Heel Pain After Running: Why it Happens and How to Fix It

Do your heels hurt after running? Heel pain is a common problem among runners, and the exact cause varies. It can be frustrating and limit your ability to complete your weekly mileage and reach your overall running goals. Plus, it can start affecting other life activities like sleep and standing.

In this blog post, we will discuss the most common causes of heel pain after running and how to prevent and treat it. We will also provide some exercises that can help stretch and strengthen your feet and improve your running form.

Disclaimer: This post was written by JayDee Vykoukal, Doctor of Physical Therapy. It has been reviewed by Chrissy Carroll, MPH, USAT Level I Triathlon Coach, RRCA Running Coach. This post is for informational purposes only and does not constitute medical advice. Please consult a physician for any medical concerns.

Causes of Heel Pain During Running

The primary cause of heel pain in the U.S. is plantar fasciitis, affecting millions of Americans yearly. Plantar fasciitis is common in runners, giving it a second common name: runner’s heel.

The plantar fascia is a thick band of tissue that runs along the bottom of your foot from the heel to the toes. If this tissue becomes inflamed or degenerates from overuse, it can cause pain in your heel and arch.

Other causes of heel pain in runners include Achilles tendinitis, stress fractures, heel spurs, structural issues, and overall tissue health.

Symptoms of Plantar Fasciitis

With plantar fascitis being the most common cause of heel pain, let’s review the symptoms:

• “First step” pain when you get up in the morning or after an extended period of rest
• Difficulty with pushing off the toes (with walking and running)
• Difficulty lifting the toes off the floor
• Reduced pain with activity and stretching

Other Symptoms

Other general symptoms associated with heel pain include:

• Tenderness to touch in the calves, Achilles, or feet
• Pain that radiates to the toes
• Swelling in the feet or ankles
• Reduced range of motion in the toes or ankles
• Stiffness in the feet or ankles

Risk Factors for Developing Heel Pain While Running

Several risk factors can increase your chances of developing heel pain while running. These include:

• Not warming up properly before running
• Running too far or too fast without taking breaks
• Increasing your running volume or intensity too quickly (i.e not building a good running base)
• Running on hard surfaces such as rocky trails, concrete, or asphalt
• Wearing the wrong type of footwear for your feet and running style
• Having a structural issue with your feet (flat feet, high arches, etc.)
• Not taking enough rest days or cross-training days between runs

Other general risk factors for developing heel pain include aging, a heavier body, and occupations that require prolonged weight-bearing and prolonged standing.

How to Manage Heel Pain from Running

If you’re experiencing heel pain from running, you’re probably ready for some remedies. Thankfully, conservative care (non-invasive) is your best option for managing heel pain. As a Doctor of Physical Therapy, these are the top recommendations I give patients in the clinic.

Reduce your training load

You may not want to lower your mileage and take a break, but pushing through the pain can give you more significant problems in the long term that will require a more extended period of rest. It’s crucial to stay on top of your heel pain by modifying your training routine until your pain has reduced and is well-managed with the other techniques listed below.

Try pain-relieving modalities

Using a foam roller, lacrosse ball, or frozen water bottle for massaging your plantar fascia (bottom of the foot) and Achilles tendon can help reduce pain.

Additionally, cryotherapy (using an ice bath or a cold pack) after running can help reduce inflammation of the local tissue- if present. These are great for short-term pain relief while you rest and get on track with other treatment options.

Get your running mechanics assessed

A running assessment can help you identify any imbalances or asymmetries contributing to your heel pain. Working with a physical therapist, coach, or biomechanics expert can help you make the changes needed to improve your running form and reduce the stress on your feet.

There is no conclusive evidence that one type of running technique is better, notably when landing on your heel or mid-foot with each stride. However, if one running style is causing you pain, it might be worth experimenting and exploring biomechanics that will benefit your unique needs.

Cross-training

Cross-training can be a great way to prevent injuries, improve your overall fitness level, and keep you from being in pain. Mix up your exercise routine with lower-impact activities such as swimming and cycling- especially in your off-season.

Also, if you aren’t already, consider incorporating strength training exercises (bodyweight movements, yoga poses for runners, weights, and resistance band exercises) into your routine to build the muscles that support the feet and ankles.

