Running with Heel Pain

Heel pain can be extremely frustrating for a runner. Symptoms typically present on rising in the morning, or after sitting for periods of time. Often sore at the start of a run but can improve when warm. There is the fear that running can worsen the condition. A common question I get asked is ‘Should I stop running?

For most runners – the short answer is no. Maintaining some running while rehabilitating the injury will likely lead to better long term outcomes.

Lets assume you are not getting pain on walking and we have ruled out a tear or rupture (clinical diagnosis can do this). If you stop running, you will loose conditioning fast. A sad but common scenario is a period of complete rest, a reduction in pain followed by a return to running – only to find symptoms flare. My general advice is to run as much as you can without making symptoms worse. Distance and intensity of running will vary from runner to runner and the balance can be delicate.

If you are training for a race or looking to increase load, proceed only if symptoms are stable. Aim for a maximum pain score of 2-3/10 (zero being no pain, 10 being the worst). If you run more and your morning pain does not worsen – you are OK. In fact, if you increase your running but your symptoms remain stable than you are on track to recovery. This combined with appropriate rehabilitation means you will come out the other end stronger. Compare this to stopping running completely and losing your running capacity.

The most common cause of heel pain is plantar fasciitis (plantar fasciiopathy we call it these days). Previous studies of treatment have used stretching, orthotics, rolling/release work and other treatment. These interventions have proven successful to some degree and are superior to placebo treatment. However a large proportion of patients still have symptoms two years after the initial diagnosis. A combination of causes is usually to blame.

In recent years, an exciting new direction is being taken for plantar fascia management. A study done comparing High Load Strength training to Stretching was performed on two groups. High tensile forces were put through the plantar fascia. (Like a modified calf raise with a towel under the toes). Starting with 3 sets of 12 reps and reducing down to 8. Weight was added gradually over the weeks.

Strength training  may stimulate increased collagen synthesis which help normalise tendon/fascia structure. Another explanation is that it may increase ankle range of motion and increase intrinsic foot strength. This can all increase load tolerability of the fascia.

Strength training is by no means a magic bullet, but it does provide us with an additional treatment option to help manage this sometimes debilitating condition.

In summary, don’t stop running unless you have to. Get an accurate diagnosis and treatment plan. Keep running if you can, start rehabilitation, monitor symptoms closely and come out the other end stronger and fitter.

Phil de Mestre – Sports Podiatrist and Runner

5 thoughts on “Running with Heel Pain

  1. Michelle Wood


    I have heel/ ankle pain after 300 metres. I was unwell then went for a run and for some reason my Achilles were really tight. I stopped after 1km. I then tried the next day and could not run after 300m with it aching. I cannot feel anything walking around. Can I still run. I have a 14 km run in 1.5 weeks. City2Surf. I need some advice please.

  2. Christian Borkowski

    Phil cured my Plantar Fasciitis in 2017 with this exact treatment. It took a little while but got me to a half marathon, the city to surf & ultimately the Berlin Marathon. I’ve continued the calf raises a couple of times a week since & haven’t had any recurrence during the 2018 running season. Can highly recommend!

  3. Sue

    I have had heel pain earlier in the year sometimes my whole foot was in pain, now heel pain sometimes and is bearable but what I’ve got now and have been told it’s related is calf pain… almost like I’ve torn the calf muscle, it’s painful during a run and just walking.. I’ve had scans done and they can’t find anything wrong
    What can I do

  4. Stefanie Visser

    This might well work for plantar fasciitis, but I have a different issue which is Haglunds deformity. Right foot first, now the left one too. Running is completely out of the question for me as there is a stabbing pain in my feet and after running or group exercises classes I can barely walk for 2 days. I have new orthodics, am on mobic, stretch, strenghten – the lot. Any other suggestion rather than OP?

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