How To Stop Running With Heel Pain! Causes, Treatment, Prevention.
If you are running with heel pain, there are some simple steps you can take to reach a resolution and see you pain free!
But before this can happen it is important to understand what might be causing this heel pain with running.
Through this article we will go through the common diagnoses that will cause heel pain during running, and the good news is that there is not many.
Once you have a diagnosis there are simple steps you can take to treat yourself.
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Causes For Heel Pain With Running:
80% of all running injuries are caused by overuse. Most involve various lower limb structures including the knee, hamstring and foot. There are a few injuries, specific to the heel which can be caused with running.
The main causes of heel pain during running are:
- Plantar fasciitis (fasciopathy)
- Achilles tendinopathy
- Other causes (nerve irritation locally or from the back, arthritis, stress fractures)
By far, the two most common heel related injuries are Achilles tendinopathy and Plantar Fasciitis. Other causes are also important to keep in mind, especially if your initial management is not helping resolve the symptoms.
Most of the above injuries can be narrowed down with a few simple questions about your pain.
- Do you experience pins and needles, numbness or burning pain? (Your pain is most likely due to some sort of nerve damage)
- Is your pain in the back of the heel near the Achilles? And do you have a lump in your tendon? (Most likely Achilles Tendinopathy)
-There are certain treatments to avoid with Achilles Tendinopathy.
- Is your pain right on the bottom of your foot? (Probably Plantar Fasciitis)
-Plantar Fasciitis is more likely if your pain hurts for the first couple of steps in the morning, then calms down with further walking.
This is not an exhaustive list of questions; however, they will get you started in the right direction. If your pain does not settle with recommended advice, it is recommended that you seek further medical attention.
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What Imaging Do I Need?
Imaging can help reach a formal diagnosis for your heel pain but is not always needed. This decision will be made by your doctor, however, Achilles Tendinopathy and Plantar Fasciitis can often be diagnosed clinically with no imaging needed.
Your doctor may opt for an x-ray and ultrasound to rule out any of the other not so common causes of heel pain. X-rays will help in determining any bony deformities and bone spurs that can often accompany both Plantar Fasciits and Achilles Tendonitis.
If these are clear a CT scan is best to pick up any stress fractures that may be present. CT scans are very sensitive at picking up small breaks in the bone that a plain X-ray might miss.
MRI’s may be used as a last resort due to its expense. MRI’s are very useful to assess soft tissue damage and can assist in the diagnoses of many neuromas and other unlikely causes of heel pain.
How to treat heel pain with running:
Treatment for heel pain is multi-levelled and it is recommended that you try a few different treatment options to see what helps the most. There are some concepts and strategies that will help incredibly with recovery. The most important is the concept of load management. This will help in the long-term, unlike some techniques such as massage, which can have short-term benefits.
Load Management To Treat Running With Heel Pain
As mentioned earlier, 80% of running injuries are caused by overuse. This means with correct load management; we should see 80% of cases resolve.
Correct load management is extremely useful however it is not often done well. We have put together some steps to walk you through what correct load management would look like.
Step 1 – Relative rest (RICE)
The first step to take is to give your injured heel some relative rest. This means cutting back your running distance and speed until you can achieve the distance pain-free.
Relative rest is important as it differs from completely resting the injury. Most recent research would suggest excluding a fracture, it is best to move an injury within pain limits to help with swelling and increase circulation.
You may need to halve or quarter the total running you were doing.
If the injury is very acute you may need to take a break for a week or so. However, it is important to try and maintain some level of normalcy, without putting too much stress on the injury.
Icing, compression, and elevation will also be important if the injury is very acute. Normal recommendations are to ice 20 minutes on, 20 minutes off for a couple of days.
Step 2 – Find the source of symptoms
Now you have a baseline level of activity, it is helpful if you can pinpoint exactly when the pain started. This is not always possible so don’t worry if you can’t, but think through the days leading up to your injury:
Was there an increase in running distance or pace?
Did you just trial new shoes?
Did the surface you were running on change?
All the above and more can affect the load going through your foot and ankle during running. If you can pinpoint something that started your pain, this is where you would start in treatment.
For exampled if you changed running surfaces, it may be beneficial to go back to the old surfaces if possible, until you can build up the heel to handle the new surface.
Step 3 – Slowly progress your loading
Now is the time to slowly progress from relative rest. If you had to stop altogether, it is important that you begin slowly.
Although the area of running rehabilitation has been extensively researched, there is still no clear advice on how to progress post injury.