Stretching and exercise

Exercises that focus on stretching and strengthening the foot muscles, calves, and Achilles tendon can help reduce strain in the heel area. Plus, running specific exercises to coordinate the entire lower body is key to preventing the heel pain from worsening or returning. In addition, it will improve your overall running economy and help you feel your best. (See specific exercises in the next section.)

Adjust your shoewear

Make sure you’re wearing the right shoes for running, and replace them when needed. What style of shoe and support you need will depend on the structure of your foot and preferences.

For example, a flat foot may need a stiffer and more supportive orthotic, while a foot with a high arch may need softer orthotic support. Other considerations include the type of terrain you’re running on, what part of your foot you land on, and whether your ankle stays neutral, overpronate, or over-supinate with running.

It’s best to talk to a podiatrist, running shoe expert at your local store, or physical therapist for personalized recommendations.

Night splints

Night splints can help reduce heel pain by keeping the Achilles tendon and plantar fascia from tightening excessively overnight due to suboptimal positioning (typically caused by pointing the toes). They work by holding your ankle in a slightly stretched and flexed position throughout the night so that your body is ready to start the day with less stiffness and first-step pain when you wake up.

Additional care

If conservative care doesn’t seem to be cutting it and your pain is becoming chronic or worsening, it may be time for more invasive options. You can talk to a podiatrist or orthopedist for specific recommendations. They can prescribe medications, injections, or even surgery if needed.

Exercises for Heel Pain

Specialized exercise for the foot and ankle is one of the essential steps for reducing your heel pain. If any of these exercises cause pain, modify or stop. It’s always important to listen to your body.

Let’s review some specific examples to get you started.

Standing Calf Stretch

This stretch helps loosen up the calf muscle, which is often tight in people with heel pain.

• Stand about an arm’s length away from a wall or other sturdy object that you can hold onto for balance, like a chair
• Step your left foot slightly forward
• Keeping your right foot in place (flat on the floor with toes pointing forward), bend your left knee slightly and shift your weight into the left foot until you feel a gentle stretch in the calf muscle of the right leg
• Hold for 60+ seconds and repeat 2-3 times on each side

Seated Achilles/Plantar Stretch

A seated plantar stretch is a great all-in-one stretch for addressing stiffness and pain in the Achilles tendon, plantar fascia (bottom of the foot), and calves.

• Sit on the floor with a stretch strap, towel, or belt
• Wrap it around the toes
• Pull the ends of your stretching tool back to bring your toes closer to your shins
• Continue pulling until you feel a stretch in the bottom of the foot and calves (where you will feel it mostly depends on where you have the most stiffness)
• Hold for 60+ seconds and repeat for 2-3 times on each side

Intrinsic foot exercises

When pain is present, you will want to work on gently strengthening the small muscles in the feet in a non-weight-bearing position. Gentle exercise allows blood flow to the feet to promote healing and optimize muscle balance.

• Sit in a chair with the feet resting on the ground
• Practice small purposeful movements of the foot, including scrunching the toes and lifting the toes
• Additionally, you can try picking up marbles (or other small objects) with your toes or “drawing the alphabet” with your toes
• Spend 3 to 5 minutes each day working on better toe and foot coordination

4-way ankle strengthening

As your toe coordination improves, it’s time to add non-weight-bearing ankle strengthening to your exercise routine.

Grab a lightweight resistance band (at least to start) and tie a loop in one end big enough for your foot to fit in. Sit on the floor with your legs out in front of you and rest them on the floor. Complete the four following movements (the four primary movements of the ankle), with each focusing on moving slowly and controlled, and repeating 10-15 repetitions for 2-3 sets total.

• Plantar flexion: Place the loop around your toes with the ends facing back toward your face. Hold the ends near taut as you point your toes against the resistance.

• Dorsiflexion: Opposite of the move above, you will change the orientation of the band so it’s looped around the front of your foot and the bands are back behind your foot. Ask a family member or friend to hold the ends for you. Otherwise, secure the band to a sturdy surface. Then, with the band taut, pull your toes toward your shin.

