What If Your Heel Pain Isn’t Plantar Fasciitis and What to Do About It

Stay the CourseNothing ruins a perfectly good runner like plantar fasciitis, the dreaded snake bite of the heel and arch of the foot. In essence, its nasty foot pain–particularly heel pain–that prevents us from running. Once it sets in, is one of the most menacing and stubborn conditions.

Ultrarunners seem particularly prone to heel and arch pain. Both uphill and downhill running stresses the foot: the ups stressing the soft tissues of the plantar arch, and the downhills providing ample pounding for the joints.

It’s okay to call your foot and heel pain plantar fasciitis–just like that Coke at the aid station that might be Pepsi or RC Cola. But be sure that you–and your doctor, PT, chiropractor, LMT or other healthcare helpers–are aware of all of the different sources of foot pain. Awareness is the first step in comprehensive treatment and fast recovery from the dreaded “PF” and its brethren.

Plantar Fasciitis, Defined

The plantar fascia is the thick connective tissue that runs from the base of the heel, to the bones of the forefoot. Collectively, with intrinsic foot and ankle muscles, it supports the arch of the foot and helps transfer energy from the forefoot to the rearfoot and ankle, and up the leg.

By definition, in a truly literal sense, fasciitis is an active inflammation of that tissue.

But is foot and heel pain always plantar fasciitis? In a clinical sense, one can only have fasciitis if an active inflammatory event is occurring. Since inflammation only lasts twenty days, indeed, not everyone with persistent foot pain truly has fasciitis.

Not all tissue paper is Kleenex. Not all lip balm is Chapstick. And so it goes, not all heel and arch pain is plantar fasciitis. But as Shakespeare once said, “Is foot pain by any other name, any less excruciating?”

However, to label all foot pain as plantar fasciitis possibly limits one’s ability to quickly and effectively recover from it. Below are some other, equally common causes of foot pain.

Foot Pain: Differential Diagnosis

There are a many possible sources of persistent heel pain and arch pain. Here are the most common I see, clinically:

Soft tissue sprains and strains. There are several major muscles, tendons, and ligaments that span from the heel and ankle to the toes. Besides the plantar fascia, there are several flexor tendons–of muscles originating on the lower leg–that course their way into the foot. Any number of these tissues can become strained under the load of road and trail running. A review of the Rules of Tissue Loading explains how a plantar surface tissue can become irritated.

However, since soft tissue tends to heal quickly given proper treatment, these causes tend to heal rapidly. Those with persistent heel pain and arch pain–who see me and other medical folks after weeks, months, and even years of pain–tend to have a pain generator of different origins:

Joint Pain. There are over two dozen joints in the foot and ankle complex. With the extreme stress of ultra trail running, these joints could become stiff, irritated, or both.

Joints–articulating surfaces of two bones–require but two things to be happy:

  • Full range of motion
  • Symmetrical, equal loading of surfaces

Seems simple, but running hard and long on uneven surfaces can strip a joint of those two things.

Range of motion loss. Joints get the bulk of their nutrition from range of motion. The vast majority of joints in the body are synovial: two bones surrounded by a leathery capsule filled with fluid. The cartilage surfaces receive very little blood flow. In order to receive nutrition, the joint must “lubricate” itself with the fluid of the joint, absorbing nutrients from the fluid along its surface–via regular, full range of motion.

When joints stop moving through their full range, elements of cartilage do not get this nutrition. The cartilage dries up. And it is replaced with bone. This, by definition is osteoarthritis. Preceding that, is pain.

Asymmetrical loading. Joints have the ability to move–sometimes small amounts in one plane; sometimes substantial amounts in many directions. But when running, joint surfaces are designed to be loaded so that the entire surface of one bone impacts flush against the other. This promotes maximum stability; it also ensures that cartilage receives a steady dose of hydration and nutrients.

Asymmetrical loading occurs as the result of abnormal running surfaces–uneven, rocky trails, or a cambered/slanted road–or with inefficient running mechanics.

And when a joint becomes unhappy, it causes pain. Typically, a painful joint will hurt at its precise point of irritation. But joints of the ankle and foot will frequently refer pain to adjacent areas, out the sides or beneath the point of irritation, at times mimicking soft tissue pain.

How can you tell if you have a soft tissue or joint issue? Below are some comparisons:

Soft Tissue Pain Characteristics

  • Succinct, reproducible, palpable tissue pain. Can you find the one spot that is tender?
  • Pain with active use: when you do a toe curl or use the muscle (absent weightbearing), does it hurt?
  • Pain with passive stretch: is pain produced when you bend back your foot and toes? (again, without weighbearing)
  • Pain with resisted testing: when flexing your foot and toes, is there pain?

Joint Pain Characteristics

  • Dull, diffuse pain: no discernible “tender spot.” Rather, it hops around and you can’t put your finger on it.
  • Pain with weightbearing through the joint.
  • Pain is worst in the morning, after prolonged weightbearing, or after resting, then bearing weight through the joint.
  • Non-weightbearing testing–actively flexing and passively stretching the foot–is pain-free.

If your symptoms align with the joint pain characteristics–and if your foot pain fails to respond to soft tissue plantar fascial treatment approaches–you likely have joint pain.

The three usual joint suspects–the talocrural, the subtalar, and the talonavicular–can all become painful and mimic plantar fascial pain. Each joint lies on the medial plantar surface of the foot, and each is prone to stiffness and asymmetrical loading during running.

Neutral foot - side view

Medial view of a foot and ankle model, identifying three common problems joints for runners.

Above shows a medial view of the foot, showing three main joints of the foot. The talus plays a role in all three: it is the go-between from the foot and leg bones.

From above, it forms the talocrural joint. The main motion for this joint is “up and down”–it allows the toe up/toe down action that occurs in the run stride.

This joint is prime to get stiff, especially with repetitive downhill running: rather than smoothly sliding and gliding, hard downhill trail running can cause jamming forces of the talus into the tibia and fibula. And when this joint gets stiff, it can refer pain in any direction around the talus–front or back of the ankle (mimicking both anterior tibialis tendonitis and Achilles tendonitis, respectively), or it can spit pain out the side–namely the medial ankle and arch.

Between the talus and the calcaneus–or heel bone–is the subtalar joint. It is designed to move in several axes, but its primary axis of motion is medial to lateral. This joint is of little consequence to the healthy, normal runner: minor motions occur depending on the gait cycle. However, deviations or inefficiencies–namely in the foot strike pattern–can cause significant pain emanating from the subtalar joint. Excessive lateral foot strike can cause stressful joint compression to the medial aspect of the joint–mimicking plantar fascial pain!

