Pain in heel of foot after running

Arch Pain

If you wake up first thing in the morning and experience a sharp, burning pain under your heel, then this is likely due to plantar fasciitis. If you’re lucky enough, you may manage to squeeze in a run and find the pain easing. Only after your run, the pain may come back, this time much stronger. This is common among flat-footed runners. We'll return to plantar fasciitis in more detail later in this article.

Plantar fasciitis is common among runners.

Toe Pain

Are you having severe toe pain? Usually, if there’s too much pressure on the big toe, you might develop a bunion. Bunions are enlargement of the big toes causing the bone to jut out at a weird angle. Often, if you’re wearing shoes that are too tight, too small or too narrow it can cause bunions.

Toenail Pain

Have you taken off your socks after a run only to find the toenail black? If you have pain and your toenails are black, it could be because you have a subungual hematoma. This is a slight bleed under your toenail. It occurs when your shoes are too small or the socks are too tight. The stress and pressure cause a micro-bleed in your toe which causes the nail to become black.

Top Foot Pain

If you’re experiencing pain while running, at the top of the foot, you have tendonitis. This is likely extensor tendonitis. Here the tendons which extend your foot are injured. You may even see a noticeable bump along the tendon. One of the reasons for this is training without warming up, tight muscles, and overtraining.

Front Foot Pain and Numbness

Numbness and pain in the front of the foot occur when you lace up to tightly. Numbness indicates that the blood supply is not evenly distributed. So you may want to warm up those tight muscles and go easy on the laces.

Side of Foot Pain

This pain is usually due to the inflammation of the tendon. This usually occurs when the tendons are strained due to overuse. Or it also occurs if you ramp up your training mileage far too quickly without giving your muscles time to adapt. Often, the pain is insidious. It’s worse in the morning and gets better with rest.

Pain in the Skin of the Foot

If there’s pain along the skin and you’ve noticed the skin is broken, then you may be developing blisters. This small bubble like lesion tends to have clear fluid and resolves on its own. They often occur due to chaffing or repeated movements. Sometimes, you may also have a fungal infection or “Athlete’s foot.” Running with your feet trapped in hot sweaty socks is very conducive for fungal growth. This might appear as a burning pain in between your toes or along the soles. You will need antifungal treatment for this condition.

Plantar Fascia

Since plantar fasciitis is one of the main causes of foot and heel pain, we’re going to look at it in detail. The lifetime prevalence of plantar fasciitis for each of us is about 10%. That means at some point in our lives, plenty of us will have foot pain from this inflammatory condition. But first, you need to know what the plantar fascia is. And what does it do in the human body?

What is the Plantar Fascia?

Contrary to what most people think, the plantar fascia is not a tendon. It’s connective fibrous tissue. This tissue connects the heel to your toes. And it spans the arch of your foot. And while we do use the term fasciitis which denotes inflammation, what’s usually happening is collagen degeneration. The “itis” is a misnomer.

What is Plantar Fasciitis?

Plantar fasciitis is a medical condition that is caused by repetitive stress on the plantar fascia. Not everyone who walks too much gets plantar fasciitis. It’s the luck of the draw from bad genetics. The excessive training can also cause the fascia to fatigue. The increased tensile load creates excessive pressure which further breaks down fascia and translates as pain and inflammation.

Over time, micro-tears can occur in the tissue, adding to the severity of symptoms. For one thing, it can present difficulties or stiffness when standing or walking, especially in the morning. Think of your arch as the bow and the fascia as the bowstring. The fascia along with the little muscles in the foot makes your foot springy. If your fascia is too springy, then your foot flattens which in turn overstretches the fascia. Contrastingly, if it’s not springy enough, the fascia absorbs too much pressure or weight abruptly. And in both cases, there is a lack of shock absorption, when walking or running. Either way the strain causes pain.

What Causes Plantar Fasciitis?

Why Is Plantar Fasciitis so Common in Runners? There could be a single cause but often multiple causes could happen all at once which makes it difficult to pinpoint why you have pain. You can have bone spurs. These heel spurs or calcaneal spurs are common in about 10-20% of the population. These are small bone growth from the heel. They are rarely the cause of persistent pain though. They can be surgically removed. However, since it’s healthy bone, it can grow back.

Pronators tend to develop plantar fasciitis. Pronation is when you roll your foot inward. It’s like being a flat foot. Surprisingly, flat feet and high arches both can cause fasciitis. Tight calves cause plantar fasciitis. The pressure from the calf muscles, namely the gastrocnemius and soleus can cause tears in the plantar fascia.

Pronators tend to develop plantar fasciitis more often compared to non-pronators.. The fascia can get overstretched if the plantar flexor muscles are not flexible enough or have flexibility deficits. You could have just one or two of these above conditions in conjunction causing you plantar fasciitis.

Risk Factors

People who are active or who spend a lot of time on their feet are the candidates most at risk for developing this condition. For example, the excess strain on the plantar fascia is extremely common amongst both professional and amateur runners. It can be seen in conjunction with stress fractures.

The plantar fascia plays an essential role in foot movement, in that it absorbs the shocks produced by various activities like walking or running. This is why pain and inflammation will usually occur after intense training. Often the pain and stiffness will decrease after warming up, only to reoccur once the training session has finished.

Occasionally, though plantar fasciitis can occur without a cause. Certain risk factors can increase your chances of developing plantar fasciitis. They are listed below.

Diagnosing Plantar Fasciitis

Plantar fasciitis is a clinical diagnosis. It rarely needs to be investigated further. However, the characteristic stabbing pain on the inside of the foot sole is often diagnostic. You may find your toes numb and decreased sensation in the foot. However, for most of us the symptoms resolve in a year.

If you have severe pain, or if your condition doesn´t improve over time, your doctor may recommend imaging studies to be done.

The first imaging modality is an ultrasound examination. The normal thickness of the plantar fascia as measured in ultrasound has a mean of 2–3 mm. Those folks who have chronic heel pain may have a thickened plantar fascia. This fascia could also have a fluid collection. This affects the thickness. If the plantar fascia thickness is over 4.0 mm, then it is diagnostic of plantar fasciitis. It can also assess the thickness, and the quality of the fat pad in your foot which cushions your bones. It can detect other causes of ankle / heel pain, such as tibialis posterior or peroneal tendonitis.

With the help of a lateral X-ray og the ankle, your doctor can identify if you have heel spurs, a stress fracture, unicameral bone cysts, and giant cell tumors.

If conservative treatment fails, an MRI is done. In addition to depicting the condition of the plantar fascia, and of the fat pad, MRI can assess uncommon causes of heel pain such as bone bruise, the tumor of the soft tissue and bone, osteomyelitis, and subtalar arthritis.

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