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Ankle Bone or Joint Injury

Heel Pain After Running

Minute Read


Posted 1 year ago


Last updated: 03/12/2022


by James McCormack

What causes heel pain after running?

Heal pain from running is one of a runner’s most common types of injury. Heel pain injuries are often a result of overuse, a biomechanical overload or a sudden change in activity levels. Heel pain after running can be debilitating; if the correct management isn’t taken, it can lead to structural damage. Numerous conditions can cause heel pain after running. We will try to cover most of them in this article.

Medial Heel Pain Running: Plantar Fasciitis

The Plantar Fascia is a band of tissue that runs from the heel bone to the forefoot. It is a non-contractile tissue whose primary purpose is to provide stability to the foot. If the Plantar Fascia becomes overloaded, it can become inflamed, leading to Plantar Fasciitis.

Plantar fasciitis is mostly felt on the inside of the heel but is can spread along the arch of the foot. It is commonly painful at the start of a run, eases during and is worse after. 

Strengthening exercises under the guidance of a Physical Therapist are the best form of treatment for Plantar Fasciitis.

Related Article: How to cure Plantar Fasciitis in one week

Heel Fat Pad Syndrome

On the heel bone’s underside is a Heel Fat Pad that acts as a cushion for the calcaneus—excess pressure on this fat pad when running can cause swelling and pain in the heel.

The heel fat pain becomes sensitive to the touch. When it deteriorates, it can be painful with every step during and after running. The pain is most often in the central aspect of the plantar surface of the heel bone and if the symptoms are terrible, it can be painful to walk.

Related Article: Bruised Heel: Symptoms and Treatment

Lateral Heel Pain

Lateral heel pain refers to pain on the outer side of the bottom of the heel bone. This is often a result of compensation mechanisms from having Plantar Fasciitis. As Plantar Fasciitis provides pain on the inner side of the heel bone, when running you may subconsciously shift your weight onto the lateral heel.

This additional force that the lateral heel is not accustomed to can result in pain. Other causes can be foot deformity or poor biomechanics that lead to excess pressure on the lateral heel bone.

Calcaneus Stress Fracture

Calcaneus stress fractures are commonly misdiagnosed as Insertional Achilles Tendonitis. The repetitive force from running can cause micro-trauma to the calcaneus (heel bone) leading to a calcaneus stress fracture. Diagnosis can be established through an x-ray in the early stages but if there is a lot of pain and swelling but an x-ray result is normal, then an MRI may be required.

Treatment for a calcaneus stress fracture typically involves 4-6 weeks in an air cast boot followed by 4-6 weeks of Physical Therapy.

Related Article: Calcaneus Fracture: FAQs

Back of Heel Pain Running

Insertional Achilles Tendonitis

The Achilles tendon is one of the largest tendons in the body. It attaches the calf muscle group to the back of the heel. If the area of the Achilles tendon closest to where it attaches to the heel bone is painful and inflamed, called Insertional Achilles Tendonitis.

The early stages of this condition can cause back of heel pain while running. Pain levels may improve after warming up but return in the 24 hours after a run. First thing in the morning is often particularly painful and stiff.

If someone continues to run without the correct management, Insertional Achilles Tendonitis can cause back of heel pain throughout the whole run. It is treated with a strength training program under the guidance of a Physical Therapist.

Related Article: Symptoms and Treatment for Insertional Achilles Tendonitis

Subcutaneus & Retrocalcaneal Bursitis

A bursa is a sac full of fluid that acts as a cushion between a bone and a tendon. The retrocalcaneal bursa sits on the back of the heel bone. If it becomes overused or experiences trauma such as a kick or other direct impact, it can become painful and swollen. If this occurs on the back of the heel bone, it is referred to as Retrocalcaneal Bursitis.

When running, if the bursa is overloaded through a sudden change in running volume or speed, running shoes are too tight or there is a biomechanical overload, this can lead to retrocalcaneal bursitis. This is an inflammatory condition so a treatment plan should include rest between runs, ice, and anti-inflammatories are helpful.

Related Article: Retrocalcaneal Bursitis: FAQs

Haglund’s Deformity

At the back of the heel bone, extra bony growth can occur. This is referred to as a heel spur. There is uncertainty over whether there is a correlation between a heel spur and pain. The reason for this uncertainty is that a large portion of the population has a Haglund’s deformity and can run pain-free.

In some instances, this bone spur can rub off the underside of the Achilles Tendon and cause pain at the back of the heel when running. Conservative management of load modification and optimizing biomechanics should be tried in the first instance while in rare cases, surgery is required.

Related Article: Best exercises for a Haglund’s Deformity

Posterior Ankle Impingement

There are a number of potential causes of Posterior Ankle Impingement in runners. These include an Os-Trigonum, which is an additional bone in the back of the ankle. A Stieda process is an extra bony growth on the heel bone or a mechanical impingement which is the result of how someone moves. Posterior ankle impingement is most painful in terminal plantarflexion and can cause back of heel pain during running when pushing-off.

Related Article: Symptoms and Treatment for a Posterior Ankle Impingement

Calcaneus Stress Fracture

A Calcaneus Stress Fracture can cause pain on the back of the heel running or on the underside of the heel running. It is sometimes mistakenly diagnosed as Insertional Achilles Tendonitis or Plantar Fasciitis. An x-ray or MRI should be taken to diagnose a calcaneus stress fracture.

Physiotherapy with James McCormack

This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.

Related Article: 

Achilles Tendonitis: Symptoms and TreatmentCauses of heel pain in the morningHeel Lifts for Achilles TendonitisBest Ankle Mobility Exercises

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