It may be discouraging to get heel pain during or after running and worse, be limited by heel pain. This blog will cover
- The causes of heel pain
- Why heel pain with running
- How hip and ankle mobility plays a role and
- The best exercises for heel pain!
What Causes Heel Pain?
calcaneus (heel bone)
Heel pain is described as pain at the bottom of the foot at the heel or on the backside of the heel. These two locations of heel pain have different soft tissue structures involved and therefore, have different causes.
To understand your heel pain better let’s briefly discuss some of the anatomy. As shown in the picture to the right, Calcaneus is the actual heel part of the foot that may break as a result of a direct injury or when soft tissue attached to it pulls on the bone and chips parts of it. That is much less common than injury and pain of the soft tissue that lays on or is connected to this bone. To clarify, soft tissue means muscles, tendons, connective tissue, blood vessels, and nerves. So now, let’s explore the different locations of the heel and what may be going on.
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Back of Heel Pain
When assessing pain in the back of the heel or ankle the most commonly affected structures include the Achilles Tendon and the Subcutaneous Calcaneal Bursa which is the cushion below the skin at the calcaneus. Most people, especially with the runner population are familiar with the term Achilles tendonitis which is an inflammation of the achilles tendon. (a tendon is a connective tissue that connects the muscles to the bone.) This tendon can become shortened and irritated resulting in pain. 
A bursa is a fluid-filled sac, and the calcaneal bursa sits right behind your heel bone, as shown in the picture. Both the bursa and achilles tendon are impacted by your choice of footwear such as high heels or shoes that may be too small, rubbing the back of your heel resulting in irritation.
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Bottom of Heel Pain
Pain at the bottom of the heel is essentially an indication of dysfunctional movement, and when it comes to runners, a tell-tale sign of issues related to the running form. The most common diagnosis that gets thrown at heel pain is Plantar Fasciitis. This is an inflammation of the plantar fascia less commonly referred to as Plantar Aponeurosis (shown below).
Plantar Fascia
Unfortunately, the generic treatment for plantar fasciitis seems to be orthotics to improve the foot arch and rolling the bottom of your foot with a ball which does nothing to address the root cause of the problem. Injections are not uncommon and at times surgical procedures are made to release the plantar fascia from being tight.
Plantar Fasciitis is not a foot problem! and the blog I wrote explores that in detail. At my clinic, I perform active rehab exercises, but shown in the video is the initial state of treatment for all plantar fascia pains and dysfunction. You ought to remember that addressing only the feet in case of Plantar Fasciitis is a mistake, which is explored more in the next section.
Why Heel Pain After Running?
Right now, I want you to stand and evaluate the pressure distribution on the bottom of your feet. Are you standing on both feet equally? Are you putting more pressure on your heel vs your toes?
Depending on your answer to these questions you may have found yourself shifting side to side, forward or back, trying to make yourself balanced; but the challenge is to make sure that is the case all the time including when you’re running.
Running is taxing on all parts of the body and when there is a dysfunction in movement of the hips, lower back, sacroiliac joints, and when there is dysfunctional breathing present, the contact point to the ground, your feet, will receive the insult the most. If you think you do not have any pain in those areas so that is not the issue, do know that lack of pain does not guarantee function.
Functional mobility is what all babies do through different stages of development. In Dynamic Neuromuscular Stabilization or DNS, we know that all babies regardless of their differences go through the same stages because we are all programmed that way. Any deviation in movement style from that signals dysfunction. Take a few minutes to watch this video.
Hip Mobility and Foot Pain
Look into your hip mobility for all foot issues and simply stretching the hip flexors is not the right answer. If movement was a concert, the body parts would be the musicians and in a concert, the musicians not only need to know their musical notes and instrument but they need to know when to chime in and when to phase out. Stretching and strengthening a body part without putting it through the challenge of working with the other body parts in movement is the biggest mistake made in the rehab world.
The exercises below address how the hips, ankles, knee, and lower back all work together while stretching what is tight and strengthening the weak.
Flat Feet and Pain in the Heel
Plantar fasciitis and flat feet go hand-in-hand given that part of the function of the fascia is arch support; it is a good idea to do exercises that address the integrity of your arch, and not solely depend on orthotic inserts to do the fixing for you. Foot orthotics should be worn while you work on strengthening what is needed to keep the arch up. Of course, in doing exercises for the arch, be sure not to disregard the rest of your foot or body posture. The exercise below is a good one.
On my Youtube Channel there is a playlist dedicated to runners as well as foot and ankles and you will find blogs written with runners in mind on my website. If you have any questions or wish to schedule an appointment, contact me and make sure to listen to your feet and your breath next time you run.
Dr. Shakib
