Dear Doctor: I recently began running again after a six-year hiatus. My only problem is that my heels hurt after I run -- so much so that I limp for a few minutes the next morning until my body adjusts. As the day progresses, I stop noticing the pain. Any suggestions?
Dear Reader: Running is supposed to be good for you, so it can seem perplexing and frustrating when, instead, it causes pain. In your case, I suspect the cause is plantar fasciitis.
The plantar fascia is a band of thick tissue that attaches to your heel bone (the calcaneus) and extends from there all the way to the base of your toes, providing support for the arch of your foot. Because the plantar fascia is prone to inflammation, it's a common cause of foot pain in adults. This inflammation, known as plantar fasciitis, is most common in adults ages 40 to 60 and accounts for nearly 1 million doctor visits each year in the United States.
One-third of the time, as in your case, the symptoms are on both sides. Runners and dancers are more likely to develop plantar fasciitis than people in the general population because of repetitive trauma. In runners, the pain can be related to poor-fitting running shoes; tightness within the calf, Achilles tendon and hamstrings; flat feet; or running on hard surfaces.
The typical symptom, which you described, is pain in the heel that is noted with the first step out of bed. The pain is sharp and may subside with walking, but may reoccur by the end of the day if an affected person is on his or her feet all day.
Your doctor can usually diagnose plantar fasciitis simply by examination, although he or she may recommend X-rays to rule out other causes for heel pain.
As for what you can do, I would recommend stretching. Tight calf muscles and Achilles tendons can cause the heel to lift so that the contact point with the ground when walking and running is at the area of the plantar fascia. Stretching the calf and even the hamstring can help change that contact point. A foam roller can massage and stretch the calf and hamstring, as can a nighttime splint that keeps the calf stretched and the foot flexed upward. Also, just as stretching the back of the leg is helpful, so is strengthening the muscles at the front of the leg. A physical therapist can recommend specific exercises.
Other pain-reducing tips include buying shoes with good arch and heel support, and using heel inserts to cushion the heel while walking or running. NSAIDs such as ibuprofen and naproxen can decrease inflammation and pain, as can icing your heels after a run.
Finally, you should curtail the running until the pain in your heels subsides. Don't resume it until you've improved your biomechanics through stretching and strengthening exercises.
If the pain persists, a doctor may recommend a steroid injection into the heel, but this should be reserved for people who have not been helped by physical therapy and courses of oral anti-inflammatories.
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