Neutral foot - rear view

Lastly is the talonavicular joint. This joint is the primary conduit from the fore and midfoot to the ankle and leg. The navicular bone is the “keystone” of the arch. Stiffness or irritation here can also cause significant arch pain.

The following are some illustrations of how mechanical forces can cause joint and soft tissue pain:

Foot and shoe position during pronation

Over-pronation, as shown with shoe and joint model.

Pronation + arch collapse - side

Medial view of a collapsed arch.

Excessive medial foot landing leads to over-stressing of the medial arch, or “arch collapse.” This stresses all tissues of the plantar surface and is the primary etiology of true plantar fascial pain.

Equally common, especially for faster trail runners, is excessive lateral foot strike:

Supination - shoe a foot - rear view

Excessive lateral foot strike/supination, as shown with a shoe and joint model.

Foot supination - rear view

Excessive lateral striking significantly compresses the medial joint surface of the subtalar joint. This compression accounts for a large percentage of non-plantar fascial foot pain cases. It refers pain at its site, but also farther down into the arch and along the heel bone.

Too much lateral strike can also cause plantar fascial torqueing: the heel rotating to the right (in the above picture), but the forefoot rotates to the left as it contacts the ground – adding a twisting force to the fascia.

Nerve pain. Perhaps the most unrecognized and overlooked factor in heel and foot pain is nerve pain. The peripheral nerves of the ankle and foot originate in the brain, course through the spine, exit the low back and pelvis, and must course–fluidly–through the soft tissues of the entire leg.

Repetitive impact forces from running–often combined with compromised spine posture from running all day (or, in our normal lives, sitting)–can cause these nerves to develop “hitches.” This is a concept called nerve tension.

Nerve tension accumulates in the spine and legs with age, injury history, and running volume. When nerves lose mobility, they begin to create pain–often very similar to soft tissue or joint pain, including plantar foot pain.

And because the same repetitive or excessive impact forces that create joint and soft tissue pain also create nerve tension, it is very common for a runner to present with both joint/soft tissue and nerve pain overlay at the same time.

Almost every runner (and most other folks) has some degree of nerve tension. Here’s a test:

Sit with your back against a chair, head and shoulders upright. Extend your knees straight, with toes up. Note the degree of “stretch” in the back of your legs. Then, slump your head and shoulders. Any increase in stretch sensation is nerve tension from tensing the nerve at the head and neck.

Nerve Pain Characteristics

  • Pain at rest–the hallmark sign of nerve pain overlay: do you have any symptoms in your foot when at rest, namely sitting (specifically, with prolonged sitting, long after you’ve stood on it)?
  • Symptoms described as burning, buzzing, or dull aching.
  • Other symptoms higher up the leg, specifically: lumbar, buttock, posterior thigh, calf or shin pain.

Very often, a runner who applies soft tissue or joint treatment concepts will get partially better, but fail to fully recover because they fail to address the nerve tension component.

Runners and clinicians, alike, need to recognize the existence of nerve tension and treat it concurrent with any soft tissue or joint irritation.

Treatment Approaches

Please discuss any of the following treatment approaches with your doctor, physical therapist, or chiropractor before performing.

Soft tissue

These are straightforward because everyone who [thinks they have] PF does them:

  • Rest, ice, soft tissue mobilization, stretch, strengthen.

Real, actual soft tissue plantar pain will heal rapidly, given correct doses of the treatments above. Those who do not respond to that approach likely have a joint or nerve issue.

Joint pain

The two treatment approaches to joint pain in the foot include full restoration of joint range of motion and symmetrical loading.

Range of motion restoration

Ankle dorsiflexion. Normal ankle dorsiflexion is about 20-30 degrees beyond a 90-degree bend at the ankle. If you cannot stretch this far–or if you have symptoms in front, or anywhere around the ankle joint–your symptoms might be due to stiffness there. To mobilize a stiff talocrural joint, try the following:

Perform a standard calf stretch, with a few minor adjustments: be sure your stretch foot is perfectly straight ahead. Keep the foot flat, lean forward with a straight knee until full tension. Then, slowly bend the knee as much as possible without allowing the heel to rise. Slowly oscillate between bent and straight knee. This mobilizes the tibia and fibula over the talus, restoring motion to this joint.

wall stretch ankle straight

Wall ankle stretch – straight knee.

wall stretch - ankle bent

Wall ankle stretch: bent knee. Keep the heel as flat as possible.

Subtalar inversion and eversion. A normal heel bone should be able to “wiggle” about 10-20 degrees side to side. To self-test, cross your ankle over opposite knee. Grasping hold of your ankle with one hand, drive firmly downward with your opposite hand on the inside of your heel bone. Can you move it, at all? If not, and you have heel and arch pain on the bottom/medial side of your foot, your symptoms may be coming from stiff subtalar joint.

To self-mobilize, perform the maneuver described above with firm, slow, on-and-off downward pressure. The degree of motion will be slight, but the potential for pain relief is substantial when motion is restored here.

subtalar mobility

The author applying a straight-downward pressure to the heel bone, stabilizing at the ankle. A normal heel will “wiggle” a few millimeters in both up and down directions.

Midfoot arch. A normal midfoot will have some degree of give, both to the hands and when standing on it. In standing, a normally mobile foot should “sink” a few millimeters to the floor.

Shoe orthotics are intended for those who are hypermobile in their arch: their arch joints are excessively flexible, and the arch “collapses” (typically defined as one centimeter or more) in weightbearing.

However, far more often than not, runners have hypomobile arches–they simply don’t move enough. These folks typically respond poorly to orthotics (often with no improvement, and sometimes they worsen pain).

A hypomobile, stiff arch will benefit from self-mobilization. If you have symptoms that originate farther down the foot, near the apex of the arch–and your foot lacks any give in standing–try the following mobilization:

Stand with stiff foot down. Place your opposite heel directly on top of the stiffest area–typically the navicular bone, which lies directly in front of the tibia-fibula complex. Gently, then progressive bear down with substantial weight onto the navicular. This may seem scary–test it first. A stiff navicular will give very little, even with full pressure. Pain usually comes from skin compression. “Stomp” on and off 10-20 times. Perform before and after running, and/or in the morning, when stiff joints tend to be stiffest.

midfoot mobility

The author, performing a mid-foot self-mobilization in standing. Try with soft-heeled shoes on, if too sore with direct skin contact.

