Running with Foot and Heel Pain

The Injurymap guide to treating and preventing running-related foot pain. learn how to deal with pain in the top of the foot, the ball of the foot and heel.

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Pamela Q. Fernandes Doctor and Medical Writer

How to Tackle Foot and Heel Pain as a Runner

Every runner, whether beginner or professional, is highly likely to experience foot and/or heel pain at some stage. Foot pain plagues every runner. You know that feeling when it feels like you’re walking on broken glass! Often, this will turn out to be a symptom of plantar fasciitis, an inflammatory condition that can interfere with your training and affect your performance. This condition accounts for as much as 8% of all running injuries.

And while plantar fasciitis is the most common, there are other causes for foot pain that you shouldn’t ignore. We’ll show you how to identify the cause of your foot pain. And then help you prevent it so you can enjoy your run.

If you have plantar fasciitis, then there’s no reason to fear. The good news is that foot injuries don’t need to spell the end of your favorite sport. If caught early, plantar heel pain, as well as the other symptoms of plantar fasciitis can be addressed through several treatment solutions, most notably targeted physical exercise.

Foot Pain: Prevention

  • Select proper footwear. Get yourself professionally fitted. If you have low or high arches, consider wearing insoles. Make sure you have footwear that isn’t too tight, small or narrow. Lace-up the right way. Too often we lace up too tight to ensure that we don’t trip over our laces. Lace up right; not too tight, not too loose.
  • Correct your gait: Make sure your walking pattern is correct. Often our gait is affected by our arches, your posture, joints, and bones. If there’s a deficit in any of these, then your gait can be affected. So correct the way you walk.
  • Running technique: Have someone evaluate your running technique. The wrong technique can affect your foot and cause stress fractures.
  • Socks: Wear comfortable socks and change them after every run. Wet, sweaty socks tend to make you more prone to fungal infections.
  • Warm-up: Before every run, warm up your muscles. Get the body temperature up. Your muscles have to be primed and flexible before they take on sudden bursts of exertion.
  • Flexibility and strength training: You have to train your muscles and ligaments to become flexible.
  • Build up gradually: Overuse and sudden increases in training push your ligaments to the limit. While your muscles may grow, the ligaments may not have adapted and so you need to intensify your run slowly. This will allow your tendons, ligaments, and fascia to adapt to the requirements of the growing muscle.

Causes of Foot Pain

Foot or heel pain can occur for a variety of reasons. The first being that you're anatomically prone to them. This could be because of the way your foot arch is shaped. The foot arch is a shock absorbing structure. Flat-footed people have more pain because their arches aren’t being held up by the tendons. It’s just the way you were born.

It could also be a gait problem. If you have a weird way of walking due to joint deformities or other arthritis, it can cause foot pain. Or it could simply be that your technique is faulty. You may have chosen the wrong shoes. There’s a myriad of things to investigate when you have foot pain. However, depending on which part of the foot is affected, it’s easier to identify the cause of the foot pain.

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.

Extensor tendonitis

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.

Foot Pain: When To Seek Medical Help

  • If your pain hasn’t subsided in four weeks. The pain in plantar fasciitis tends to ease with exercise and reduction of your running distance or running pace. If your pain is constant and unrelenting, you may have a stress fracture and it needs to be seen.
  • If there’s swelling. If there’s a growing swelling anywhere along your ankle joint and foot, chances are the joint is inflamed. You need to meet with a doctor to make sure there’s no infection.
  • If you experience a loss of movement. If you cannot move your foot or carry out normal movements, get medical help. This includes raising your foot, inverting it inside or outside, you may have torn some ligaments.
  • If you hear a pop or crackle. These are not normal sounds. You’re not supposed to hear them when you move. However, if you’ve heard these sounds, then you’ve definitely injured or torn some ligaments or tendons.
  • Black toenails: If you find that several of your toenails are turning black, this could be a sign of fungal infection. And it would need oral, systemic antifungal therapy for as long as three months. Fungal infections take a long time to treat. ?
  • Worsening of symptoms. If your symptoms seem far more serious than they look, go see a doctor. Pain that won't let you sleep, redness in the joints, rash on the sole of the foot or blisters that won't heal require attention. See your doctor about what to do next.

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.

The plantar fascia

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.

