Member Case Study: Heel Pain

author : AMSSM

comments : 0

I suffer from pain in the bottom of my left heel after my run. It doesn't hurt when I run but as the day goes on the pain worsens.

Member Question from Hoopska

"I suffer from pain in the bottom of my left heel after my run.  I bought a new pair of running shoes after being evaluated and fitted at a running store. I also put shoe inserts and bought cushion socks.  I do extra stretching of the achilles and calf muscles prior to and after my run.  It doesn't hurt when I run but as the day goes on the pain worsens.  It especially hurts after being sedentary for more than 30 minutes."

Answer from Fred Brennan Jr, DO
Member AMSSM

Heel pain after running could be caused by a few potential problems. We all have a pad of fat that cushions the heel bone from the impact of foot strike with the ground. This fat pad can become inflamed with the repetitive impact of running. If the heel counter in the running shoe is very tight this too can cause inflammation of the fat pad.

Typically you would expect this to hurt while running but some inflammatory conditions are relatively free of symptoms during running, and then hurt more after the run is over. The same holds true for plantar fasciitis. The tough band of tissue that spans from the inside bottom portion of the heel to the ball of the foot is called the plantar fascia.  The classic symptom for this problem is a sharp pain in the heel, “stabbing”, when taking the first step of the day. The pain tends to lessen as the day goes on but may ache at the end of the day or after a run. Finally a stress fracture of the heel bone (calcaneus) can cause pain on the bottom of the heel. This injury, however, usually hurts during the run and tends to lessen once the repetitive impact (running) is over. An x-ray, MRI, or bone scan can help rule out a calcaneal stress fracture.
 
The key to treating all of these potential injuries is to lessen the impact on the heel: cross training with non-impact activities, relative rest, icing, pain relieving topical or oral medications, silicone or viscoelastic heel cups, and running on a treadmill or rubber compound track to lessen the impact on your heel. If the pain does not subside in 2-4 weeks or is getting more intense it would be a good idea to seek medical consultation.

Seacoast Orthopedics & Sports Medicine
Univ. of New Hampshire

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date: November 23, 2009