We all know that exercise is a great way to get (and stay) fit and healthy. It’s good for body and soul, but what happens if your exercise causes pain? Heel pain after running is an experience that can sideline runners of all ages and fitness levels. If you have heel pain after running, here’s everything you need to know about it (and how to fix it when it happens).

Why do I have heel pain after running?

We ask a lot of our feet every day, and our heels take a huge brunt of that force. Our feet are incredibly complex and contain 25% of the bones in our body; 100 ligaments, muscles, and tendons; and over 30 joints.

The calcaneus (the heel bone) is the largest bone in the foot. It forms one angle in the essentially triangular shape of the bottom of the foot. The talus bone (our ankle bone) rests on top of the calcaneus. We also have three large bones – cuboid, navicular, and cuneiform – that rest at the base of our toes (what is frequently referred to as the balls of the feet).

Finally, we have the toes, made up of phalanges and metatarsals.

Connecting all of these bones and optimizing our movement and support are muscles, ligaments, and tendons. The heel bone is the origin of the Achilles tendon, a tendon that attaches the calf to the heel itself.

The anatomy of our individual feet determines the placement of the arches of the feet. Together, the heel and arch of the foot distribute the force placed upon the foot as it moves across the ground. This allows us to walk comfortably over uneven surfaces.

There are a variety of reasons why you might develop heel pain after running. The force placed upon a foot when running is three or more times that person’s body weight. This force alone, over time, can strain the structures of the foot and cause pain.

What causes heel pain after running?

A person’s risk of developing heel pain after running can increase or decrease depending on a variety of causes.

Considering the force on our feet, we can break down the reasons why we have heel pain after running into three main categories:

1. Plantar fasciitis
2. Structural issues
3. Poor movement (leading to injury or strain)

Plantar fasciitis

Plantar fasciitis is the most common cause of heel pain from running.

The plantar fascia is a thick, ropy tendon that connects the ball of the foot to the heel. It offers support in the arch of the foot and helps to absorb much of the impact as we walk, run, and go about our daily business.

With overuse, misuse, or injury, this tendon can become inflamed due to overstretching or tearing. In addition to pain that ranges from mild to excruciating, you might also experience one or more of the following symptoms:

• Stiffness at the heel
• Sharp pain in the morning when first putting weight on the foot
• Visible swelling and redness
• Aching arches of the feet

If you experience heel pain after hiking (or running), it’s likely that plantar fasciitis is the cause. Just over 10% of all adults in the U.S. will experience this condition at some point in their lives.

Left untreated, your feet form protective bone spurs on the heel. This is the foot attempting to offer more bony support of the body, but what actually happens is it increases the pain and may require surgery to resolve.

An estimated 70% of people who experience plantar fasciitis also develop bone spurs as a result.

Structural issues

Structural issues in the foot, especially combined with overuse, misuse, or unsupportive footwear, can lead to heel pain after running.

One of the main structural concerns in the foot is the arch. The arches of the foot are like shock absorbers. If they are too high, the shock is concentrated at the apex of the arch. Too low, and there isn’t much shock absorption happening at all. Both of these can lead to excessive strain on the plantar fascia. Further, bone spurs are more likely to develop when the arches are either too high or too low.

Other structural issues that can lead to heel pain when running include:

• Muscle weakness in the calves and other supporting muscles
• Poor alignment (e.g., if the ankles roll inward or outward)
• Injuries or structural issues in the knee or hip that cause a change in the way you use your feet

This last structural issue is more common than you might think. Our bodies are designed to accommodate injury wherever it occurs. Sometimes this means a shift in how we use our feet, even far away from the injury.

Poor movement (leading to injury or strain)

Poor movement, or exercising on unforgiving terrain that causes you to shift your gait, can also lead to heel pain after running.

Runners with weak bones in the feet may experience undetected small fractures that shift their movement slightly. This slight movement adds up when running and hiking (or even walking) long distances.

Falling into the category of poor movement is also excessive movement. Even the most dedicated athletes require cycles of activity and rest. If you are not allowing your body periods of rest and recovery, especially after intense activity, your feet will surely let you know.

Finally, where we run or hike matters when it comes to keeping our feet healthy and strong. Running over rocky, uneven terrain or only sticking to hard, unforgiving pavement can lead to heel pain when running.