Plantar Fasciitis: Risk Factors

  • Age: It is only natural that as we age, the connective tissue in our body starts to break down. Plantar fasciitis is most common between the ages of 40 and 60. And since it’s fibrous tissue it cannot be simply replaced like your knee joint.
  • Certain exercise: Activities that place increased tensile stress on your heel and the attached fascia can increase the risk of plantar fasciitis. Examples of these include long-distance running, jumping activities, ballet dancing, and aerobic exercises.
  • Foot mechanics: Like we said earlier, being flat-footed or having a high arch can affect the way weight is distributed across your foot. This puts added stress on the plantar fascia.
  • Gait: A wrong or odd gait can also affect the way weight is distributed along the foot stressing the fascia.
  • Obesity: This one is a no-brainer. All the extra pounds put extra stress on your plantar fascia.
  • Occupational hazard: Jobs that keep you standing on your feet all day long can lead you to develop plantar fasciitis. Construction workers, teachers, and workers who spend most of their workday walking or standing can damage their plantar fascia.
  • Wrong footwear: choose shoes that are tight around your heal: they will support the fat pad, that is located between the heal skin and the plantar fascia, and protect the fascia from injuries.

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.

Reduce Foot And Heel Pain With Targeted Exercises

After diagnosis, the next treatment step is to design a suitable rehabilitation plan consisting of carefully selected exercises and stretches. Over time, this rehabilitation plan should: 1) Reduce levels of discomfort and inflammation that may be experienced during the acute period of injury. 2) Restore the feet back to their full physiological range of motion. 3) Improve core foot stability and balance. 4) Increase foot flexibility and strength to help avoid the risk of any future strains or injury

  1. Stretches

    Stretches in the calf and the plantar area are helpful. Calf stretches as shown are done by standing towards the wall with the feet staggered. With calf stretching, you can improve the flexibility of the flexor muscles. This makes the Achilles tendon that continues down to the plantar fascia more flexible and less prone to wear.

    Achilles tendon stretch
    30 sec. x 3 sets

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    • Stand with bare feet.
    • Place your toes up against a wall.
    • Bend the knee a little and move it towards the wall.
    • You should feel it stretching at the bottom of the back of the heel and in the arch of the foot.
    • Hold the stretch for 30 seconds and perform 3 repetitions with each leg.
  2. Strength Exercises

    Resistance Band Toe Pulls: Sit on a chair. Loop a resistance band around the big toes. Point the toes forward and plant your heels. Rotate both feet outwards and away from each other. Maintain this position for 30 seconds. Start again and then repeat. You can begin with two to three sets once a day. As you get better you can do three sets twice a day.

    Sitting outwards turn of the foot
    15 reps x 3 sets

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    • Sit on a chair with your legs bent.
    • Place the exercise band around the feet just behind the toes.
    • Keep the heel of the sick foot on the floor and slowly lower the foot outward and slowly back to the starting position.
    • Go as far as possible in both directions.
    • Make sure that your knees and hips are not moving.
    • The exercise band should be tightened so that the exercise can be repeated exactly 15 times in 3 sets.
    • Perform the exercise alternating between the sick and the healthy foot.

Antiinflammatory treatment

If you have severe pain and inflammation, your doctor may choose to reduce inflammation by prescribing NSAIDs for a short duration of time, or by giving you a steroid injection.

Splints

Night splints can be used to treat foot pain. Night splinting is effective in keeping your ankle in a neutral position overnight. This will passively stretch the calf muscles and plantar fascia while you’re sleeping. You can use any type of night splint. There’s no difference between them.

The purpose of each splint is to give the fascia time to heal. Evidence suggests that night splints do improve symptoms of plantar fasciitis. They are often recommended for 1 to 3 months. If you have experienced pain for more than 6 months, you should consider night splints.

Orthosis

Orthotics and insoles for correcting pronation have been recommended by some specialists. However, the evidence is conflicting. Some studies show that insoles support the longitudinal arch and have no effect. Others suggest that short term custom-foot orthoses used for 3 months do improve function and reduce pain.

Deep tissue massage

Deep finger massage techniques have been applied to relieve plantar fasciitis. No studies have been done to evaluate the effect. The justification, however, is that with slow deep strokes, the muscle tension can be eased and any massage can break fibrous tissue and speed up healing.

Operation

If none of the conservative treatment modalities work, an operation where a slight slit of the fascia plantaris is performed, may help.

Conclusion

Preventing foot pain from running is all about choosing the right footwear, following the proper technique and warming up before you dash away. Since plantar fasciitis is not studied as intensely as structures in other joints, newer therapies have lagged. There’s no reason you can’t prevent it though.

At Injurymap we teach you how to warm up specific joint groups to prevent any activity-related injury. Our app is a highly useful application that can help you to address both the symptoms and the causes of plantar fasciitis safely and effectively. It offers a series of complete training programs developed by experts to meet all of your injury needs at every stage of your recovery journey.

The great thing is that it allows you to take full control of your rehabilitation and go about achieving it, all from the comfort of your own home. So go ahead and make the best of your next run!

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