Joint Loading Factors

Loading the joint equally is vital to joint happiness. Orthotics can be helpful for those with hypermobile feet, as they can prevent arch collapse. They are also helpful for slower runners with shorter stride lengths. A short stride tends to include excessive vertical forces (up and down motion). This vertical loading bears down on the medial arch–beyond the capability of muscles, tendons, and the plantar fascia to support it. An orthotic can aid in sustaining the arch. But ultimately, an efficient stride that emphasizes normal hip mobility with greater forward momentum is most important in preventing arch collapse.

Other important factors for symmetrical, low-stress loading include the position and angle of foot strike. The foot should always land as close to directly beneath one’s center of mass as possible. A foot that strikes in front, tends to strike:

  • On the heel;
  • On the outside edge of the foot (heel or midfoot); or
  • On the mid or forefoot, laterally-biased.

A heel strike creates considerable stiffness through the talocrural and subtalar joints. A lateral strike might cause asymmetrical loading of the subtalar joint, and/or a twisting, torqueing force through the midfoot and plantar fascia (see photo above). A midfoot or forefoot strike–significantly ahead of the body–will stress out those joints or strain the plantar fascia.

The most simple, sustainable and important way to correct a foot strike issue is addressing it proximally with:

  • Proper forward trunk engagement, and
  • Moving the hips such that the foot is “pulled” beneath the body

After ensuring proper foot placement beneath the trunk, shoot for a whole-foot strike, where all elements of the foot are absorbing and sharing impact forces.

Nerve Pain Treatment

To treat nerve tension, refer to the test above, except make one slight adjustment:

Sit in a chair, slumped forward. Slowly extend the affected leg with toes up. As the foot and lower leg rise, slowly extend your head at the same speed. The degree of stretch should be significantly less, but still present. Hold one second, then slowly lower. This is referred to as a “nerve floss” exercise: the head gives the nerve slack that is taken by the foot, and vice versa. Repeat ten to twenty times, and perform three to four times a day, especially before and after running. Here is a video link for the exercise.

Call for Comments (from Bryon)

  • Have you suffered from heel pain, plantar fasciitis, or other foot pain?
  • How did you heal your plantar fasciitis, heel pain, or other foot pain?
Joe Uhan

is a physical therapist, coach, and ultrarunner in Eugene, Oregon. He is a Minnesota native and has been a competitive runner for over 20 years. He has a Master's Degree in Kinesiology, a Doctorate in Physical Therapy, and is a USATF Level II Certified Coach. Joe ran his first ultra at Autumn Leaves 50 Mile in October 2010, was 4th place at the 2015 USATF 100K Trail Championships (and 3rd in 2012), second at the 2014 Waldo 100K, and finished M9 at the 2012 Western States 100. Joe owns and operates Uhan Performance Physiotherapy in Eugene, Oregon, and offers online coaching and running analysis at uhanperformance.com.

There are 160 comments

  1. Sara

    Joe I just have to say THANK YOU! This is exactly the type of information I needed about the foot issues I have been having! Thank you so much! Now I understand what is going on. Knowing is half the battle!

  2. Dustin

    Hi Joe,

    Well, I find your explanations very helpful, especially in seeing the photos of the foot in a planting motion. I have been running about 25-30 miles per week and have been recently experiencing stiffness/dull pain in my left foot arch when I plant it during my stride. I thought because I have ramped up my speed work over the last month or so that may explain it. Typically after warming up for 15-20 mins the pain will subside. I do not pronate and I figured maybe I should stop after 15 minutes to stretch the foot out, any other recommends for mid workout therapy?

    Thanks!

    Dustin.

    1. OOJ

      Dustin-

      If you do not pronate much, as you claim and your arch is stiff, try the midfoot "stomp" mobilization as shown above. Gently perform before and mid run. Good luck!

  3. Judy

    I would love to find a physical therapist in my area of St. Louis, MO that had as much knowledge and insight into the whole foot/heel pain issues! I have suffered for months and seems like there are about four things going on in my foot. I am thinking it isn't plantar fascitis and hurts all around the heel area then I got a stress fracture from walking out of synch on that foot and am so frustrated. I am a walker and could scream because this won't go away! Do you have a listing of therapists or other professionals who could help like you do? Thanks.

    1. OOJ

      Judy-

      Sorry to hear about your foot!

      I don't have any specific references. My preference is for Certified Functional Manual Therapists – trained in both hands-on techniques and motor control. Here's a listing of those certified, nationwide:

      http://www.instituteofphysicalart.com/ipa/referra

      Unfortunately, I don't see any in the StL area. But ask around – find someone with good hands-on ability who works with runner/walker gait mechanics! Good luck!

  4. Paul Banbery

    Hi joe…really good forum and good to know that someone knows what theyre talking about.
    I had pain at the back of my heel and achiles for a year or so. Stretched it off for a while and seemed to dissappear. I then when I got up in the morning could hardly walk due to extreme stiffness on the underside of the heel which would subside after 20 mins of walking. 8 months ago when playing football (soccer – im English) I felt a pop under the heel. Actually thought the gel sack had popped in my trainer. Could hardly stand and was then on crutches for a couple of weeks at least. I was told I had possibly ruptured PF but that I should try to put some weight on it as soon as possible.
    8 months on im still not running / playing football as there is heel pain there – but not painful as such – just a knowledge that it is still injured. Mainly I am getting discomfort from the centre (slightly left) of the PF BUT mainly I get a discomfort up the outer / underside of my foot from by the ankle up to to little toe ball of my foot. Any idea – becuse im all out of them TBH.. hot and colding every night ang generally staying off my feet.
    Does this sound like plantar facaitis or somethiing else??

    1. OOJ

      Paul-

      Thanks for the message – sorry to hear about your foot!

      It's not possible to diagnose what is going on, but a "pop" followed by severe pain indicates that something might've sprained.

      8 months later is sufficient time for even that tissue to heal, if allowed. Check out my Pain #2 article on Inflammatory vs Ischemic pain. You might have dysfunctional tissue pain at this point that simply needs progressive stretching, strength, and impact. But without a thorough exam, it's impossible to say.

      Have a physio (English!) or osteopath thorougly examine your foot and heal, and see how the joint and tissue mobility is.

      Good luck!