The most recommended advice is to progress approximately 10% per week until you have reached your pre-injury standard. Further down we talk more about returning to running and include a running program that can help with getting you back to running.
Footwear and modifications
Having the right shoes is extremely important as it has a direct impact on the loading of the structures around the foot.
For example, it has been shown that runners INCREASE the amount of load on the Achilles tendon. This is because people stride longer and have more heel strike with the added support.
We also know that heel lifts over 1 cm reduce the load on your Achilles tendon. Other research shows that if the Achilles is flared up that a walking boot can help initially to reduce load on the tendon.
Although there is no perfect shoe, it is worth trialling heel cushioning or heel wedges to see if this reduces your heel pain with running. These are cheap and easy to get, and sometimes they can make a big difference.
It’s also recommended that if your footwear is hurting you trial different shoes for your run. If you usually wear very cushioned shoe, trial a more minimalist shoe type. This encourages you to forefoot strike which will change the load in your lower limb.
There has been research suggesting training in shoes over 6 months old is a risk fracture for stress fractures.
Taping is another alternative that can help reduce some load on the foot, helping to alleviate heel pain with running. We have created a video here which takes you through some common taping techniques used for Achilles Tendinopathy, but these will also help Plantar Fascia pain.
Returning to Running After Injury – Your Complete Guide
Having a plan for returning to running is hugely important. This topic was briefly covered further up under how to treat your heel pain, but this section will go further.
You do not need to be pain free to return to running.
Let your body and the injury guide you as you slowly increase your running. Some minor pain during a run is alright. However, if you notice an increase in pain one or two hours later, this means you have pushed yourself too much on the last run.
If you followed the principles of load management, you should hopefully still be running some distance – it may be much less than what your normal is.
From this point we would recommend a 10% increase weekly, or 500m increase (whichever is more) for the first 4 weeks. This is a conservative guide, and many people may get away with progressing faster.
After this point in time we recommend progressing by 20% weekly usually having one longer run and two or three that are shorter in duration. This will help the heel to adapt, whilst not overloading it too quickly.
You will find if you have had the injury for a long period of time, and this has limited your running, it will take longer to progress back to where you were.
Below is a running guide to help with your running progression. If you need a HD copy of this guide click here.
Prevention Of Running With Heel Pain
There are many things you can do to prevent injuries during running. If you have just recovered from heel pain with running, then some of the below strategies should be second nature by now.
Load Management – Progress Slowly
This term is so important is features in the treatment and prevention section. Every muscle, tendon and joint have a certain capacity to bear load. If it is taken beyond that capacity the result will be an injury.
Structures in your body can adapt to load, but this takes time. Muscles take weeks to adapt, tendons take months, due to low blood supply. This explains why Plantar Fasciopathy or Achilles Tendinopathy are so much more prevalent than calf tears.
If you used to run a lot and are getting into it, make sure you take at least six weeks to build up to where you used to be. This will help reduce the strain on your foot.
Even if you run regularly, a sudden increase in load might look like doing the same usual road run on soft sand at the beach. Or increasing your run by 10km in the space of one week.
Change shoes regularly
As mentioned previously one risk factor for stress fractures is training in the same shoe for more than six months.
Make sure you keep an eye on wear in your shoes and change them regularly. This will help prevent injury and avoid too much wearing of the soles.
The emphasis has been for a long time on stretching. Unfortunately, there is no good evidence to suggest that stretching prevents injury.
We do know that strength training allows greater tendon adaptation, and this is why we suggest strength training over stretching for injury prevention.
One simple strength exercise is the calf raise.
You shouldn’t have to endure running with heel pain in the long term. There are many strategies to alleviate the load placed on the tendons and bones around the heel.
If you apply the principles mentioned in the article you should be able to get on top of your heel pain.
Gardner LI, Dziados JE, Jones BH, et al. Prevention of lower extremity stress fractures: a controlled trial of shock absorbent insole. Am J Public Health. 1988; 78: 1563–7
Liem, Brian C. MD1; Truswell, Hallie J. BA2; Harrast, Mark A. MD1 Rehabilitation and Return to Running After Lower Limb Stress Fractures, Current Sports Medicine Reports: May/June 2013 – Volume 12 – Issue 3 – p 200-207 doi: 10.1249/JSR.0b013e3182913cbe
Lopes AD, Hespanhol Júnior LC, Yeung SS, Costa LO. What are the main running-related musculoskeletal injuries? A systematic review. Sports Med. 2012;42(10):891-905.