Running is a repetitive activity that places substantial force on the lower body, with the heel absorbing a significant portion of that impact. Experiencing heel pain while running is a common complaint among athletes, signaling that the foot structures are being overloaded. Pain is the body’s warning system, indicating that tissue breakdown is occurring faster than the body can repair it. Understanding the specific location and nature of this discomfort is the first step toward identifying the underlying cause, whether it is a common soft tissue strain or a more serious structural problem.
The Primary Suspect: Plantar Fasciitis
The most frequent cause of pain located on the bottom of the heel is Plantar Fasciitis (PF). This condition involves the plantar fascia, a thick band of tissue spanning from the heel bone to the toes that supports the arch and absorbs shock during running. Repeated stress leads to degenerative changes in the fascia where it attaches to the calcaneus (heel bone), rather than simple inflammation.
The most telling symptom of PF is a sharp, stabbing pain felt during the first steps taken in the morning or after any prolonged period of rest. This characteristic “first-step pain” occurs because the fascia shortens and tightens while the foot is inactive. When a runner begins to move, the fascia is suddenly stretched, causing intense discomfort. The pain often diminishes after a few minutes of walking as the tissue warms up and loosens.
The discomfort often returns and intensifies after long periods of standing, walking, or during and after a run, reflecting continued mechanical strain. Physical examination reveals localized tenderness directly on the medial tubercle of the heel bone, the insertion point of the plantar fascia. This condition is common, affecting roughly 10% of the population, and accounts for up to 80% of all cases of heel pain.
Other Common Running Injuries Affecting the Heel
While Plantar Fasciitis is the most recognized culprit, pain can also stem from other areas around the heel, each with a distinct presentation. Achilles Tendinopathy causes pain and stiffness at the back of the heel where the Achilles tendon inserts, or higher up in the calf muscle. The pain is generally described as a dull ache and can be worse in the morning or after periods of rest, but the location is clearly posterior, not on the sole of the foot.
A more serious, though less common, cause of heel pain is a Calcaneal Stress Fracture, a tiny crack in the heel bone itself. This injury presents as deep, internal bone pain that consistently worsens with weight-bearing activities, including walking and running. A common clinical sign is extreme tenderness when the heel bone is squeezed from the sides, and the pain does not ease with activity, unlike the temporary relief seen with PF.
Another condition is Fat Pad Atrophy, which involves the thinning or loss of elasticity in the fatty tissue that cushions the heel bone. The pain is a deep, bruise-like ache felt directly in the center of the heel. This discomfort is aggravated when standing for long durations or walking barefoot on hard surfaces, as the compromised fat pad is less able to absorb impact. The pain tends to build up throughout the day with increased activity, rather than being most intense upon first steps.
Training Errors and Footwear as Contributing Factors
The majority of running-related injuries, estimated to be between 60% and 70%, are linked to errors in training regimen. The most common mistake is violating the “too much, too soon” principle, where a runner increases mileage, intensity, or frequency too rapidly without allowing the body adequate time to adapt. This sudden overload prevents bones, muscles, and tissues from repairing the microdamage sustained during each run, ultimately leading to overuse injuries.
Footwear plays a significant role in managing the forces applied to the heel and arch. Wearing running shoes that are worn out or have lost their shock-absorbing capacity increases the mechanical stress on the foot. Running in shoes that lack proper support or are inappropriate for the activity can also contribute to heel issues. Biomechanical factors also predispose runners to heel pain; for example, excessive inward rolling of the foot (overpronation) or high arches can place abnormal strain on the plantar fascia.
When to Seek Professional Medical Attention
While many cases of heel pain can be managed effectively with simple self-care measures, certain signs warrant prompt consultation with a healthcare professional, such as a doctor or physical therapist. If the pain is severe, or if you experience a sudden inability to bear weight on the affected foot, seek immediate medical attention. These symptoms could indicate a more acute injury, such as a severe tear or a bone fracture.
You should also schedule an office visit if the pain persists for more than two weeks despite consistent rest and home treatment, or if the discomfort is present even when you are not standing or walking. Initial self-care involves following the RICE protocol: Rest (temporarily stopping running and high-impact activities), Ice (applied to the painful area for 15 to 20 minutes several times a day), and Elevation (if swelling is present). Utilizing over-the-counter pain relievers and ensuring you wear supportive shoes, even around the house, can help manage symptoms until a professional diagnosis and tailored treatment plan can be established.