Common running injuries - heel pain
Heel pain is usually caused by damage to the tissues near the Achilles tendon, which runs from the bottom of the calf muscles to the upper part of the heel bone. There are several conditions that can affect the Achilles tendon and cause discomfort.
Symptoms and causes
- Increased pull on the tendon where it joins the heel bone (calcaneus) - this can cause significant discomfort. This condition is called 'insertional tendonitis'.
- There is a small fluid filled sac (bursa) situated between the Achilles tendon and the calcaneus that can also become inflamed. This condition is called 'bursitis'.
- The symptoms of insertional tendonitis and bursitis are felt in the heel bone area and are particularly painful as the heel raises from the ground.
- There is a small sheath surrounding the tendon called a 'paratenon'. The tendon itself has a relatively poor blood supply but the sheath has a good blood supply. This sheath is designed to allow the tendon to move smoothly through the tissue. Sometimes, this sheath can become inflamed and cause discomfort. If this is the case, there tends to be general thickening along the course of the tendon. The area of discomfort will be felt where the thickening occurs and remain in the same place as the tendon moves. This is called 'paratendonitis' or 'peritendonitis'.
- Damage to the tendon itself will often cause more lumpy thickening where pain will be felt - this will cause the area of discomfort to move with the tendon. This will often be less painful with the tendon under tension. This is called 'tendonosis'.
- In some cases, there is bony enlargement at the back of the heel bone where the tendon joins it. This can cause irritation of the tendon in that area and cause problems when rubbing against shoes.
- Ideally rest from running. When feeling recovered, re-introduce running on alternate days and at a steady state.
- Avoid unnecessary walking or time on your feet.
- Replace some running sessions with other non-impact forms of training.
- Try putting small heel inserts or raises into your training shoes to reduce the tension on the calf muscles and Achilles tendon (you should be able to buy these from specialist running shops).
- Avoid wearing less supportive shoes.
- Heat the area before running and cool immediately afterwards.
- Massage the area before running to increase blood flow and make more pliable.
- Stretch the calf muscles 2-3 times each day.
- Use anti-inflammatory or homeopathic skin creams or gels in the area of pain, four times each day.
- Seek professional help if the problem does not show signs of settling within a week.
Stretching will help ©Dmytro Panchenko
In most cases, treatment consists of calf stretches to remove some of the tension, purchase of appropriate shoes, customised orthoses to control the foot position and physiotherapy.
Strengthening exercises of some of the other muscles acting around the ankle can often help relieve symptoms and if there is bony enlargement it may require protective padding. In stubborn cases, surgery may be necessary.
- Average recovery time - two weeks to long term.
- Prevention - good stretching, footwear and training programme.
Neil qualified as a physiotherapist in 1981 and is an ex-international middle-distance runner. He has been the Chief Physiotherapist for UK Athletics and is now UK Athletics Performance Director. Since 1990, Neil has worked with many of the greats in athletics including Sally Gunnell, Colin Jackson, Jonathan Edwards, Kelly Holmes, Denise Lewis, Jessica Ennis and Mo Farah.
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