  5. Nick

    Hey joe, I am 21 and i have had a severe issue with my feet for about 3 years now. I cant stand for any prolonged period of time with extreme pain developing if i do. I cannot run, walk or do anything at all without feeling some form of the pain. When i wake in the morning my feet are stiff and all throughout the day depending on what i do, some form of the pain exists. I cannot wear shoes at it superheats my feet and it feels like they are drastically inflamed and after i do exercise they are obviously worsened. It all starts at the back of my heel ( well thats where i think it starts , I feel the pain under the base of calcaneous when standing still, closer to the inside of my feet but basically at the back of the heel. ( dont know technical terms ). If i stood for 20 minutes it would radiate from that area to underneathe my feet, feel extremely painfull, hot, itchy and in general uncomfortable. It would also cause pain on either side of my heel connecting to the achilles ( or bursa sacs?)On both exterior and interior sides but more pain on the inside a cm or two away from the achilles i guess. I always here a cracking ( release of fluid or air or whatever it is ) when i stretch or move them, if i have not done so in a while and it can get so bad if i am mobile in the day that i feel it throbbing. If i move in general ( ie: walk, run it wont be as bad but will eventually come to hit me ). In summary, bilateral, symmetrical heel pain with ANY FORM of weightbearing upon the heel.

    I do not take any regural medications, have no other forms of injuries other than an episode of achilles tendonitus around 5-6 years ago with 2 years freedom before the onset of this issue. No family history of the problem, although my mother has athritus, still common however in 60 yr olds. I have had blood tests for for inflammation related illnesses. I have seen 3 podiatrists and tried short and long hard and soft orthotics to no avail, each for extended trials. Treated for plantar fasciitis, possible severs disease when first onset, issues with the flat footed nature of my feet and what not. I have seen a back speacilist with no problems and no connection to the issues with my feet. I have had steroidal injections based off an mri into possible development of soft tissue thickening around the medial side of both feet, with only a week of minor pain relief. I have seen a neurologist and several physios all with no real affect. I have also take anti-inflammatories for a month long period and it had little affect. My thoughts are now simple after this 3 yr long journey, maybe it is a combination of things. Im thinking that it may be as simple as inflamed bursa sacs and a prolonged exposure to this linked with possible bouts of haglunds deformity, although no real calcitic lump is evident ( only a small one ). Maybe it is issues with my achilles and the bursa and that pain radiating away from the area?? after prolonged exposure to this and incorrect localisation of pain and misconstrued diagnosis it could be possible that scar tissue has developed alongside the tissue any time it gets worn and torn. Similar to me waking up every morning like the day before i did a marathon when i did not….Icing certainly helps but only for short periods of time following….

    Any response to this, any help at all would be greatly appreciated and if you have thoughts on what it is, let me know i will be forever in your debt. Reading this article brought me to the idea of possible joint issues?? i do feel dull constant pain but sometimes its sharp, especially if im standng for any time.

    Thankyou for listening.

    Kind Regards

    Nicholas Brunning.

    1. JasonJohnson23

      Nick,

      My name is Jason Johnson, I just turned 30 and I have the exact same symptoms as you. Literally the exact same symptoms. It sounds like I've gone through the same path of treatment as well. Nothing works and I'm having other issues in the hands/arms. It would be really helpful to pick your brain about your experience. My email is:

      [email protected]

      I don't know if you'll be able to see this. I'm going to try emailing OOJ as well and see what became of you.

  6. ginger

    Dear Joe,

    Thank you for this great article. Though I am a natural therapist myself, I can not help myself. I have been running intensively (mostly trails), but do Yoga at the same time. Yet, this January, I felt that something was not right. Incruciating pain on the right outside heelbone of my right foot. I stretch, I have stopped running, tried again and it comes back again. Thus, it is not PF after your great explanation. I am a fore-foot runner, however, do run with supporting running shoes from Salomon. Yet, I had been running in the same old shoes for 5 years which was probably not the best idea.

    Anyway, it turns out to become chronic now, I love running especially with spring approaching.

    I would really appreciate your advise.

    Best regards

    Ellen

  7. OOJ

    Ellen-

    Your symptoms (lateral heel) plus your run style (forefoot) makes me *think* (read: shot in the dark) that you might be over-stressing your lateral foot/peroneal muscles. It's very common for forefoot strikers to overstride, and when they do, it's usually a lateral foot strike.

    Beyond that, it's difficult to for me to provide any other insights.

    My general recommendations (as they apply to everyone):

    1.) make sure your foot is landing beneath your body (https://www.irunfar.com/2012/09/give-it-a-brake-form-fundamentals-for-healthy-efficient-running.html)

    2.) make sure you're not landing/pushing off too narrowly, which also stresses the lateral foot/leg tissues (https://www.irunfar.com/2013/03/going-wide-the-role-of-stride-width-in-running-injury-and-economy.html)

    Good luck!

  8. TCJ

    Hi Joe,

    I was wondering your thoughts on the relationship between plantar fasciitis and chronic ankle instability. My idea is without the ATFL and CFL for support, over the course of a long run, the peroneals are asked to do too much work and start to fatigue/give out. This leads to an over-supinated footstrike described by a couple previous writers. The muscles and ligaments on the medial side subsequently tighten, which leads to plantar fasciitis.

    Does this sound reasonable to you?

    Thanks very much!

    1. OOJ

      TCJ-

      That's plausible, but I'm partial to flipping that on its head:

      – The ankle has instability (e.g. ligamentous laxity) AND plantar fascial pain as a result of an excessive lateral foot strike, which: A.) chronically overstretches those ligaments, and B.) causes over-pronation "slapping" (lateral edge –> flat), which over-stresses the plantar surface of the foot.

      So again, worth looking into are overstriding (https://www.irunfar.com/2012/09/give-it-a-brake-form-fundamentals-for-healthy-efficient-running.html) AND/OR a narrow stride (https://www.irunfar.com/2013/03/going-wide-the-role-of-stride-width-in-running-injury-and-economy.html), both of which result in excessive lateral foot strike.

      1. TCJ

        Fantastic response. Unfortunately my MRI does show chronic ankle ligament damage. But your response give me hope to get through my issues with strength and conditioning and not a scalpel! Thank you.

  9. BallyT

    Thanks so much for the article I will be re-reading till it all makes sense and watching some of the video's.

    My starting point, I had a left ankle re-construction about 20 years ago after rupturing the lateral and medial tendons and almost shredding the third.

    I was fat, unfit and suffered PF about 2 years ago. I had walked for a month, 6km 3 times a week for a month and then started interval walk / jog. within a couple of weeks I was diagnosed with PF and it took a couple of years to recover.

