Does your heel hurt after you run?

Running injuries are frustrating, exhausting, and confusing. It's incredibly disappointing when you don't understand what caused them.

The complex overlap of nerves, tendons, and muscles around the heel area can make diagnosing it difficult.

We will discuss the most common causes of heel pain and how to treat it.

For each cause or pathology, you must obtain a rehabilitation plan from a qualified healthcare professional.

Running with Plantar Fasciitis is our comprehensive guide on how to deal with this condition.

This guide will examine the causes of heel pain.

Our articles do not replace medical advice.

This article will examine the causes of heel pain:

• Tendinopathy Around the Heel (Three Types)
• Bone stress fractures (3 types)
• Nerve compression & irritation (3 classes)

Tendinopathy Around the Heel Three common causes of heel pain

All cases may not cover the areas of pain that are most common for each pathology.

 Non-Insertional Achilles Tendinopathy (Non-Insertional Achilles Tendinopathy) – Causes and symptoms

The Achilles tendon connects the gastrocnemius and soleus muscles to the heel bone. It is the longest, strongest tendon on the body. It absorbs the weight of the body and supports it when running.

Achilles tendinopathy can be classified as either insertional (insertional) or non-insertional (non-insertional).

Noninsertional, A tendinopathy of the Achilles tendon affects the tendon about 4cm below, where it attaches itself to the heel bone.

Insertional Acute Achilles Tendinopathy: This condition affects the tendon where it attaches to the heel bone.

This is usually caused by repeated stress, resulting in microtrauma of the tendon. This is generally due to an abrupt increase in loading activities such as a long-distance run or a high training volume.

A gradual increase in intensity usually characterizes the pain as you exercise. The pain can be felt in the heel after or when you run. The tendon can be tender or swollen.

Tibialis Posterior Tibial Tendinopathy

The posterior tibial tendons connect the calf muscles to the foot bones on the inside.

The primary function of a tendon is to support and hold the arch up when you walk.

Overuse is the most common cause of injury, as it causes inflammation. A tendon tear may occur if you roll your ankle or participate in contact sports.

You will notice that the arch of your foot is deteriorating over time.

TPT occurs most often in women over 40 and older people.

You will feel pain inside your foot or ankle where the tibialis is located. The pain will increase when you exercise, especially if you are running.

Flexor Hallicus longus

Flexor Hallicus Longus is a powerful muscle located deep in the calf muscles. It runs behind the bony bump inside the ankle along the inside foot and inserts in the big toe.

It helps with plantar flexion and inversion. FHL is responsible for the last push of the foot during the toe-off phase of gait.

Tendinopathy and other FHL dysfunctions are common among runners and dancers because of the forceful plantarflexion required.

FHL tendinopathy is likely to cause pain under the bony bump inside the ankle or along the inside foot.

Three common types of bone stress fractures

The pain areas most commonly experienced by each pathology may not be covered in all cases.

Calcaneal stress fracture

The heel bone is called the calcaneus. The heel bone is the calcaneus. It's where the Plantar Fascia and Achilles tendon attach.

The calcaneal stress fracture occurs when small breaks occur in the heel bone. This fracture often happens because of long-term, repetitive stress. Fractures can be caused by repetitive activities, such as running long distances without rest.

If you ignore the pain, it can become chronic.

It is difficult to diagnose a calcaneal fracture, and it can be misdiagnosed. The pain is usually intense and makes walking difficult. Pain is generally localized, and it will increase after prolonged standing.

The heel stress fracture test is usually performed by palpating the heel bone with two fingers.

 Navicular stress fracture

The navicular is found at the top middle of the foot. The navicular bone is shaped like a boat and connects the lower bones of the foot to the ankle.

Stress fractures are common in areas where high amounts of force are transferred.

The most common symptoms of a Stress Fracture in the Navicular Bone are deep pain or ache in the ankle, in the middle, or on top of the foot.

Pain is often only present in the early stages of the condition. If you continue to exercise, it can become permanent.

 Medial Malleolus Stress Fracture

The medial malleolus (the inner ankle bone) is a bony lump found inside the ankle.

A stress fracture can occur, although it is rare. This is usually due to repeated stress or a direct blow.

There may be localized tenderness in the area, with swelling possible.

Compression & Irritation of Nerves

1. TTS - Tarsal Tunnel Syndrome
2. MCN - Medial calcaneal nerve compression
3. Baxter's Nerve Compression

The pain areas most commonly experienced by each pathology may not be covered in all cases.

Tarsal Tunnel Syndrome

The tarsal canal is located on the inside of your ankle. It's formed by the ankle bone and the band that runs across the foot.

This vital passage contains blood vessels, nerves, and tendons. The correct function provides flexibility and movement to the foot.

The posterior tibial is often compressed in the tarsal canal, which can cause pain, tingling, or numbness.

Diseases like diabetes or arthritis can cause swelling.

To diagnose TTS correctly, neurologists and nerve specialists with experience are required.

Compression of the Medial Calcaneal nerve

The Medial Calcaneal Neurone is part of the Posterior Tibial Nerve involved in TTS.

The symptoms of both injuries can be very similar, so they are easily confused.

Walking or running, your foot rolling in, can cause nerve compression.

The calcaneal neuropathic pain can radiate into the arch of the foot.

Baxter's Nerve compression

Baxter's Nerve is a part of the lateral Nerve that runs inside your heel.

Baxter's Neuropathy is primarily a problem of nerve entrapment. When it occurs, it can cause a burning, sharp pain that may be accompanied by numbness or pins and needles in the heel area.

Baxter's entrapment is responsible for up to 20% of chronic heel problems. It's a common cause of heel pain.

How to Fix it!

We have now discussed some lesser-known causes of heel pain.

Each pathology has a specific diagnosis and treatment. As we have already mentioned, it is essential to seek the help of a medical professional.

The body should not be overstressed during the rehabilitation process. This will only exacerbate the condition and delay recovery. In the same way, not doing anything can detrain your body to a level where it is difficult to return to running.

We can make some specific recommendations based on how we have classified the injuries.

Progress is a long process.

Tendinopathy: How to Treat it

Rest, Ice, Compression, and Elevation should be followed in the short term. In the acute phase, ankle support and footwear may also reduce pain.

Once the pain is more manageable, begin a gradual stretching and strengthening program.

Aim to reach a point of maximum adaptation by increasing the load.

How to Deal with a Stress Fracture

X-rays are the most common imaging method to diagnose fractures. To maximize your recovery, making the correct diagnosis as soon as possible is essential.

Initially, it may be necessary to use a boot or cast for the foot to remain in one place while the fracture heals. Your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) or pain medication if swelling is excessive.

The majority of stress fractures heal without surgery.

Under the supervision of a professional, you can begin incorporating into a progressive stretching program.

Nerve compression: What to do?

Neuropathologies are harder to diagnose. MRI and ultrasound are often required.

There is insufficient solid evidence to support using unique treatment methods.

Physical Therapy is used along with pharmacological prescriptions to maximize recovery and reduce functional disability.

You may be referred for surgical treatment if there is no improvement following the initial treatment.

Credit: NoRXPharmaUSA.com