• Inversion: Now, turn the band, so the end is on the outside of your foot. Then, cross your legs with the foot you’re strengthening on top. Hold the band diagonally as far away from your foot as possible. With a taut band, push and rotate inward with your foot- taking care to only move your ankle (not your hip).

• Eversion: Finally, uncross your legs and turn the band to face inward. Hold your hand to the side with your opposite hand while you push and rotate outward, once again taking care to only move the ankle.

via GIPHY

Eccentric heel raises

An eccentric strengthening exercise focuses on the lengthening phase of the muscle, usually the returning motion in a movement. Eccentric strengthening can be beneficial in addressing Achilles tendinitis, plantar fasciitis, and general tissue inflammation. 

A heel raise strengthens and promotes coordination in the calf muscles but can also be painful initially. Don’t force this exercise if it hurts. Instead, try again later to see if your muscles are ready.

• Stand with the feet hip-width apart and hold onto a sturdy object for balance
• Rise onto your toes and then lower the heels down as far as possible without allowing them to touch the floor
• Hold at the lowest point for a second and then come back up onto your toes
• Do 10-15 repetitions for 2-3 sets, working on slow controlled movements throughout the exercise
• Stand on a step (or a book as pictured) to progress. You can lower the heels below the step for a more extensive range of motion. 
• Additionally, you can lift with both legs and then lower back to the starting position with one leg- eventually progressing to a full single-leg lift in both directions of movement.

Single leg balance

Working on single-leg balance can help improve coordination and strength in the feet, ankles, and lower legs. Balance exercise is a great way to increase proprioception- or your sense of position and movement- while helping you maintain control as you move.

• Stand barefoot (if possible) in a safe place where you can catch yourself if you lose your balance
• Shift your weight into one foot, taking care to keep your arch lifted (not flat) while lifting the opposite leg by bending your knee
• Focus on feeling balanced and steady as you stand and hold for 30+ seconds
• Once you feel comfortable, you can make your balance exercises harder by standing on a softer surface (carpet, grass, pillow, foam pad, etc.), closing your eyes, or dynamically moving your arms and legs (swings, reaching, throwing a ball, etc.)
• Complete each leg for 2 to 3 sets, working on progressing the time

via GIPHY

Other functional exercises

In addition to the strengthening and balance exercises, other functional activities can be beneficial in helping you maintain strong muscles while running. Try some of the following when you’re ready:

• Lunges
• Jump lunges
• Jump squats
• Skater hops
• High knees

How to Prevent Heel Pain After Running

As with most injuries, it is best to focus on prevention rather than treatment. Here are some tips for preventing heel pain when running:

• Wear proper shoes: Look for shoes that provide sufficient cushioning and support your feet while running. Also, replace old shoes regularly.

• Stretch and warm up before running: Take 5 to 10 minutes to get your blood flowing and muscles ready.

• Don’t always run on hard surfaces: Try changing up your terrain- opting for softer surfaces such as grass, dirt trails, or a track on occasion.

• Gradually increase mileage/pace/intensity: Increase gradually (no more than 10%), so you don’t strain local tissue with overuse.

• Weight management: If you are in a larger body, losing a small amount of weight may help reduce pressure on the feet, ankles, and knees.

• Listen to your body: If something hurts or feels off, take a break and rest up before heading out for another run.

• Experiment with your foot strike, as needed: Some runners naturally heel-strike, and others forefoot strike. If you are experiencing heel pain, try consciously shifting to a more mid- or forefoot strike pattern and see how it feels (or vice versa).

• Exercise regularly: Participate in activities that keep the lower body strong, balanced, and coordinated with regular low-impact cross-training and strength training.

• Make healthy lifestyle choices: Eat a balanced diet, drink plenty of water, practice stress management, and get enough rest. Keeping your body healthy with good habits helps support optimal tissue health.

Feel Your Best as a Runner with Less Heel Pain

Although heel pain can be painful and disruptive for runners, it is often manageable and preventable with the right tools and techniques. Give the tips listed above a try. I recommend getting professional help sooner than later if you still need relief. It can translate to less downtime, unnecessary suffering, and more time for doing what you love.