    I started walking again about 6 months ago and interval walk/run for the last 2 months and have just completed my first 6km fun run (without stopping). During my training I started suffering heal pain but more interestingly in the week leading up my left calf and Quad felt tight as a drum and didn't seem to recover from my runs (right leg perfect). I was afraid it was PF again and saw the physio. I did also after the leg issue suffer a blow to the left foot in jumping out of a boat and that's important.

    Physio has said my core strength is terrible (I agree) which I'm working on and my foot roles laterally. However the second physio I saw (after a week of no running) said she believed I had bruised the fat pad on the heel (likely from the blow). This made sense for a lot of the pain but I had already had the issue with my left calf / quad being unusually tight. My masseur even commented she could draw a line from the ankle to inside of leg (calf) up the inside of quad into groin but also wrapping around to lower back.

    So whilst I believe the bruised heel has been an issue, I'm not sure if I also have a bit of PF, circulation issues or nerve problems. I do know I'm not right yet and I think there are other issues. My right leg feels great after every run, my left leg, heavy, brick like and I just know it's not right.

    I'm currently rolling the foot on ice. I purchased a tens machine to assist in what I believe to be possibly circulation issues and I'm also trying to make sure I get my core exercises happening. Am I doing all I can do or do you think I should be looking for something else?

    I have another small run this week but have 5 weeks to build up to double distance. I don't think I can afford another 2 weeks of no running. I've never been a runner but this is making me feel much better about my self and has really helped me on my journey to be a fitter and better me. I need to run, for me and for my kids and any help or direction would be fantastic.

    Thanks

    1. OOJ

      BallyT-

      Your left ankle injury is traumatic – by definition, and how it affects your future motor performance (e.g. how you do EVERYTHING: stand, walk, jump, run). The brain changes in response to even mild injuries; on top of that, if there was a fracture and you were <20 years old, you might have a difference in leg length on top of it.

      THEN, on top of that, you had PF "for a couple years" – another major "brain change"! (https://www.irunfar.com/2013/01/navigating-the-pain-trail-concepts-of-pain-physiology-in-running-injuries.html)

      The bottom line is, this is a running mechanics issue: you're doing something weird with your left leg. No amount of core strength (unless integrated into run mechanics drills), soft tissue or joint mobilization, or modality (TENS, ultrasound, etc) will change how your brain uses your left leg.

      The key to happy running is sustainability. The key to sustainability is efficiency and symmetry. My recommendations:

      1.) Find a physio that is extremely experienced in gait mechanics (very often, these folks aren't "sports med" – they frequently work in neurological rehab settings!) to watch you run. And walk. For you, this is an *absolute must* if you want to continue running in the future, as well as avoid chronic pain in your left leg, as you age.

      2.) Progressively load. Your body is telling you that the current stress level (given your motor control AND tissue tolerance) is TOO much. Supplement heavily with biking and swimming/shallow water "real" running. Build fitness without tearing down muscle, joints, etc.

      Good luck!

  10. Tash

    I have suffered PF in my right foot a few years back whilst trying to move up from a marathon runner to ultra runner (increased mileage too quick). I took a month off, it went away. Then late last year I got a dull pain in the left foot. I ignored it and kept running. I assumed it was PF. All the symptoms were text book but the thing is – it always started to hurt about 15km into a run. I got a second opinion from a podiatrist who sent me for an ultrasound and Xrays and his opinion was that I had done some damage to the PF in the past and had small nodules on the PF as a result. Every time I ran over 15km, I got a bit sloppy with my form and started to roll my foot into my shoe therefore causing the pain. I was dubious about that explanation – ignored him – kept training and ended up with a stress fracture.

    Since returning to the sport, I now have steady base of 50-70 miles per week. I do a marathon or ultra most months. The last three months I've been doing a lot more hill work and bam! The pain has come back in the left foot.

    My osteopath thought it was PF and so did I except same as last time – I get pain about 15km into my run. This is making it really hard to do any long runs.

    I really can't afford rest as I have a couple of big races coming up.

    Do you think it could still be PF even though I'm getting pain DURING activity?

  11. Elizabeth Clarke

    Dear Joe,

    Great web page!

    I have been suffering from heel pain on weight bearing, for a couple of years, and have been treated for PF.

    I have had Orthotics, Physio, exercises, & cortizone injections. The first injection worked for three months and the pain came back worse that ever, the second one last November did not work.

    In January last I had a MRI scan, result in brief – "6mm osteochondral lesion within the posterior aspect of tibiotalar joint, with minimal oedema, likely chronic. Trace ankle effusion. Plantar Fascia appears normal"

    I met with an orthopaedic specialist who felt that the MRI result was not significant enough to be causing the discomfort. But is to consult with Neurophysiology Department and get back to me.

    At the moment I feel I am getting nowhere.

    I am 51 years old and I am not an athlete

    I can send you a copy of the scan if required or the radiological report.

    I would appreciate your comments.

    Kindest regards

    Elizabeth Clarke

  12. OOJ

    Elizabeth-

    Thanks for the post! Though I definitely CANNOT diagnose or treat anything in this forum, your "defect" is suggestive of a gait (walking and/or running) issue where you're loading asymmetrically – in other words, how you're landing on that foot is not "equal", thus causing that defect.

    Is the defect causing pain? No one can say (just as 50% of all people with ZERO back pain will have a bulging disc on MRI). But, you do have pain.

    Find someone to take a good, hard, comprehensive look at how you walk and/or run. Make it equal, then slowly/progressively load!

    Good luck!

    -J

  13. laura

    hi! thank you for this great article!

    i battled pf for awhile over a year ago, and now have a new heel pain that hurts on the back/sides of my heel… like if you were to pinch the sides of my heel and squeeze, it hurts! this is *not* plantar fasciitis is it? i can't find what it might be from your article and don't really know where else to look as everything seems to call heel pain plantar fasciitis. i think it's due to a new shoe. didn't hurt during my last run in them (of 8 miles, after several shorter runs in the same shoe, 25 total shoe miles), but hurt to walk that night and the next day (which was yesterday) and i still can't walk normally now! i supinate if that helps.

    i too will bookmark this article! : ) thanks for your work!

  14. Henry

    Hi,

    Great article. I found it searching for "heel pain from running". My experience is a little different. 3 years ago I had a subtalar implant in both feet (in the sinus tarsi cavity) to correct flat feet. Things have been great (except for an occasional twinge in my left foot if I'm on an uneven surface) However I've started a very slow "Couch to 5K" running program. The first day I ran a total of 8 minutes in a 30 minute program. The next day there was significant pain in my right foot when I put weight on it. It doesn't hurt any other time. I can't replicate the pain when pressing only when walking.

