Member Case Study: Heel Pain

author : AMSSM

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Heel pain, especially in runners, is usually due to plantar fasciitis. The plantar fascia is a band of connective tissue on the bottom of your foot that stretches from the heel to the ball of the foot

Question from cwiehel:
I think I have the beginnings of a calcaneal heel spur, judging by some of the symptoms I have seen online. I stopped running soon enough where I don't think it is too serious. I blame it on poor stretching and early morning running. How long should I wait before trying to run again? For now, I am stretching a couple times a day. Any other input would be appreciated.

Answer from Daryl A. Rosenbaum, MD:
Heel pain, especially in runners, is usually due to plantar fasciitis. The plantar fascia is a band of connective tissue on the bottom of your foot that stretches from the heel to the ball of the foot. It acts as a shock absorber and support structure for your arch. When stressed beyond what it can handle, tiny micro-tears start to form in the tissue and pain develops at the heel or base of the in-step. Interestingly, “heel spurs” seen on x-rays are simply evidence of calcium deposits, probably the result of plantar fasciitis---but not the actual cause of your pain!

A period of relative rest such as decreasing mileage or switching to non-weight-bearing exercise all together is the first step. Once you are pain free, you can gradually resume running, but I strongly recommend you look for possible culprits that caused your pain, and try to correct them so that you might reduce your chances of recurrence.

Consistent stretching is very important. You can do wall and curb stretches focused on the calf muscles as a more flexible “heel cord” takes tension off of the plantar fascia; you can also do seated calf stretches using a stretching strap. Stronger foot muscles can take on some of the support and shock absorption burden from the plantar fascia. Picking up marbles or curling a towel with your toes can help accomplish this. Certain foot shapes or motions can put extra strain across the arch, so ask a qualified shoe fit specialist, podiatrist, or sports medicine doctor to evaluate whether you might benefit from arch supports or a specific type of shoe.

Once you have this foundation in place, make a gradual return to running by slowly increasing mileage, intensity, and hills. Be sure to take the time for calf stretches and a proper warm up before each run. Good luck!

Daryl A. Rosenbaum, MD
Wake Forest University Baptist Medical Center Sports Medicine

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date: September 3, 2006