ASK A PHYSIO..Pain in my heel.

I have been getting pain in my heel especially when I wake up in the morning. Can you tell me what it is? I have recently taken up running to lose weight for summer and it seems to feel better when I run. Thanks. Kylie, 37.

 
Hi Kylie. Good question..a common problem and often you do not need to be running to suffer this sort of issue. So non-runners..read on. It is important to differentiate between pain at the base of the heel under the foot, and pain behind the heel up into the calf. The location of pain will help determine which structure is causing the pain.
 
If the pain is at the back of the heel the problem is likely to be what we call an Achilles tendinopathy (or commonly called tendoniitis). If pain is under the heel extending into the arch of the foot it is most likely a condition called Plantar Fasciitis.
 
Both of these problems are what we call overuse injuries and are probably the result of you doing too much running too soon. In both cases, the tissue in the tendon or plantar fascia has failed to cope with the extra load you are placing on it by running. Other things that may have contributed include:
Footwear (old shoes with no support or new shoes your foot is not used to?)
Weight (if you are overweight your tissue may be having trouble coping with this extra load)
Foot biomechanics (your foot is rolling in or out too much)
Weak muscles in the lower limb (i.e. bum, quads, calf and foot)
Too much running on hard surfaces
Tight muscles (especially the calf and hamstring)
 
Problems such as this unfortunately do not disappear by themselves… 

I have been getting pain in my heel especially when I wake up in the morning. Can you tell me what it is? I have recently taken up running to lose weight for summer and it seems to feel better when I run. Thanks. Kylie, 37.

 
Hi Kylie. Good question..a common problem and often you do not need to be running to suffer this sort of issue. So non-runners..read on.
 
It is important to differentiate between pain at the base of the heel under the foot, and pain behind the heel up into the calf. The location of pain will help determine which structure is causing the pain.
 
If the pain is at the back of the heel the problem is likely to be what we call an Achilles tendinopathy (or commonly called tendoniitis). If pain is under the heel extending into the arch of the foot it is most likely a condition called Plantar Fasciitis.
 
Both of these problems are what we call overuse injuries and are probably the result of you doing too much running too soon. In both cases, the tissue in the tendon or plantar fascia has failed to cope with the extra load you are placing on it by running.
Other things that may have contributed include:
  • Footwear (old shoes with no support or new shoes your foot is not used to?)
  • Weight (if you are overweight your tissue may be having trouble coping with this extra load)
  • Foot biomechanics (your foot is rolling in or out too much)
  • Weak muscles in the lower limb (i.e. bum, quads, calf and foot)
  • Too much running on hard surfaces
  • Tight muscles (especially the calf and hamstring)
Problems such as this unfortunately do not disappear by themselves. If you rest from running it should help settle the acute pain but often it will return when you try to start running again which is no use to the “get fit for summer” idea. You need to deal with those contributing factors. It is often easier and quicker in the long run to deal with the issues sooner rather than later as both of these problems progress into degenerative stages if not dealt with in a timely manner. This means significantly more time and effort to get rid of it!
 
What you should do: 
  • Take a little rest from running to help settle your symptoms. 
  • Only ever increase your running distance by 10% each week.
  • Try stretching your calf muscles
  • Wear supportive shoes at all times for a few weeks (I.e sneakers, no thongs)
  • See your Physio to help identify your contributing factors and what to do about them
What a SquareOne Physio might do:
  • Identify your contributing factors and develop a plan to fix them
  • Correct your biomechanics 
  • Tape your foot up to relieve pain and unload the painful area (this is often very successful)
  • Give you exercises to strengthen weak muscles and release tight ones
  • Give you a progressive strength program to build up your tendon capabilities (this should enable you to start running again)
  • Release tight muscles with massage or dry needling
  • Advice on how to structure your training so it does not reoccur
So the message is…you should really see your Physio for a tailored program to get your heel better so you can get fit and toned for summer. In the meantime certainly give those points above a try to help settle the acute pain. These problems will always feel better or “warm up” when you go for a run but will feel worse afterwards and certainly the next morning. Running more is definitely not the right answer and will in fact make it worse over time.