Heel Pain While Running? Why It Might Not Be Plantar Fasciitis
- Marie Whitt
- Jul 14
- 7 min read
You read that title correctly.
Here's why:
"I had to stop running last week as there were pains behind and under my heels. Nothing to do with the skin etc (no visible bruise or cuts etc), but it feels like internal bruising."
"My heels have had a burning feeling when I walk and are sore to the touch especially in the morning. But when I run it seems to not even affect me at all?"
"Everyone says I have plantar fasciitis but I've stretched my calves, massaged my arches with a lacrosse ball, even tried a night splint. But none of this is working and I'm not any closer to getting back to running.
What you need to know as a runner:
Not every heel pain is plantar fasciitis, even if the internet likes to think so.
A more accurate name or descriptor that's used now is plantar heel pain.
Plantar heel pain is defined as pain experienced in the middle of your heel on the plantar aspect (the bottom of your foot), most notable where the plantar fascia inserts into the calcaneus (your giant heel bone).
However, a lot of runners describe their pain as traveling as far as half way up their foot.
But what's most interesting is that it's common for a runner with plantar heel pain to also be struggling with some sort of tendinopathy elsewhere in their legs (knees, achilles, etc).
So why is it a problem if every instance of heel pain gets labeled plantar fasciits?
Mostly because there are a handful of other issues that present that same way:
fat pad atrophy (the fat pad sandwiched between your skin and your heel bone atrophies)
fat pad contusion (that same fat pad becomes bruised after an aggressive impact like jumping)
low back pain (low back refers to all sorts of weird places)
Baxter's neuropathy (meaning a nerve around your ankle is compressed)
calcaneal stress fracture (a teeny tiny fracture in your heel bone can be very unpleasant)
and even plantar fascia rupture (you'd know if this was you...)
Don't freak out. No, your foot will not fall off.
I'm only listing these so you realize that if what you're doing isn't working, it's not necessarily your fault.
There could be something else going on.
The "something else" that runners should be aware of:
a calcaneal stress fracture
and
Baxter's neuropathy
Breezing through these quickly:
a calcaneal stress fracture is difficult to acquire, but I have seen a runner do it. If you want to test it for yourself, cup your heel and squeeze. And also go get checked out by a physician if you're able to reproduce your pain.
The Baxter's neuropathy simple means there's a nerve that loops underneath your outer ankle bone and it's compressed. If you tap the area below that bone, you're tapping relatively on that nerve. If that reproduces your pain, go get that check out too.
So what's a runner to do?
Regardless of whether plantar heel pain is cleanly defined or diagnosed, we still know that heavy strength training helps.
So, no, you're not left hopeless.
You don't have to stop running.
But you do need to get to work on these exercises ;)
Let's jump in.
Plantar Heel Pain Relief Circuit: Support Your Return to Running
Circuit:
2-3 sets each // LIGHT & medium weights
Runner's Foot Plank on Edge of Step
5 sets X 45 sec hold
adding weight as able for RPE of 7 (hold onto weight with one hand, hold on to wall with the other)
Isometric Calf Raise with towel under toes
5 sets X 45 sec hold (adding weight as able; optional to add in HK)
Single Leg Deficit Calf Raises with towel under toes
Week 1-2: 12RM for 3 sets
Week 3-4: 10 RM for 4 sets
Week 5 +: 8RM/ 5 sets
Wall Plank Power-Up Calf Raise
3-4 sets X 10 ea side with 3 sec descent heel to floor
Overhead Weight Tip Toe Walk
3 sets X 10 yards total @ RPE 6-8
Exercise Breakdown: for Heel Pain that's NOT Plantar Fasciitis
Runner's Foot Plank on Edge of Step
It's so simple, but it's one of my favorite exercises ;)
THE SECRET: sometimes simple exercises like this isometric are the best for pain management and creating a strong foundation, especially when it comes to foot strength. I've talked about this exercise so many times in other blog posts, but what I want you to take away here is the number of reps and how long you need to hold them.
Isometrics like this with sustained holds are excellent at beginning the remodeling process, a fancy way to saying healing degenerated, damaged connective tissues like your plantar fascia. But what's fun is adding a heavy weight...when you're ready.
The beauty of this exercise is that body weight is sufficient especially if things are flared right now. But it's easy to progress by adding weight when you're ready.
