Treating Chronic Heel Pain in Runners

Heel pain can quickly sideline runners, from professional athletes to weekend warriors. Although the cause of this discomfort can often be attributed to plantar fasciitis, other bone or soft tissue injury may be to blame.

If you put off seeing an orthopedic foot specialist or sports medicine physician, the condition can worsen. As a result, you could be sidelined for weeks or months. By identifying and treating the underlying cause of your heel pain, we can help ensure that it doesn’t return.

heel pain runners

Common Causes of Chronic Heel Pain for Runners

When runners experience heel or foot pain, the reason is typically plantar fasciitis. However, it may also be caused by Achilles tendinitis or a joint-specific issue such as a calcaneal stress fracture. Overuse is almost always to blame in the case of chronic pain.

If you automatically assume that the source of your pain is plantar fasciitis, you’re in good company, because that’s what most runners believe. This condition develops as the result of training too much or too hard, standing for long periods, wearing improper footwear or using poor exercise biomechanics.

Plantar fasciitis pain is typically located toward the center of the heel, under the bone, although about a third of patients will experience pain in the arch of the foot. Achilles tendinitis is felt more toward the rear of the foot. However, before rendering a diagnosis, your orthopedic, sports medicine or foot specialist will have to rule out other conditions, including tarsal tunnel syndrome, bone cyst, fat pad atrophy or dysplasia, sciatica or even gout.

Why You Should Never Ignore Chronic Heel Pain

The proud motto of the misinformed athlete was once, “No pain, no gain.” This axiom is dangerous in any situation, but especially if you experience heel pain.

Diagnosing and treating the cause of your pain is necessary to prevent the problem from becoming worse — because your condition, left untreated, can become much more serious. Amateur athletes are notorious for trying to work through the pain, and even when their doctor recommends taking a few weeks off to heal, continuing to run and work out.

More than a million runners develop plantar fasciitis every year, and more than 40 percent continue to have heel pain two years after their diagnosis. An injury that could heal with four to six weeks of rest or modified activity could require eight months or more to heal once the condition worsens. And if the problem is the result of poor mechanics or technique, it will return again and again until the underlying issues are corrected.

If you are unable to relieve heel pain after two weeks of at-home treatment, schedule an appointment with a foot specialist or sports medicine physician.

Most Effective Treatments for Runners’ Heel Pain

Unless the diagnostic process suggests a more serious problem, doctors typically begin with a conservative treatment approach for heel pain. The RICE protocol (rest, ice, compression and elevation) combined with nonsteroidal anti-inflammatory medication (NSAIDs) is the common starting point. Physical therapy may also be beneficial for stretching and increasing flexibility and for strengthening the plantar fascia.

The doctor may also encourage you to adopt a cross-training regimen to strengthen specific muscle groups while you heal. Orthotics and proper footwear will also be necessary to help prevent future recurrence. However, until the tissues heal, it’s critical for you to avoid any impact stress. That means no running.

If your injury does not respond to conservative treatment, the doctor may use guided injection therapy (corticosteroids or platelet rich plasma), nerve ablation or low-level laser therapy. Arthroscopic or open surgery may be required; however, only about 10 percent of heel pain patients require surgical intervention.

Once your heel pain abates, we recommend that patients undergo a functional assessment for running techniques and athletic mechanics. This allows your doctor to recommend exercises and strength training techniques to overcome any mechanical defects, keeping you healthy and pain-free in the future.

In northern Utah, the Center of Orthopedic & Rehabilitation Excellence (CORE) provides world-class orthopedic and sports medicine treatment. Our foot and ankle specialists, including Dr. Belton, Dr. Macintyre and Dr. Muir, serve patients at our West Valley City, West Jordan and Riverton, Utah, locations. Contact us today to schedule a consultation to discuss your heel pain with a specialist.


muir orthopedic surgeon utah
Orthopedic Surgeon at CORE West Jordan
Dr. Traske Muir is a fellowship-trained and board-certified lower extremity orthopedic surgeon. He specializes in treatment of injuries and arthritis of the knee, ankle and foot. He is an active Fellow of the American Academy of Orthopaedic Surgeons and American Orthopaedic Foot and Ankle Society. Dr. Muir has done extensive research on Achilles Tendinopathy and orthopedic injury associated with ATV crashes.