Heel Pain After Running? Here are 10 Possible Causes + How To Fix It

Heel hurts after running?

Running injuries can be troublesome, tiresome, and confusing. Particularly when we don’t know what’s causing them.

Pain in the heel can be especially confusing, given the intricate overlap of tendons, nerves, and muscles surrounding the area.

Today we will break down the most likely causes of heel pain after running and present some guidance on how to fix it.

Each different cause, or pathology, will need a specific plan of rehabilitation, which you should obtain through a qualified health professional.

One of the main culprits of hell pain in runners is plantar fasciitis. You can find our complete guide to dealing with it here: Running With Plantar Fasciitis.

In this guide, we will look at the other potential causes of heel pain.

As always, our articles are not designed to replace medical advice.

In this article, we will be examining the following potential causes of heel pain:

  • Tendinopathy Around The Heel (3 Types)
  • Bone Stress Fractures (3 Types)
  • Nerve Compression & Irritation (3 Types)
  • And How To Deal With Each Of These

Let’s take a look!

Tendinopathy Around The Heel: 3 Common Heel Pain Sources

foot labelled to show Tendinopathy Around The Heel
  1. NIAT/ IAT – Non/Insertional Achilles Tendinopathy
  2. TPT – Tibialis Posterior Tendon
  3. FHL – Flexor Hallicus Longus

These are common areas where pain may be experienced for each pathology, but they may not cover all cases.

#1: Non/Insertional Achilles Tendinopathy – Causes and Symptoms

The Achilles tendon is the longest and strongest tendon in the body, and it connects the muscle of the calf, gastrocnemius, and soleus onto the heel bone. When running, it absorbs and supports the body’s weight.

Achilles tendinopathy is usually categorized into either insertional or non-insertional pain.

Non-insertional Achilles tendinopathy usually affects the tendon around 4cm above, where it attaches to the back of the heel bone.

Insertional Achilles tendinopathy: affects the tendon at the point it attaches to the back of the heel bone.

It is often caused by repetitive stress resulting in micro-trauma to the tendon. Usually, this is due to a sudden increase in loading activities, such as a long run or high-volume training period.

It is often characterized by a gradual onset of pain that worsens as you continue to exercise. It can manifest as heel pain after running or a painful heel when running. The tendon may be tender to the touch or visibly swollen.

You may also experience pain and stiffness at the back of your heel in the morning or after long periods of sitting.

It is essential to initially protect the Achilles by reducing load-bearing activities that exacerbate the pain.

man with heel or ankley pain

#2: Tibialis Posterior Tendinopathy

The posterior tibial tendon attaches the calf muscle to the bones on the inside of the foot.

The primary function of the tendon is to hold up the arch and support the foot when walking.

The most common cause of injury is overuse, where it will become inflamed. However, a tendon tear can happen by rolling the ankle or participating in contact sports.

Over time you will likely notice a collapse in the foot’s arch.

TPT is most common in women and people older than 40 years of age.

If you have aggravated the tibialis tendon, you will likely experience pain along the inside of the foot and ankle, where the tendon lies. Pain will usually increase with activity, particularly running.

#3: Flexor Hallicus Longus

Flexor Hallicus Longus (FHL) is a strong muscle that runs deep within the calf muscles. It passes behind the bony bump on the inside of the ankle and along the inside of the foot until it inserts into the big toe.

It assists with plantar flexion and inversion of the foot. When running, FHL produces the final push from the foot in the toe-off phase of the gait cycle. 

Tendinopathy and other dysfunctions of the FHL are common in runners and dancers due to the repetitive forceful plantarflexion and stabilization required.

FHL tendinopathy will likely cause a gradual onset of pain underneath the bony bump on the inside of the ankle and along the inside of the foot. 

Bone Stress Fractures: 3 Common Types

foot labelled to show 3 common bone stress fractures
  1. CSF – Calcaneal Stress Fracture
  2. NAV – Navicular
  3. MM – Medial Malleolus

These are the common areas where pain may be experienced for each pathology, but they may not cover all cases.

#1: Calcaneal Stress Fracture

The calcaneus is the heel bone. It is where both the Achilles tendon and Plantar Fascia attach, and it supports the foot.

A calcaneal stress fracture is when multiple small breaks form in your heel bone. These fractures often occur because of repetitive, long-term stress on the bone. Repetitive activities such as running long distances without rest can begin to cause fractures.

Initially, you may just experience heel pain after running, but if ignored, this pain can become constant.

A calcaneal stress fracture can be hard to spot and is often misdiagnosed. It will usually cause intense pain and make walking difficult. The pain is often localized and will likely increase after periods of standing.

Usually, palpating the heel bone with two fingers is tender, called the heel stress fracture test.

heel pain, palpating heel with hand

Proper diagnosis will require an X-RAY.

