They don't call it "pounding the pavement" for nothing. Running puts a lot of stress and strain on the body — especially on the feet, which are a common source of discomfort for runners. Getting to the bottom of your foot pain is sometimes as easy as noticing where you feel the sensation most. Heel pain after running is often a sign of plantar fasciitis, heel spurs or Achilles tendinitis.
Plantar fasciitis, bone spurs and Achilles tendinitis could be why your heel hurts after running.
Is It Plantar Fasciitis?
If you feel stabbing pain in your heel and possibly the arch of your foot, plantar fasciitis is a likely cause. According to Mayo Clinic, this condition, which is caused by inflammation of the tendon that runs from the heel to the toes, tends to occur in runners.
Usually, the plantar fascia's purpose is to absorb shock and support the arch of the foot. However, excessive stress and strain on the tendon causes micro-tears, and this repetitive tearing can cause inflammation and irritation.
Heel pain is the main symptom of plantar fasciitis. The pain is often present after your run, not while you are running. The pain may be worst first thing in the morning when you rise from bed and take your first few steps.
Risk Factors for Plantar Fasciitis
Simply running is a risk factor for plantar fasciitis, but there is a cumulative effect, and long-distance runners tend to be at higher risk for the condition. Runners who overtrain, do too much hill training or speedwork and don't sufficiently stretch their calf muscles are at greater risk, as sports medicine physician Jordan Metzl, M.D., told Runner's World. Tight calf muscles can pull on the plantar fascia, leading to pain.
Your foot mechanics also play a role. If you are flat-footed, have high arches or an abnormal walking pattern, these can all affect weight distribution on your foot and increase stress on the plantar fascia. Running with these poor mechanics worsens the problem.
Other factors include age, with those between 40 and 60 having the highest risk. Being overweight and spending long periods of time standing on your feet may contribute to this condition too.
Treatment for Plantar Fasciitis
One of the major barriers to proper treatment of plantar fasciitis in runners is that they often don't want to take time off from running. The longer plantar fasciitis is left untreated, the more difficult it is to resolve. Therefore, it's important not to keep running when the fascia is inflamed.
Ice and Stretching
During this time, icing your foot will further reduce pain and inflammation. Either place your heel on an ice pack, or stick your foot in an ice bath. Do this for 10 or 20 minutes at a time on the hour or as often as you can throughout the day.
Stretching is also a key part of treatment. Stretch the calf muscles for five minutes three times a day with a simple wall stretch. Keep the back leg straight to stretch the gastrocnemius muscle; then bend the back leg slightly to stretch the soleus muscle. You can also stretch the plantar fascia by flexing your ankle and pulling your toes toward you.
Prevention of Plantar Fasciitis
Once plantar fasciitis is under control, you can take steps to reduce the risk of recurrence. Dr. Metzl recommends running on soft surfaces, such as trails and grass, and being conservative when increasing your mileage and intensity.
You should also wear proper footwear for your foot type and gait both when you are running and when you aren't running. Last, stretch your calf muscles regularly, and do strengthening exercises for the midfoot such as toe curling and picking up a small towel off the floor with your toes.
It Could Be Heel Spurs
Heel spurs are closely related to plantar fasciitis. A heel spur is a bony outgrowth on the underside of the heel that can cause heel pain when it irritates the surrounding tissue and fascia.
But heel spurs don't often cause pain. In fact, according to Cleveland Clinic, 10 percent of people have heel spurs, but only 5 percent of those with heel spurs experience pain.
More often than not, people mistakenly think they have a heel spur when they actually have plantar fasciitis. Still, if you've ruled out plantar fasciitis, a heel spur could be causing the irritation that is making your heel hurt after running.
What Causes Heel Spurs?
The cause and treatment of heel spurs is similar to that of plantar fasciitis. Heel spurs are common in runners, according to WebMD, and result from stress and strain on foot muscles and ligaments, stretching of the plantar fascia and repetitive tearing of the membrane covering the heel bone.
Just like plantar fasciitis, your foot type and gait abnormalities, as well as age, poor-fitting footwear, obesity (or just being overweight) and spending long periods of time standing can cause heel spurs.
Treatment and prevention are also the same. Rest, ice, and stretching and strengthening exercises, as well as proper footwear, can help reduce inflammation and prevent flare-ups.
For both plantar fasciitis and heel spurs, if the pain persists for more than a few weeks, see your doctor. He may take X-rays to further examine your foot and rule out other causes of pain such as a fracture. He can also assess whether other treatments, such as cortisone injections, special orthotics or night splints, will help relieve your condition.
Achilles Tendinitis — A Potential Cause
The repetitive nature of running leaves runners vulnerable to overuse injuries like Achilles tendinitis. The largest tendon in the body, the Achilles tendon, is located at the back of the ankle and connects the calf muscles to the heel bone. Although this tendon can withstand a lot of stress, it's susceptible to overuse and degeneration.
The irritation and inflammation that occurs with Achilles tendinitis causes pain in the back of the ankle and behind the heel. You may feel a lot of pain and stiffness in the tendon in the morning and during running. According to OrthoInfo, the pain may be particularly severe the day after a run. Thickening of the tendon and persistent swelling are other common symptoms.
Causes of Achilles Tendinitis
Achilles tendinitis is common in runners, especially when the duration or intensity of their runs increases suddenly. For example, if you increase the distance of your runs by a few miles without allowing your muscles to adapt to the added stress, you are more likely to experience Achilles tendinitis.
Tight calf muscles are also a risk factor, and having tight calf muscles and suddenly starting an intense running program can increase the risk, according to OrthoInfo.
A bone spur where the Achilles attaches to the heel bone can cause tendinitis as well.
Achilles Tendinitis Treatment and Prevention
Treatment for Achilles tendinitis is similar to that for heel spurs and plantar fasciitis. Rest the foot, apply ice and do strengthening and stretching exercises for the calf muscles. In most cases, this conservative treatment can resolve the pain; however, if the pain persists, visit your doctor.
The most important part of prevention is to gradually increase the duration and intensity of your runs. Continue to do stretching and strengthening exercises to further reduce the risk of another flare-up.
- Mayo Clinic: Plantar Fasciitis
- Runner's World: How to Know If You Have Plantar Fasciitis—And What to Do About It
- PainScience.com: Save Yourself From Plantar Fasciitis!
- Washington University Physicians: Plantar Fasciitis Exercises
- Cleveland Clinic: Think You Have a Heel Spur? It’s Probably Plantar Fasciitis
- WebMD: Heel Spurs and Plantar Fasciitis
- OrthoInfo: Achilles Tendinitis
- Kirby Podiatry: Gastrocnemius and Soleus Muscle Stretching Exercises