    THe doctor who did the surgery doesn't know why as his other patients who run haven't had the same issues. He's also in LA and I now live in London so it's not like I can just pop in for him to check!!! I'm thinking it has "something" to do with the implant although I would expect the other foot to hurt as well.

    Any advice? I've been taking NSAIDS just in case it's inflammation.

    Thanks :)

  15. Burns

    Joe

    Thanks for the in-depth article! My 10 year old son who is very active (soccer, 3days a week, Roller hockey, tennis, etc.etc) is currently and has had in the past very tender spots on the inside and outside of his heal bone. There is no acute pain on the arch or base of the heel strictly on the sides on a very small area. His soccer cleats and shoes all have good support. We have replaced the soccer insole with Super Feet and have bought more expensive running shoes for daily use and support. Wondering if you have any treatment suggestions and perhaps a diagnosis.

    Thank you for your time!

    1. OOJ

      Mr Burns:

      A wonderful little nugget of sport medicine is, "When you FEEL symptoms is not necessarily what CAUSES the symptoms."

      With all athletes, I always look at how they WALK. Is your son a stiff walker? Does he take long/big steps in front of him? Does he bang down hard on his heel when walking?

      Even if a kid plays soccer 3 hours a day, he's walking around 8 hours a day. Be certain that all activities outside soccer are "normal".

  16. OOJ

    Henry-

    Thanks for the post.

    With a procedure like a subtalar implant, the playbook goes out the window – you have new (and sensitive) anatomy! With a change like that, it's doubly important to have excellent strength/range of motion AND efficient run mechanics.

    My advice is to see a professional with a lot of experience in running gait – make sure you're efficient as can be, then be very patient!

  17. OOJ

    Laura-

    Thanks for the post!

    I would have a PT, chiropractor or osteopath look at the mobility of your rear foot (ankle, heelbone, etc). Make sure it's moving the way it should. The area where you describe symptoms is a prime area of referral for a stiff heel bone. But be sure to have it looked at, as it could be a muscle, tendon or even nerve issue, as well! Good luck.

  18. BallyT

    Thank you so much for your reply. I wanted to give you an update on my progress.
    I took inboard what you said, did some cutting back and variation of my activities and variation of where I was doing my activities.
    I completed a second run I had already entered that was only 5.5km the week after my post to u. The night before I got some ITB pain predominately in my right leg. Fortunately a friend who is a very good runner helped me and we went and got a foam roller and sorted that out very quickly. But again as I hadn't run that week it continued to point out to me just how wrong everything was going.
    We have a store here about an hour and a half from where I live called Active feet where the sales assistance are either qualified or final year podiatrist and they video u to see gate etc and then recommend shoes.
    When they watched me bare foot yes I roll laterally but not so bad, get me into a jog it just gets worse and worse. interestingly it was my right ankle that appeared most unstable. 3 style of shoes later we achieved stability. Add In gel heel I had been wearing in my shoes just to cushion impact and they felt great. In comparison to my previous fitted shoes by a specialist they had easily 3x the lateral support.
    Wore the shoes for the rest of the day and where I had started with ITP pain, I had non.
    Went for a jog later in the week felt better again, left calf not so tight.
    I couldn't tell u every response in the weeks following, but I can tell u I've only put my old runners (which were new) on for one walk since then.
    Because i was stubborn and as part of my weight loss journey i needed to complete it, I progressed up and did do my 10km run. Legs pretty good after no need for a massage which is so different to back in March but I did suffer a fair amount of heel pain after I cooled down. I went and saw my Dr and said I need help I don't want to stop running but needed more help and we weren't getting to a resolution. I asked if I could get an X-ray, as I thought that previous blow a few months back may have caused a fracture. Ps I had X-ray 2 years ago at start of first PF issue which showed nothing.
    This time the X-ray showed a big heel spur. The doctor put me on an anti inflammatory immediately and has booked me for a cortisone injection in a few weeks. He said we will give that a go and if that's not working he recommends surgery as from our history discussed I have already progressively worked my way threw the other management options which haven't worked.
    Well after just 6 days on the tablets the heel pain has dramatically reduced. I had my final pre booked run on two days ago which was 13km which again mentally I needed to get over and do and despite having been in bed all week with a cold (so not even walking in the lead up) I got up and did. It took me 1:42 which was only 2 minutes behind my goal time. More amazingly though I feel great. I just got out of bed bare foot 1 day later which would normally hurt even without running and my foot feels great. I have a bit of thigh pain but it was a long run with hills it's expected, but calf fine, ITP fine, heel never better.
    When the dr gave me the action plan I was skeptical that the injection would do anything, but given the tablets have done so much already I am hopeful.
    My next planned run is in a month and its 10km. I won't do much running between now and then as I know mentally and physically I can do it and will be doing the majority of my work on an exercise bike and gym equipment giving my entire body a workout.
    Hopefully that will give my foot recovery time and the injection a chance to work. I am more hopeful than I have been that a plan is coming together to help me manage and resolve into the future.
    Certainly the new runners after having my gait reviewed has made a huge difference to my leg issues and feet and now the Dr's plan seems to also be working.
    I am young, after being thin all my life and putting on to much weight over the last 5 years I have lost 14kg and have at least another 10 to go but if non of this works to keep me running I do know that I want to have this resolved for my future mobility.
    I wanted to say thank you for your advise it made me think everything through and whilst I took a lot of your advise I also knew in these couple of months I needed to modify what I did do I could still achieve my short term goals that were mentally so important for me in achieving my long term weight loss.
    My husband who has been overweight since being a teenager has become inspired by me and has now lost almost 10kg himself. He said he has never been able to run, but after coming out on his bike one day when I went for a run, he realised just how far I had come and how far behind he was. He started running on the treadmill and has worked his way up to a regular 5km with a weekly 10km and is going to do his first run with me next month. He has got the bug and as a family and attending my last 2 runs is seeing what I have got from the experience and our goal is to do 1 run a month to help keep us motivated and active, the kids are also itching to do their first run at some point.
    So fingers crossed everything comes together for me and my foot and we get to achieve our monthly goal.

