whilst running or walking.

According to the Australian Family Physician, around 60,000 Australians seek medical treatment for plantar fasciitis.[4] It usually occurs overtime through repetitive impact onto the foot. Examples of such activities include running, jogging and long-distance walking. Researchers have also noted it is the most common condition for heel pain on the sole of the foot.[4]

2. Achilles tendinopathy

Achilles tendinopathy is a condition where the Achilles tendon begins to wear down and swell. The Achilles tendon is a piece of connective tissue which connects the calf muscles to the calcaneus (heel bone). As a result, many people will report heel pain at the back of the ankle. Its role is to help the calf move the foot and absorb impact while running or walking.

Achilles tendon injuries are typically seen in active individuals. For instance, approximately 21.5% of Australian Football League players developed this type of injury.[5] It is one of the most common reasons for heel pain above the sole. Women with heel spurs are at a higher risk of developing Achilles tendinopathy.[6]

3. Stress Fracture of the Heel (Calcaneal Stress Fracture)

Stress fractures describe cracks and breaks of bones that occur with repetitive impact. Unlike fractures that occur with direct impact, activities such as running and hopping create constant shock through the calcaneus (heel bone). Heel pain when standing/walking and swelling under the heel bone can occur with calcaneal stress fractures.

Calcaneal stress fractures are more likely to occur with those with osteoporosis, regular alcohol use and underweight individuals. Runners who suddenly increase their training volume are also at a high risk of developing stress fractures.

4. Arthritis

Arthritis is a condition which occurs when the cartilage between the joint(s) begins to become inflamed and breakdown. According to the Australian Institute of Health and Welfare, more than 2.2 million Australians are diagnosed with arthritis.[7] Arthritis can lead to joint pain, stiffness and swelling.

Those with specific types of arthritis which cause inflammation throughout the body[8] (e.g. psoriatic arthritis, rheumatoid arthritis) are at high risks of developing heel pain. However, heel pain develops indirectly from these types of arthritis. Instead of the joints being affected, the increased inflammation throughout the body increases the chances of developing heel pain conditions, such as Achilles tendinopathy and plantar fasciitis.

5. Sever's Disease (Calcaneal apophysitis)

Sever’s disease is a condition that commonly occurs in children between the ages of 8-14 years where growth is rapid.[9] As a result, children are likely to develop injuries near the growth plates (which are areas found between the tendon and the bone). This condition occurs because the growth of the tendon and bone do not match.

Children with Sever’s disease develop heel pain which causes them to limp. This occurs because of inflammation around the growth plate between the Achilles tendon and calcaneus (heel bone). Those who are regularly active and run are more likely to develop symptoms.

Treatment of Heel Pain after running

Heel pain can be a bothersome problem for runners. Fortunately, there are treatments available that can help ease symptoms quicker.

1. Rest

A large reason why people develop heel pain when running is due to the repetitive and high impact nature of running.[10] Pain often shows that the structures (e.g. ligaments, bones, tendon) of the foot are overworking. These structures often need a period of rest or reduced amount of training to recover.

2. Pain Relief

There are certain treatments that can be used to reduce heel pain and inflammation. Examples include:

• Heat and ice therapy

• Pain medications (e.g. paracetamol)

• Non-steroidal anti-inflammatory drugs (NSAIDS) (e.g. ibuprofen)

• Anti-inflammatory gels (e.g. Voltaren gel).

Before considering these pain relief medications, it would be recommended to consult a relevant health professional, such as a doctor, podiatrist or physiotherapist.

3. Using Orthotics or Insoles

Orthotics and shoe insoles are types of support that can be placed between the shoe and foot to reduce heel pain. They help provide the foot with additional cushioning, shock absorption and better alignment to reduce stress and strain onto the heel.

Insoles can be purchased at your local chemist or shopping centre. On the other hand, orthotics may require input from a podiatrist or orthotists to make sure that it provides the ideal support. Wearing orthotics has been shown to provide short-term pain relief in people with heel pain.[11]

Prevention of Heel Pain

Prevention is better than cure, and heel pain is no exception. Below are some strategies that can be started today to avoid seeking treatment.

Fixing Your Training Patterns

A major reason why runners experience heel pain is because of their training patterns. Factors, such as the volume of distance, running surface and periods of rest can be adjusted to help with recovery. Inactive individuals who have started running should be particularly careful of heel pain and slowly increase their training patterns(e.g. speed, distance).[3]

Choosing Appropriate Footwear

Choosing comfortable running footwear is important to ensure that the feet have enough support to prevent heel pain.[12] Selecting footwear that is comfortable for your feet should be one of the main criteria for purchasing a pair of shoes. Do not get caught up in marketing or whatever famous athletes wear, always try a pair of shoes before purchasing.

Exercises

Specific exercises to help address any imbalances around the foot or ankle should be considered. Common issues, such as stiff ankles, tight calves and weak leg muscles are just some factors related to heel pain.[3] Exercises, such as strengthening and stretching can help fix up these areas to help prevent the development of heel pain. Consider consulting a physiotherapist so that you are aware of any imbalances and which exercises would be the most appropriate.

What Next?

If you are experiencing heel pain while running, we recommend that you consult your local physiotherapist. They will be able to perform a physical assessment to help you determine any conditions and/or causes for your discomfort. Imaging investigations (e.g. MRI, CT scans) may also be required for a more accurate diagnosis. Additionally, you will be provided with a tailored management plan with exercise, lifestyle strategies and other treatments to get you back running comfortably.

Depending on your circumstances, your physiotherapist will also involve other relevant healthcare professionals, such as podiatrists, doctors, orthotists and specialists. Healthcare professionals work collaboratively to deliver the best outcomes for those with heel pain.

Key takeaways

Running is one of Australia’s most popular sports and exercises. However, the constant impact through the foot can lead to heel pain.

Some people are more at risk of experiencing heel pain, such as having stiff ankles or being overweight. Whereas, others will train in a way which increases the chance of injury, such as rapid increases in running distance or speed.

Ongoing heel pain may be a sign of an injury, such as Achilles tendinopathy and even stress fractures. Early diagnosis and treatment from a healthcare professional (e.g. physiotherapist, doctor, podiatrist) allows for a faster recovery and return to running.

However, there are several strategies for preventing heel pain from running, including exercise, footwear and changing training methods.