Member Case Study: Burning Heel

author : AMSSM

comments : 0

They are comfortable, but on longer runs the ball of my foot starts to heat up. I actually had to STOP, take off the shoe, massage my foot. This would help for a while, but the pain usually returned.

Question from Autumn

I switched to New Balance 766's this year after two years in 765's. They are comfortable, but on longer runs the ball of my foot starts to heat up. I was really concerned that since the sensation was intense heat, it might be the 'burning sensation' of plantar fasciitis, which my mom and older brother both battle with. Different socks and using body glide have not helped. Speed laces seem to make the problem worse. I ditched the speed laces on one pair and went back to the original laces. I also picked up some new insoles from the running shop (gave them to me for free). Anyway, I should mention that three times now, including the Oly I did on Sunday, I actually had to STOP, take off the shoe, massage my foot. This would help for a while, but the pain usually returned in 10 minutes or so. Any suggestions?

Answer
Mark Snowise, MD - We always look for changes in training or equipment when evaluating running injuries. Try switching back to your old style of shoe if available to see if this helps. If that fixes the problem you can stop right there.

Pain under the balls of you feet can come from various causes. The most likely cause given your complaints is either a mortons neuroma or tarsal tunnel syndrome. Plantar fasciitis can cause these symptoms but the pain is usually closer to the heel. People with bad plantar fasciitis also complain of pain upon first walking in the morning. Another issue to consider, although less likely, is a stress fracture in the heel or midfoot.

Morton’s neuromas cause a burning type pain that will usually radiate into the affected toes and can also be accompanied with numbness and tingling. This usually results from irritation of the nerve bundle that sits between the metatarsal heads (the ends of the long bones in your feet). This can come from wearing shoes that are too narrow in the toe box. This can easily be diagnosed on physical exam as your pain can be reproduced with squeezing the metatarsal heads together. Treatment usually consists of changing footwear to a wider toe box. Metatarsal pads can help alleviate symptoms as they help to separate the metatarsal heads. In persistent cases a steroid injection can decrease symptoms. If all else fails, this condition responds well to surgery.

Tarsal tunnel syndrome results from compression of the posterior tibial nerve as it passes behind the ankle. This will cause a shooting, burning pain that starts around the arch of the foot and extends down to the toes. Again, this can be diagnosed on exam or with nerve conduction studies. Treatment consists of rest, typically with casting, antiiflammatories, orthotics to control foot motion and in rare cases surgery.

Mark Snowise, MD

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date: July 3, 2006