Other causes

There are other causes of heel pain after running that are less common but can occur. These include:

• Sever’s disease
• Achilles tendonitis
• Arthritis

Running or other vigorous exercise may not cause these conditions, but their presence can contribute to pain afterwards.

How to prevent heel pain after running

For mild heel pain after running (or heel pain after hiking), the best treatment is really an ounce of prevention.

The first step starts with the basics. Selecting and fitting the best shoes for plantar fasciitis prevention is crucial. If you are an avid runner or hiker, take the time (and spend the money) to go to a shoe store that specializes in properly fitting shoes for exercise. They will analyze your gait and offer several options so you can find the most supportive and comfortable shoes possible.

Other ways to treat mild heel pain after running include the following:

• Rest: Few athletes like to take time off, but tendon injuries require rest. If you experience mild foot soreness after exercise, take a day or two off.
• Ice: Ice is a good idea after running or hiking. Whether you have side heel pain after running or back of heel pain after running, concentrate the ice in that area. Follow a 20 minutes on – 20 minutes off schedule for a couple of hours after exercise.
• Stretch: Even without heel pain after running or hiking, stretching the feet keeps them healthy. You can select a full-body yoga practice that focuses on the feet, or just complete a few foot stretches every day for happy, healthy feet.

The above suggestions are for mild, normal aches that runners or hikers might experience. For long-term healthy, happy feet, these can be applied even when feet aren’t hurting.

If you experience more extreme heal pain, or pain that does not subside after the above treatment and prevention options, it’s time to see your doctor.

Common heel pain treatments

Even the most diligent runners and hikers may experience heel pain that doesn’t go away without further treatment. Here are nine steps you can take (pun intended!) to fix heel pain after running.

1. Medications

Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen sodium can help relieve the pain and inflammation of heel pain after running.

2. Rolling massage

Place a tennis ball (or other ball designed for this purpose, like a lacrosse ball) under the arch of your foot and roll all around, placing weight as you can. It can sometimes help to place all of your weight on the ball for a few breaths, releasing after a bit.

You can also freeze a bottle of water and roll that under the arch of your foot to combine the benefits of ice and rolling massage.

3. Tape the foot

Use athletic tape to provide your arches with more support.

Taping can not only provide support for the arches but can also protect against shin splints (another common and painful condition among runners).

4. Use orthotic inserts

If spending money on proper shoes is not in your budget, protect your feet from further damage by finding (and consistently using) orthotic inserts.

Your doctor can recommend custom orthotics, but a temporary fix can be found in the pharmacy as well.

5. Night splints

If the cause of your heel pain after running is plantar fasciitis, a night splint can help. This keeps your foot in a flexed position overnight, preventing the plantar fascia from shortening (and causing pain with that first step in the morning).

6. Maintain a healthy weight

It seems counterintuitive to prescribe weight loss or healthy weight maintenance when pain in the feet prevents you from moving, but the less weight we carry in our bodies means less force on our feet.

If heel or foot pain is keeping you from weight-bearing exercise, consider swimming, cycling, or yoga as you recover.

7. Physical therapy

A skilled physical therapist will design and guide you through a personalized sequence of stretches and strengthening moves to prevent help pain after running.

8. Injections

For pain and inflammation, injections into the bottom of the foot can help.

Some studies have shown that Botox injections for plantar fasciitis may be even more effective than corticosteroid injections, but talk to your doctor about all available options.

9. Surgery

Always a last resort, foot surgery may nevertheless be required to relieve chronic, intractable heel pain. There are a variety of surgeries available. The one that works best for you depends entirely upon the cause of your heel pain after running.

At Arizona Pain, we want to help you enjoy all of the beauty the Arizona outdoors has to offer. We want to keep your feet happy and healthy for whatever activity you choose.

If you are experiencing heel pain after running (or any type of foot pain) and want to find a comprehensive treatment plan, get in touch today!

Getting a full, restorative night of sleep is something we take for granted, that is, until foot pain at night keeps us tossing and turning. Our feet work hard to support us every day, with little reward or attention until something goes wrong. When you begin to experience foot pain after lying down, here are our tips to relieve foot pain at night.

What causes foot pain at night?

We might be used to foot pain after a long hike or a grueling day on our feet, but there are other foot pain causes that aren’t necessarily connected to these common events. Foot pain can occur in anyone at any age. Child foot pain at night, in particular, can be especially challenging.