Isometric Calf Raise with towel under toes
This one simple hack could everything.
PRO TIP: there's a reason for the towel roll. And it's called the windlass mechanism. Your plantar fascia needs to be strong in its shortest position but also it's longest position. But propping your toes up onto a towel roll, we stretch and lengthen that plantar fascia as much as we can into a position resembling the extremes of your running stride (at least at the level of your feet).
By then performing a static or isometric calf raise here (meaning come up onto your tip toes and hold!), we continue to load up that plantar fascia, asking it get stronger, but without creating too much demand incase you're experiencing pain.
Single Leg Deficit Calf Raises with towel under toes
an oldie but a goodie we can't forget.
THE REASON: you'll notice there's not dedicated a video for this one only because it's been done a thousand times. Single leg deficit calf raise videos can be found aplenty on the internet. But what you care about is the windlass mechanism, aka the towel roll you place under your toes, just like in the previous exercise.
Again, we want to place max stretch or strain on your plantar fascia but now, by performing a deficit calf raise, we begin to add load to the structure, strengthening both it (the plantar fascia) and all the other structures connected to it like your gastroc.
Wall Plank Power-Up Calf Raise
There's a method to madness.
THE KEY: yes, you still need to do weighted calf raises like we've talked about before in other blog posts, but there's something to be said for combining power and eccentric strength together. By landing on your tip toes during that quick switch, you're asking your plantar fascia, intrinsic feet muscles, and calf muscles to "brace for impact" or absorb energy-load. And since running is a high impact sport, this is just one way to simulate that in lower-stress environment.
Don't forget: You land on your tip toes and you control that slooow descent of your heel to the ground for 3 secs for eccentric strength gains.
Overhead Weight Tip Toe Walk
talk about a balance challenge...
MY TOP TIP: don't sleep on this exercise. I need you up on your toes, as high as you can go! While also keeping those elbows straight, pushing that weight towards the ceiling the entire time.
I love using this exercise for runners because you can spice up this balance challenge by performing high knees rather than simply stepping forward (but it's not necessary!)
however, if you do, you'll feel just how hard your feet and calves are working to keep you upright and that's how you know that plantar fascia is working over time to stay strong and provide arch support throughout this entire exercise the resembles your running stride.
WRAPPING UP
But how do I know whether I should keep running or not?
There aren't clear cut rules. So some of this is up to your discretion.
However...
Here are some guidelines that we can pull from tendinopathy research.
*record scratch*
Tendinopathy? I thought we were talking about plantar heel pain?
We are.
But it's worth while noting, your plantar fascia is probably involved in some way.
And...there are TONS of itty bitty muscles, and therefore tendons, in your feet.
Which makes the likelihood your plantar heel pain being tendon related, a lot higher.
So the running guide-rails I gives my runners while they rehab from heel pain:
Cut volume and intensity back to 50% to begin with
It's ok to run if your pain improves after you warm up
It's ok to run with mild pain (3/10), but be cautious while increasing distance
You'll know you've gone too far if the next morning, you have increased stiffness or increased pain (meaning greater paint than your "normal" amount).
Yes, I know a 50% cut back can feel dramatic.
Yes, I eventually I want you to be able to tackle your workouts and build your mileage again.
But I actually want to keep you running as much as possible DURING your rehab-come back.
*yes you read that correctly.
This is because of tissue capacity.
There are times where we need to stay off our feet and NOT run. But in instances where we can keep you running, your body fares better (not just your mental sanity).
Running is load by itself.
And keep your body exposed to some of that load helps you maintain a portion of "running-made" foot and leg strength (yes, you still need to strength train).
That "running-made" strength translates into tissue capacity, or how much load that tissue can tolerate (aka how much running it can handle).
By keeping you running as much as possible, but within reason and managing pain levels, we not only preserve your fitness, but help with your recovery, avoiding a rebound injury.
So If you're looking for more foot, calf, and achilles strength training specifically made for runners to keep you running strong, avoid further injuries, and even help you chase down your next PR, check out my FRE Calf & Achilles Cure.
I made it for the marathoner who wants to keep running, protect their training cycle, and finish strong during their next race.
Until next time running fit fam...
Dare to Train Differently,
Marie Whitt, PT, DPT // @dr.whitt.fit
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