  19. A.L

    I was told that I have PF but I am really beginning to question this since nothing seems to be helping the stiffness and pain seems to be getting worse i can pinpoint a tender spot it is on the inside edge of my heel just as it starts to curve around by the arch but i am finding that all around the back of the heel is becoming painful and very stiff running up the cord at the back of my foot / ankle cannot weight bear when i first get up and extremely painful after sitting for a short period i am not a runner but I am on my feet 10 hrs a day in steel toe work boots got orthodics but still cant seem to get them correct so we are working on that still this pain has been going on for 7 months and is only getting worse not better i am doing heat cold stretches have tried anti- inflammatories nothing is working

  20. Derek

    Hi there. I have read your article and was going through the comments, and I have a similar problem as Nicholas who posted here recently. Please I don't know what to do, I have experienced pain in the arch of my left foot only for the last year. The more I am on my feet the more it hurts. The pain is hardly noticeable or not there at all when my foot is resting for long periods of time. It feels stiff in the morning when I wake up and I usually stretch my foot and leg for about 10 minutes before I get out of bed. The pain gets worse as the day goes on, significantly worse if I am walking a lot at work and such. The pain begins just in front of the bottom of my heel where the arch begins and radiates to the rest of the arch. Running is hardly even an option for me as the pain becomes too unbearable. I usually ice the painful area at night or sometimes before work and then stretch my foot afterwards. This gives me short term relief but I haven't gone a day without some form of pain in the last year.

    I have had pain in my feet before a few years ago. I visited a podiatrist and was given orthotics but they did not help. The problem went away by itself but it came back two years later and has lasted longer than ever now. I am on my feet much more now than I was back then.

    When I stretch my feet I can feel a 'clicking' in my left foot around the middle but not in my right. Could this be the talonavicular joint? I think my feet have some over pronation as well but like I said only my left foot experiences pain. My right foot is perfectly fine. I am going to see a professional this summer when I can but honestly I dont have high hopes. This is seriously ruining my life. I am a 23 year old male, quite tall (6'4) and about 215 lbs. Please share any advice you might have for me. Thank you.

  21. Derek

    Hi there. I have read your article and was going through the comments, and I have a similar problem as Nicholas who posted here recently. Please I don't know what to do, I have experienced pain in the arch of my left foot only for the last year. The more I am on my feet the more it hurts. The pain is hardly noticeable or not there at all when my foot is resting for long periods of time. It feels stiff in the morning when I wake up and I usually stretch my foot and leg for about 10 minutes before I get out of bed. The pain gets worse as the day goes on, significantly worse if I am walking a lot at work and such. The pain begins just in front of the bottom of my heel where the arch begins and radiates to the rest of the arch. Running is hardly even an option for me as the pain becomes too unbearable. I usually ice the painful area at night or sometimes before work and then stretch my foot afterwards. This gives me short term relief but I haven't gone a day without some form of pain in the last year.

    I have had pain in my feet before a few years ago. I visited a podiatrist and was given orthotics but they did not help. The problem went away by itself but it came back two years later and has lasted longer than ever now. I am on my feet much more now than I was back then.

    When I stretch my feet I can feel a 'clicking' in my left foot around the middle but not in my right. Could this be the talonavicular joint? I think my feet have some over pronation as well but like I said only my left foot experiences pain. My right foot is perfectly fine. I am going to see a professional this summer when I can but honestly I dont have high hopes. This is seriously ruining my life. I am a 23 year old male, quite tall (6'4) and about 215 lbs. Please share any advice you might have for me. Thank you.

  22. OOJ

    Derek-

    Very sorry to hear about your foot pain.

    With *chronic pain* – defined currently as any injury/pain that persists >3-6 months – requires a comprehensive approach:

    1.) PAIN CONTROL. Your pain is current out of control. What that means is, your foot is trying to heal, and forces in your daily life ("walking a lot at work"…) are exceeding the healing and tissue tolerance of your foot.

    Imagine a cut on your hand: it will scab over, and gradually close. But what happens if, after a day of healing, you rub on it for 10 seconds? Doing so on your uncut hand would be no problem (in fact, maybe you could rub hard for 2 minutes without as much as mild redness). But on a healing cut, 10 seconds re-opens the cut. And you start all over.

    You must get pain under control: do only so much standing/walking so that you *feel better tomorrow*.

    You need a professional to help you achieve pain control. All other elements – Mechanical, Neuromuscular, Motor Control – are secondary and useless without pain control.

    2.) Mechanical, Neuromuscular, Motor Control: https://www.irunfar.com/2012/03/anatomy-of-a-runni

    3.) Find a highly-skilled physical therapist. I recommend folks with advanced certifications:

    http://www.instituteofphysicalart.com/ipa/referrahttp://www.naiomt.com/index.cfm?fuseaction=Page.V

    Good luck!

  23. Dan

    Just wanted to share a success story of battling with PF. Last year I developed a nasty case of PF, due to overuse and switching to flat shoes while overusing. I was waking up every morning, dreading that first step, but kept running thinking it'd work itself out. Finally, I'd had enough and stopped running. I switched to a more supportive shoe, Mountain Masochists, and wore these all the time. I didn't run for over 3 months but did some hiking, climbing and took up swimming (including pool running). Daily, I did PF stretches and iced, usually 2-3 times a day. I also did self massage with a tennis ball and foam roller. I would've gotten more professional massages if I could've afforded them but only had a couple. I tried the sock that stretches the calf at night. I hated it. It would waked me up at night or I would take it off in my sleep. A new element I tried was acupuncture. I received treatments 2-3 times a week for 5 weeks. A week after I finished treatments, I woke up with absolutely no pain or stiffness. I then started to run again, building up really slowly and still wearing the masochists exclusively.

    I have been free of PF for 6 months and just finished the Jemez Mtn 50k with no pain and feeling the best I've ever felt. The hills have caused a little bit of Achilles tendonitis but now I know the signs of when to stop and rest. I still stick with the Mountain Masochists for hard and long runs. I know they work so I don't want to chance injury by changing up shoes too much.

    I hope I can keep PF away for good. Good luck to anyone battling this nasty injury.

  24. Abeline

    Hi I am a netballer and I train quite regularly for about 3 years already. About three months ago, I started developing pain on my heel which was only felt when I took the first step in the morning. I self-diagnosed it as PF and ice it after every training. But now, the pain has gotten worse and I feel it whenever I try to run or when I stretch the area alittle bit. The pain lies only on the right side of my left foot, between my ankle and heel but slightly towards the lower part. Is this PF? I am not too sure whether to visit the doctor since I reckon that they would tell me to ice and stretch it, when I already am. Hopefully, you can help me with this problem! Thank you so much! :)

  25. OOJ

    Abeline-

    Thanks for the comment.