Here are the most common causes of foot pain, in adults and children alike.

Plantar fasciitis

The plantar fascia is a long band of connective tissue that stretches from your heel to the ball of the foot. It provides stability for walking and support for the arch of your foot. When the plantar fascia is injured due to overuse (or improper use), inflammation and tightness can cause tremendous foot pain at night.

This condition is known as plantar fasciitis. During the night, your plantar fascia may shorten as the toes point in sleep, making the first step in the morning excruciating. This pain generally gets better for a short period as the day continues, but after a full day of movement the pain flares up, resulting in foot pain at night.

Reflex sympathetic dystrophy

When the foot is injured, swelling and pain are the body’s reflexive, protective response. This tells you something is wrong so that you slow down and care for the injury.

However, sometimes the body takes it too far, offering an abnormal nerve response with excessive swelling, pain, and even temperature changes. The nerves of the foot are essentially hyperactive in their response. This can lead to very sensitive feet that experience painful sensations even with the slightest touch.

Peripheral neuropathy

Peripheral neuropathy involves pain in the nerves reaching towards the extremities. An injury the sciatic nerve, for example, can cause pain all the way down to the feet (where the nerve ends).

Other causes of this type of pain include poorly controlled diabetes (both types I and II), infections, and vitamin deficiencies.

Chronic overconsumption of alcohol

Overconsumption of alcohol leads to poor circulation in the body and a condition called alcoholic neuropathy.

In addition to foot pain at night, symptoms of this condition may also include:

• Burning sensation in the feet
• Muscle spasms
• Loss of muscle control or weakness

Morton’s neuroma

Affecting more men than women, Morton’s neuroma is the thickening of the nerves surrounding the toes—most often the third and fourth toes.

People with this condition experience burning, tingling, and cramping, all of which worsen at night.

Pinched nerves

Pinched nerves in the legs, hips, back, and feet can cause excessive foot pain at night.

In some cases, this occurs as a result of sleeping position. Minor adjustments can go a long way towards relieving this type of pain. In others, the pinched nerve becomes damaged due to injury or other trauma and must be treated to provide relief.

Restless leg syndrome

Those with diabetes, rheumatoid arthritis, low iron, and kidney failure may be familiar with restless leg syndrome that leads to nighttime foot pain.

With this condition, a dopamine imbalance confuses the nerves responsible for sending signals to the brain. More than just legs that cannot seem to be still, this syndrome also comes with burning, tingling, numbness, and pain after lying down. These symptoms occur from the waist down, including the feet.

Bunions

Bunions are hard deposits of bone on the side of the foot just below the big toe or pinkie toe joint (sometimes both). Left untreated, bunions can result in toe pain at night that feels like a stabbing pain sideways through the foot.

Swelling, stiffness in the morning, and soreness at the affected toe joint are also common.

Child foot pain at night: growing pains

The most common cause of child foot pain at night (and one that can wake your children from sleep) is growing pains. Most people assume that growing pains are caused by spurts of growth in the bones that outpace muscles, tendons, and ligaments, but bones grow at an approximately even pace throughout development.

In many cases, growing pains are actually caused by other mechanical issues, such as:

• Gait imbalances
• Structural issues (i.e., being knock-kneed or pigeon-toed)
• Poor posture
• Flat feet or feet that point outwards
• Fatigue

All of these can lead to what feels like shooting, stabbing pains in the feet at night. Typically, growing pains are more severe at night and ease with activity.

When should I see a doctor for foot pain at night?

As stated above, occasional foot pain at night due to a long day or a grueling hike might result in sore muscles all over the body, including the feet. This type pain is nothing to be concerned about and should pass quickly.

However, you should consider seeing a doctor for foot pain at night if your foot pain:

• Is not related to abnormal exertion
• Persists for more than a night or two
• Begins to worsen
• Begins to change or move further into the body (i.e., calf pain or knee pain occurs, too)
• Impacts your mobility during the day
• Is accompanied by visible redness or swelling that is unrelieved by comfort measures (e.g., rest, ice, elevation, and over-the-counter medications)

Foot pain that lasts longer than a couple days is not always a cause for alarm, but it’s best to get it checked out just in case.

How to relieve foot pain at night

The best way to ease foot pain at night is to develop a toolkit of therapies that address the root cause of foot pain while relieving symptoms so you can get a full night’s rest.

