Heel Pain After Running: What Are the Possible Causes?
Heel pain after running troubles recreational and competitive runners alike, and for some it becomes persistent. As a sports medicine doctor, it’s one of the most common complaints I see in runners — and it has several causes, not just one. This guide explains the key causes of pain in the heel after running and how we reach the right diagnosis, so treatment starts early and you get back to running sooner.
Why does heel pain occur after running?
The heel strikes the ground first with every stride, so repetitive impact stresses the bones, tendons, and nerves around it. Excessive mileage, poor footwear, or biomechanical issues overload these structures and produce heel pain. Plantar fasciitis is the most common cause — but not the only one, so careful assessment matters.
Common causes of pain in the heel after running
Plantar fasciitis
Plantar fasciitis irritates the thick band running from the heel bone to the toes. Runners feel pain at the bottom of the heel, worst with the first steps after rest or in the morning. It may ease during a run and flare afterwards; in severe cases it hurts throughout and makes running hard.
Calcaneal stress fracture
A calcaneal stress fracture strikes long-distance runners and those who ramp up training quickly. The pain is deep and constant, worse with walking and running, and often felt at the side of the heel rather than underneath. Unlike plantar fasciitis, warming up brings no relief, and you may limp.
Insertional Achilles tendinopathy
Insertional Achilles tendinopathy causes pain at the back of the heel where the Achilles attaches, especially with uphill training or poor heel support. Expect morning stiffness, sometimes a visible lump, and worse pain in tight shoes.
Baxter’s nerve entrapment
Baxter’s nerve entrapment compresses a small nerve near the heel, causing burning pain or a numb heel during running. Unlike plantar fasciitis, there’s no morning pain, and the tender spot sits at the medial arch rather than under the heel.
Other, less common causes include fat-pad atrophy, subtalar joint arthritis, bone growths, sural nerve entrapment, and referred pain from the lumbar spine.
Heel pain after running: causes at a glance
| Heel pain cause | Where it hurts | Morning pain | Key clinical clue |
|---|---|---|---|
| Plantar fasciitis | Inside heel | Yes | Warms up with activity |
| Baxter’s nerve entrapment | inside heel to medial arch | No | Worse with activity and numbness |
| Calcaneal stress fracture | inside and outside of heel | No | Worse with activity |
| Insertional Achilles tendinopathy | back of heel | Yes | pain in the back of the heel, lump |
How do we assess heel pain in runners?
The history does most of the work. I ask when the pain started, what triggers it, whether it eases or worsens with activity, and about morning stiffness. Training changes are crucial — shoe wear, surfaces, and recent jumps in volume or intensity. I also ask about past stress fractures and bone-health risks such as vitamin D deficiency, low bone density, irregular periods, or disordered eating.
Examination pinpoints the tender structure: the medial heel in plantar fasciitis, the back of the heel in Achilles tendinopathy, a deep ache on squeezing the heel in a stress fracture, and the medial arch in Baxter’s nerve entrapment. I also check ankle and subtalar movement, gait, and foot posture, and explore any numbness or tingling that hints at nerve entrapment or spinal referral.
Imaging for heel pain
Imaging isn’t always needed when the picture is clearly plantar fasciitis. It becomes essential when symptoms are atypical or pain won’t settle. Ultrasound is the usual first choice — it shows the plantar fascia, Achilles, bursae, and surrounding tissues, and can reveal subtalar joint swelling. MRI is best for a suspected calcaneal stress fracture, detecting bone marrow oedema before a fracture line appears, and it also clarifies nerve compression and fat-pad problems. X-rays rule out bony causes such as spurs and bone growths.
Frequently asked questions about heel pain after running
Why does my heel hurt after running but not during?
Classic for plantar fasciitis — the fascia loosens as you warm up, then stiffens and aches once you stop and cool down. A stress fracture, by contrast, tends to hurt during the run too and doesn’t ease with warm-up.
Can I keep running with heel pain?
Sometimes — if the cause is plantar fasciitis or early Baxter’s entrapment and you keep pain below about 3/10 during and after. But a suspected calcaneal stress fracture means stop running and get assessed, because running on it risks a full fracture.
When should I see a doctor about heel pain after running?
See a sports doctor if the pain persists beyond a few weeks, is deep or constant, doesn’t ease with warm-up, or comes with numbness or tingling. Early, accurate diagnosis is the fastest route back to running.
How do I know if it’s plantar fasciitis or something else?
Location and timing are the giveaways — see the table above. Under-heel pain with morning stiffness points to plantar fasciitis; side-of-heel constant pain suggests a stress fracture; a burning or numb medial arch suggests Baxter’s nerve. Imaging confirms it when the picture is unclear.
Final word from Sport Doctor London about pain in the heel after running
Heel pain after running needs careful assessment to find the true cause. Plantar fasciitis is most common, but stress fractures, Achilles tendinopathy, and nerve entrapment all masquerade as it — especially when symptoms are atypical or stubborn. If persistent heel pain is keeping you off the road, a sports medicine assessment gets you the right diagnosis and the fastest route back to running.
To book a one-stop heel pain assessment with Dr Masci in London, contact his team here or call +44 (0) 203 488 0350.
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