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Now that everyone is starting their marathon training regimens, heel pain is the most common complaint seen by sports podiatrists.
While most runners tend to self diagnose, it is important to distinguish between the 3 most common types of heel pain in order to treat it appropriately and prevent recurrence.
As most runners would agree, a nagging injury can derail any training plan so it is important to recognize exactly what the cause of heel pain is and treat it appropriately.
Plantar fascitis, also known as heel spur syndrome, is a pain directly on the bottom of the heel which is worse first thing in the morning or after sitting or resting for a while. It is due to poor biomechanics or foot function and a tight plantar fascia ligament, which is on the bottom of the foot. It usually is very tight and causes small micro tears and swelling that leads to pain. Left untreated, the fascia can develop a tear which can take many months to heal. The tension from the ligament on the heel can cause the bone to overgrow, causing a heel spur; however, the bone spur is not the cause of pain as most people imagine. Treatment consists of stretching the ligament, anti inflammatory and orthotics to improve foot biomechanics.
Insertional Achilles Tendonitis tends to be painful on the back of the heel where the Achilles tendon connects to the heel bone. This is usually most painful during activity. This is due to a tight Achilles tendon and constant tearing away from the bone causing pain and swelling. Over time, the tendon can become calcified and the person may develop a large bump on the back of the heel. It can also lead to tearing of the tendon as it becomes weakened with swelling. This is treated by stretching, anti inflammatory and orthotics. If this does not resolve the pain, sometimes it is necessary to surgically remove the bump and lengthen the tendon.
Stress fractures of the heel bone or calcaneus are usually due to overuse and are painful on the sides of the heel. They can be diagnosed by x-ray or a CT scan. Repetitive trauma such as the pounding motion seen in running can weaken the bone to the point where it swells and sometimes cracks. If this injury is ignored, it can become a true fracture requiring immobilization for 6-8 weeks. Stress fractures are usually treated with active rest, anti inflammatory and orthotics. A softer surface such as grass or a rubber track are also recommended when running.
Whether a runner has plantar fasciitis, insertional Achilles tendonitis or a stress fracture, it is important to recognize the injury and treat it appropriately. Left untreated, each one of these injuries has the potential to end any training routine