Here are our tips for relieving your nighttime foot pain. Always discuss the best course of treatment with your doctor.

1. Start with a proper diagnosis

Successful treatment depends on a proper diagnosis of the cause of your pain. If you simply treat symptoms without addressing the underlying cause, you will continue to experience worsening symptoms (and may cause permanent damage).

2. Rest

Sometimes foot pain at night is a result of a pain condition that worsens with activity during the day.

If you can, takes some time off of your feet, resting those hardworking muscles, tendons, and ligaments.

3. Apply ice

Ice is a magical, free treatment that can ease pain and swelling and provide comfort to feet that ache at the end of the day.

If your feet are red, swollen, or painful to touch, apply ice on a 20-minutes-on, 20-minutes-off schedule for a couple of hours, elevating your feet if possible as you ice.

4. Consider over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs)

When taken correctly, NSAIDs like ibuprofen and naproxen sodium ease pain and reduce swelling. Talk to your doctor about taking NSAIDs before bed to ease your nighttime foot pain.

5. Check your mattress

Sometimes pinched nerves and nerve pain come down to your mattress. Too soft and your body collapses in on itself at night. Too hard and you cannot find a comfortable release into sleep.

You want a mattress that is just right, offering firm support that is also soft and comfortable. Shop for a mattress with a return policy that allows you to test it out and return it if it’s not right for you.

6. Wear a nighttime splint

One of the key treatments for foot pain caused by plantar fasciitis is a nighttime splint.

This keeps the foot in a flexed position so that the plantar fascia does not contract at night. A contracted plantar fascia can mean an incredibly painful first step in the morning. The splint helps maintain the natural length of this crucial tendon.

7. Try yoga

Our feet contain 25% of the bones in our body, have over 30 joints, and are made up of more than 100 muscles, tendons, and ligaments. Yoga that focuses on releasing, strengthening, and stretching the feet can help them become more balanced and suppler.

Find a great video of foot yoga, or bring together a few good stretches and massages for the feet on a daily basis.

8. Refine your nighttime routine

Consider revamping your entire nighttime routine to set the scene for a good night of sleep.  Keep your bedroom cool and dark, and reserve it only for intimacy, sleep, and reading before bed.

Develop a consistent nighttime routine that gets your body ready for sleep.

• Drink a relaxing herbal tea (lavender, chamomile, and valerian are all good choices)
• Give your feet some attention before bed by trying yoga for feet at night or self-massage
• Go to bed at the same time every night and wake up at the same time, too
• Turn all screens off at least one hour before bedtime

A nighttime routine helps you mark the end of the day and signals your brain to rest. This alone can go a long way towards a better and more healing night of sleep.

9. Explore physical therapy

Physical therapy helps to gently stretch and strengthen the feet, more so than simple exercise on its own. A physical therapist can also conduct a gait analysis to see if there are structural or mechanical issues that are causing your foot pain.

10. Ask about prescription medications

Although opioid therapy is not indicated for most types of chronic foot pain, there are prescription medications that may offer some relief.

For example, pregabalin, gabapentin, and duloxetine are medications that are used to treat nerve pain, including nerve pain in the feet. Depending on the cause of your pain, your doctor may also recommend muscle relaxers.

11. Try TENS unit therapy

Transcutaneous electrical stimulation (TENS) is a non-invasive treatment option that delivers a mild electrical current to replace pain signals to the brain.

While this does not address the underlying cause, it may help you rest as you try other treatments at the same time.

12. Consider injections

An injection of corticosteroids and a local anesthetic can be used to ease inflammation and swelling that leads to foot pain at night. For radiating foot pain that occurs due to sciatica, an epidural steroid injection or a lumbar sympathetic blockade may help ease pain.

13. Look at more interventional treatments

When conservative treatments do not provide relief, you may find that more interventional treatments are necessary. Spinal cord stimulation and other surgical interventions might be necessary to relieve your foot pain at night.

These more advanced procedures should always be done as a last resort, after you’ve attempted other more conservative therapies.

Learn more

At Arizona Pain, our goal is to help you get a good night’s sleep with the most comprehensive treatment approach possible. Our integrated pain management approach incorporates multiple therapies so you can get back up on your feet as soon as possible.

If you experience foot pain at night, schedule an appointment today to discuss all of your options.