I have a confession. Even though I blog about and know how to prevent injury as a Doctor of Physical Therapy, I still get hurt. For instance, right now I have a nagging pain in my right heel when running and throughout the day. It has been ongoing for a few weeks now.
Also, did you know that heel pain when running is one of the most common injuries?
What Types of Heel Pain are there when Running?
Heel pain is common. It is also a sign of a lot of different things. While it can be caused by something system-wide like Rheumatoid Arthritis or Gout, those are less typically common occurrences with runners.
Heel Pain when running can usually be attributed to one of the following.
1. Plantar Fasciopathy
This can be caused by over-stretching and over-using the plantar fascia of the foot. This fascia runs along the bottom of your foot and into your arch. Typically pain is felt on the inside and bottom of your heel but can sometimes be dead center as well.
More symptoms include painful when taking the first few steps in the morning or after sitting for a while as well as after prolonged running.
2. Heel Spur
Sounds pretty bad huh? A bone spur on your heel. Not really actually.
Almost 40% of the population has heel spurs but the vast majority of those don’t have pain due to them. Typically they are a painful result and formation after chronic plantar fasciopathy.
3. Calcaneal Apophysitis
This is more common in younger athletes. Before or during a new sport being introduced (or more load) or right after a growth spurt.
I’m not going to go into this much. However, just know that it is considered a traction injury from the achilles pulling on the heel bone.
Typically a pain felt on the undersurface of your heel in the middle that worsens with prolonged standing is bursitis. Also, If you are feeling pain at the back of the heel that worsens if you move your foot up and down as well is a sign of bursitis.
There are fluid filled sacs throughout the body to help cushion joints where tendons/ligaments rub on a bone and that is a bursa. What happens is these sacs become inflamed for various reasons and then cause pain.
5. Pump Bump
This is also known as posterior calcaneal exostosis, which is an abnormal bony growth on the back of the heel. Commonly caused by women wearing “pumps”. It is another form of bursitis in younger women wearing this style of shoes.
Pump Bump is characterized by a painful bump on the back of the heel. It is especially painful when wearing shoes that press on this part of the heel.
6. Achilles Tendinopathy
This is a pain where the Achilles tendon attaches to your heel bone. It usually gets worse when you run and is typically followed by soreness, stiffness, and mild swelling.
7. Posterior Tibial Insertional Tendonopathy
The posterior tibial tendon passes behind your medial malleolus (the bony bump on the inside of your ankle). The Posterior Tibial tendon stabilizes the foot and more specifically the arch of your foot. Typically, pain is felt on the inside of the shin and down around the inside of the ankle/foot.
What Causes These Types of Heel Pain When Running?
This and point #2 are very similar. The key difference is that overuse can be from doing the exact same thing over and over again. If you consistently run 60 mile weeks with no variation or no taper weeks you are going to have some overuse injuries happen.
Overuse causes increased load and sustained load to happen on joints and the tissues in the joints which results in injury.
2. The Hangover Effect
Too much, Too soon, Too fast.
Too many miles, too soon and running them too fast. That’s really all there is to say.
Run slower and run fewer miles while gradually building up your weekly mileage.
3. Poor Running Form
Running form is key. There are a lot of different causes of running form issues out there that range from Overstriding to muscle imbalances to just plain laziness when you are running. Getting a professional gait analysis could be beneficial if you are having recurring aches and pains.
Side note on gait analysis. When I refer to them I’m not talking about going to your running store to get “analyzed”. This is with a physical therapist or running coach that has experience in analyzing running forms.
4. Poorly Fitted Shoes
This is not where I tell you to get stabilizing shoes vs neutral shoes etc. This just means to make sure they fit you right. Shoes fit everyone differently.
For example, my sister and I both have a pair of Brooks Levitates (love brooks but neither of us likes the levitates) on her she hates how the heel hits her in the Achilles. Me? I don’t like how tight they are on my midfoot.
Same exact shoe. Very different fit on our feet.
More Information on Heel Pain when Running
If you really want to dive deeper into what causes a lot of these injuries head over to learn the most common training errors that runners do which lead to injury. Another great resource is my 10 secrets for injury prevention.
Also, just because you have heel pain when running it doesn’t mean that running is the cause. It might not be helping the situation but it could be worth it to look a little deeper.
Take my heel pain for example. I’m not 100% convinced it is from running. In fact, I’m pretty sure I’ve traced it back to my shoes that I wear daily in the winter. I typically wear Toms shoes during the spring, summer, and fall to work or tennis shoes. However, in the wintertime, I start to wear my heeled boots most days. When you go from having little to no heel drop on a daily basis to a large heel drop daily it will shorten/increase tightness in the tissues of the foot and ankle and result in pain. Turns out, as I looked back at myself, this is something that I feel to some degree every spring…….
Have you had heel pain before? Do you still struggle with it?
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Dr. Abby Siler, PT, DPT is a Physical Therapist with 10 years of experience in a variety of settings. She has spent the majority of her time treating athletes in orthopedic clinics and worker’s compensation cases. She is a runner herself for the past 15 years and a lifelong athlete. Dr. Abby loves to teach runners how to stay injury free and out of her clinic.