Flawless Physio Logo
Ankle Pain

Heel Pain After Running

Minute Read


7 months ago


by james

What causes heel pain after running?

Heal pain from running is one of the most common sites of injury for a runner. Heel pain after running can be caused by numerous conditions, we will try to cover most of them in this article. 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 and if the correct management isn’t taken then it can lead to structural damage.

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 and its main purpose is to provide stability to the foot. It is one of the most common causes of running injuries.

It becomes overused or overloads it can cause pain and discomfort. This is most often felt where it attaches to the heel bone on the inner side. It is possible that plantar fasciitis may cause arch of foot pain while running.

It is common for plantar fasciitis to be painful immediately after a run and to have greater pain for the following 24 hours before subsiding. Strengthening exercises under the guidance of a Physical Therapist is recommended.

Heel Fat Pad Syndrome

On the underside of the heel bone, there is a fat pad that acts as a cushion for the calcaneus. If excess pressure is placed on this fat pad when running it 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 particularly bad, it can be painful to walk.

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 plantar fasciitis. The repetitive force from running can cause microtrauma 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 aircast boot followed by 4-6 weeks of Physical Therapy.

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.

In the early stages of this condition is can cause back of heel pain 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.

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.

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 having 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.

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.

Calcaneus Stress Fracture

This 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

Share this page