“I am 62 years of age and have always participated in sport. I love running and have completed 5 marathons. I have been diagnosed with a calcaneal spur on my left heel. It started about December 2014 and is very uncomfortable. I can run on it although it is sore, and for a couple of days after very sore which causes me to limp. I ice it after running and use ibuprofen. I use gels in my trainers and everyday shoes.
I have been told it will eventually heel although I am unsure when. Am I make it worse by running on it? When I have rested it for a week or so it reverts back to its previous soreness when I resume running.”
Reader’s email to Matt Phillips, in-house Injury Specialist for UK magazine Running.
Heel pain is something that many runners find themselves struggling with. I would like to start by pointing out that even if heel spurs show up on an X-ray, they may not be the underlying cause of your heel pain. Research shows that heel spurs can exist even in pain free runners.
The presence of heel spurs is more likely to indicate an overloading of the plantar fascia – the thick connective tissue found on the bottom (plantar side) of your foot that stretches all the way from your heel (calcaneus) to your toes. You may already be familiar with the term plantar fasciitis? That’s essentially what we’re talking about.
Persistent overloading can cause a partial tearing of the plantar fascia from its origin at the calcaneus which in turn can lead to new bone formation (heel spurs) at the site of the injury in an attempt to make the area stronger and more able to deal with the load. In other words, heel spurs are created to help the situation. They can obviously sometimes add to the pain, but recovery should be directed towards initially reducing the load on the plantar fascia and then increasing its ability to handle load.
The ice and ibuprofen you have been taking may well provide short term relief (although plantar fasciitis is today thought to be a problem of degeneration of tissue rather than inflammation) but they will not increase the ability of the plantar tissue to handle more load. Resting for a week will obviously help offload the tissue, but once you resume running the issue will return (as you have discovered). The gel cups may likewise help reduce pain but they won’t be dealing with the underlying issue.
I would suggest you see a professional and get a suitable strengthening program put together. Once you have increased the ability of the plantar fascia to handle more load, you will hopefully find you are able to slowly return to running without pain. Slow and gradual will be key.
Watch out for other scenarios that could be overloading the plantar fascia: excessive standing during the day, being significantly overweight, having limited range of ankle dorsiflexion (can you squat to 900 without lifting heels off the floor?), wearing old or flat footwear. You may find a shoe with more arch support (or use of an insert) could help alleviate symptoms, as well as heel lifts.
Daily stretching of calves and the plantar fascia itself can sometimes also be effective. Take hold of the heel with one hand and pull the big toe back with the other. You should feel a stretch in the inner sole of the foot. Hold for 30 seconds and repeat a few times a day. For a variation, pull try pulling all the toes back at the same time.
Do you have any tips on dealing with heel pain? Whether you are a therapist or a runner, we would love to hear from you in the Facebook Comments section below!