Ask The ST Run Expert

Pain in heel linked to repeated stress of foot

Q I am a runner and I am training for an upcoming race. However, in the past few days, there has been a stabbing pain in the heel whenever I put weight on my foot. What is the problem and are there ways I can reduce the pain?

A You may have heel spur syndrome, also known as plantar fasciitis. It typically causes a sharp stabbing pain at the bottom of the heel.

This can make running and sometimes, even walking, very painful.

Runners with heel spurs usually get the pain at the beginning of the run and it can slowly improve as the distance increases.

Some runners feel a longer lasting ache and soreness in the heel after a run. In some cases, the pain is so severe that the person is unable to run.

This is caused by a chronic injury to the plantar fascia, a long tendinous structure at the bottom of the foot that attaches to our toes in the front and to the heel bone at the back of the foot.

Repeated strain and stress can cause chronic injury to the insertion of the fascia at the heel bone, which results in pain.

Over a prolonged period, calcium is deposited there, resulting in the appearance of a heel "spur" on an X-ray scan.

To ease the pain, daily stretching - once or twice a day - of the plantar fascia and calf muscles is very effective.

But if the pain persists, visiting an orthopaedic or sports doctor is a good idea.

Your doctor will check the foot for other causes of heel pain, such as pain from the Achilles' tendon or, in some cases, a stress injury of the heel bone.

He will then discuss the different treatment options with you.

If your foot is too flat or high arched, it is good to visit a trained podiatrist for insoles that can be used in your running shoes.

Taping the plantar fascia and wearing a splint at night to stretch the fascia are also useful measures.

If you continue to run, check the soles of your running shoes for wear and tear.

If the sole is worn or the material has hardened, it is good to get a new pair of running shoes.

You should also consider getting a shoe that is suitable for your running style. For example, heel strikers would benefit from a shoe with a more cushioned heel.

Though still controversial, some runners experience relief from heel pain when they switch to a midfoot or forefoot running style.

Plantar fasciitis generally responds well to treatment. Most runners with heel pain will feel much better within a few months.

However, temporarily reducing the distance you run may help with recovery. During this period, cross-training with either cycling or swimming is a good way to keep up your exercise routine.

Unfortunately, there are some cases where the heel pain persists despite simple treatment.

You can discuss further treatments with your orthopaedic or sports doctor. This can include steroid injections or shockwave treatment.

There is some evidence that platelet-rich plasma (PRP) injections are useful for plantar fasciitis.

For some patients who still have persistent pain, minimally invasive radio-frequency treatment and a release of the tight plantar fascia can offer relief.

Dr Tan Ken Jin

Orthopaedic surgeon at Mount Elizabeth Novena Hospital

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A version of this article appeared in the print edition of The Straits Times on June 20, 2017, with the headline 'Pain in heel linked to repeated stress of foot'. Print Edition | Subscribe