#2: Navicular Stress Fracture

The navicular bone is located at the top of the middle part of the foot. It is boat-shaped and connects the ankle bone to the bones lower in the foot.

It is an area where large amounts of force are transferred, making it prone to stress fractures.

Symptoms of a stress fracture in the navicular bone usually involve a deep ache or pain in the ankle or at the middle or top of the foot.

In the early stages, pain often occurs only with activity, and if you continue to exercise on it, pain can become constant.

#3: Medial Malleolus Stress Fracture

The medial malleolus is the bony lump on the inner portion of the ankle.

It is rare to have a stress fracture of the malleolus, but it can still occur. It is likely due to a direct impact or an activity that causes repeated stress.

You may discover localized tenderness over the area, with a possibility of swelling.

nerve Compression & Irritation

foot labelled to show common causes of nerve compression
  1. TTS – Tarsal Tunnel Syndrome
  2. MCN – Medial Calcaneal Nerve Compression
  3. BN – Baxter’s Nerve Compression

These are the common areas where pain may be experienced for each pathology, but they may not cover all cases.

#1: Tarsal Tunnel Syndrome

Located on the inside of the ankle, the tarsal tunnel is formed by the ankle bones and the band of ligaments that stretch across the foot.

It is an essential passage with blood vessels, nerves, and tendons running through it. The correct function will provide movement and flexibility to the foot.

If the posterior tibial nerve is compressed within the tarsal tunnel, one may experience pain, tingling, or numbness in the foot.

Flat feet, swelling, or diseases such as arthritis or diabetes can cause swelling, which may contribute to compression.

Proper diagnosis of TTS requires the expert attention of experienced neurologists and nerve specialists.

#2: Medial Calcaneal Nerve Compression

The Medial Calcaneal Nerve is a component of the posterior tibial nerve involved in cases of TTS.

Symptoms of the two injuries are often very alike so they may be easily confused.

Overpronation can compress the nerve when your foot rolls in when walking or running.

Compression of the calcaneal nerve will likely cause a burning pain below the medial malleolus. Pain can radiate from the malleolus into the arch of your foot.

#3: Baxter’s Nerve Compression

Baxter’s nerve makes up a portion of the lateral plantar nerve running along the inside of the heel.

Baxter’s neuropathy is predominantly a nerve entrapment issue; when it becomes impinged, it causes a sharp, burning pain, often associated with numbness and pins and needles around the heel.

Up to 20% of cases of chronic heel pain are caused by Baxter’s nerve entrapment. However, it’s an often-overlooked source of heel pain.

How To fix it!

heel pain runner holding heel

So we have gone through some of the lesser-known causes of heel pain.

Each pathology requires specific treatment and diagnosis. As mentioned before, you should seek a medical professional to help you along the right track.

Rehab should be comfortable; at no point do you need to put the body under excessive stress. Doing so will exacerbate existing conditions and prolong recovery. Similarly, doing nothing can detrain the body to a point where it may be hard to get back into running.

However, there are a few specific recommendations based on the categories we have divided the injuries into.

Take your time; progression is a process. 

How To Deal With Tendinopathy

In the short term, RICE (Rest, Ice, Compression, Elevation) protocols should be followed. Ankle support and footwear can also help to reduce pain in the acute phase.

When the pain becomes more manageable, start incorporating a progressive stretching and strengthening program.

Try to get to the point where heavier loading is manageable in order to stimulate the most adaptation from the muscle and tendon.

How To Deal With A Stress Fracture

X-rays are the most common imaging tool to diagnose fractures. It is essential to determine the correct diagnosis early to maximize your rehabilitation.

Initially, a boot, cast, or splint may be necessary in order to protect the foot in one position while the fracture heals. If swelling is excessive, your medical professional may recommend nonsteroidal anti-inflammatory drugs or pain medication.

Most stress fractures will heal with noninvasive treatment. You rarely need surgery for a stress fracture.

Once the bone has re-ossified, you can start incorporating a progressive stretching and strengthening program under the guidance of a professional.

How To Deal With Nerve Compression

Neural pathologies are much harder to diagnose. The use of MRI and Ultrasound is often necessary.

Unfortunately, there is a lack of solid evidence in the literature on unique treatment approaches.

Physical therapy, alongside pharmacological prescriptions, is often used in conjunction in order to optimize recovery and decrease functional disability.

If there is no noticeable improvement after treatment, you may be referred to a clinician for a surgical approach.

physical therapist helps patient with heel pain
Photo of author
Ben is a qualified Personal Trainer and Sports Massage Therapist with a particular interest in running performance and injury. He has spent the last 9 years working with runners at his clinic in Brighton. Ben is a keen runner and avid cyclist himself. Evenly splitting his time between trail running, road biking, and MTB.

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