    For those with persistent foot pain, I have to encounter one that did NOT have a significant "walking problem" or "running problem": in other words, have significant inefficiencies (read: over-stressing habits) with how they run and/or walk.

    That said, you need to find someone that can take a good look at how you run/walk, and make adjustments so as to reduce the stress going through your foot/heel.

    This is something I offer on my personal website, but you would be best served by finding a skilled physio in your area to work with.

    Good luck!

  26. Tim

    Great article!

    I had my first encounter with PF last summer.

    It wasn't nice, a pretty horrible injury.

    I had acupuncture on it for 4 weeks after finding another article on it regarding anatomy trains and the calf.

    I approached my physio with this in mind. She found nerve tension with some reflex tests and went to work. She also provided the 'chair / nerve floss' exercise plus some others.

    6 weeks later i was slowly returning to running.

    Until now, it's been fine , but a few weeks ago I done a 13 miler more on my fore-foot.

    I'm trying to move further forward with my foot strike as I get faster.

    It seems this has upset the PF again. Straight away I have moved XT for the time being.

    I made the mistake last time of trying to run through it. lol!

    Seeing this article especially the lateral/supination footstrike part and how it effects the PF has definitely made me think this is what has happened.

    I've been performing the nerve tension exercises and already can feel an improvement. I Will wait to see how these effect it over the next week or so before deciding whether acupuncture is also needed.

    Great article once again thanks.

  27. David

    What a great article , you really got me thinking about my injury

    I am 45 and considered myself to be a runner until last year. I rolled my ankle 1 year ago while running at dusk. Apparently nothing was broken.( besides tearing ligaments etc. My foot showed an enormous amount of bruising. MRI showed I had suffered an injury to the Talar Dome. Now a year later I have pain that is burning in the left arch close to the Navicluar -n spot.

    I massaged it last night and now I can hardly walk on it and it burns while sitting. I had a bone scan and it didn't show any hotspots in that area. I read that the Navicular doesn't have much blood supply – so would it take up much of the dye? Any way I have gone through months where I can cope and some days hardly know I had a problem ,to days like today where there is a return of the burning pain with no reason really.

    Its not painful in the morning but can get worse during the day .

    I wonder if I have nerve entrapment in the fascia near the Navicular and the deep tissue massage I performed has stirred it up?

    Worst thing about this accident is that the surgeon said no more running ,otherwise I could get arthritis . Yet the pain doesn't come from the ankle where the Talar injury is. Could I have an undiagnosed fracture?

    May be time for more investigation. I would love to run agai. It's how I defined my life.

    Thanks again for all your info. Top site!!

  28. IAIN

    Hi,I misplaced my footing whilst competing in a half marathon a few months ago. Since then I've had a stinging sensation on inside of my left foot near my heel. I have seen a doctor and sports massage therapist. The diagnosis has been PF. However I'm not convinced as the PF is subsiding but I am still left with the stinging sensation. The best way to describe the pain is the stinging sensation you get when you are injected with a hypodermic needle.

  29. Mark

    Dear Joe,

    Thank you for your article, however, I am still none the wiser as to what my problem may be. It started several months ago and stopped for about a month (after electro-acupuncture stimulation: 3 treatments of 3/4 hour) before restarting about 3 weeks ago. The problem is R heel pain that wakes me up every night between 3 and 4 a.m. I lie in bed rolling my foot and tensing my leg by 'pulling' my R foot toward the knee causing a stretch in my calf muscle. Often when stepping out of bed, the first few steps are excrutiating and only a few minutes walking around brings relief. During the day, the pain is not there, but the heel/foot does not feel 'right'. There is a mild discomfort and the heel feels slightly numb.

    Any clarification on possible cause and relief/ cure would be much appreciated.

  30. OOJ

    Mark-

    Night pain is generally not a good sign: it can indicate either nerve pain or an internal issue (fracture, or worse). Numbness is also a sign of nerve involvement.

    I would recommend a doctor follow-up to rule out any nasty stuff.

  31. Dave

    Hi Joe,

    I really appreciate your article although my situation doesn't fit into any of the scenarios. 6 weeks ago, I missed a step coming down stairs at night and landed hard on the edge of the stairs (hard granite) with no shoes on. The pain is in the rear of the arch of my left foot. At first it was extreme and improved during the first week and has remained mild ever since. When I don't wear shoes, I have no pain during walking, except in the morning when it last for about ~ 10 minutes. With shoes I have mild pain during walking which is my real problem. I have no pain at rest with or without shoes. Can use please offer a treatment I can do on my own to try and improve the situation or do I need to see a doctor?

    Best regards,

    Dave

  32. OOJ

    Dave-

    Sorry to hear of your injury.

    I would consult with an experienced physical therapist – one who has experience in both gait mechanics and manual therapy. They will want to address and treat all possible factors, including soft tissue, joint stiffness/pathology and how your gait might've changed as a result of the injury.

    Good luck!

  33. andrea

    I'm so happy to have found this article! I've been having terrible heal pain that is getting worse the more I run. I'm going to (begrudgingly) take a week off and try these treatments, and see if it improves.

    Thanks!

  34. David J

    David – Have you gotten any more information? I am 49 yo male. I have been running since 1997 with over 35 marathons and several ultras. I had typical PF many years ago and successfully treated with rest and orthotics. I have been struggling for 2 1/2 years with "PF" pain again. However, this pain is at the very back of my right heel and localized to one spot. It hurts when I plant my foot and when I press on it. I have been to three podiatrists, three PT's, and to a chiropractor. I have tried complete rest, extensive stretching and strengthening, new orthotics (newly identified leg length discrepancy – so 1/4 lift added to non-affected side orthotic), cortisone injections (after 2 years of trying to avoid it), shockwave therapy, acupuncture with e-stim. X-rays have all been negative. I plan to have MRI next. Nothing has helped. I finally cut a horseshoe shaped notch out of my orthotic making the most posterior portion completely open. My idea was that possibly it's nerve related and this could take the pressure off of the nerve. Amazingly this has helped keep the pain at bay (not completely gone). Not sure why the pain and hoping the MRI will show what's going on.

  35. lorraine

    Hi,

    I have been having pain in both my heals now for months, I walk twice every day as I have dogs and they need to go out, I also run, but I have had to stop this as the pain is unbearable. Even touching my heals with a finger causes pain. I have been to phisio but they cant help. I am really stuck for ideas of what this could be , any ideas?

    1. OOJ

      Lorraine-

      I would have your physio check the following:

      Walk gait: it is shocking how many people are "pathologically" (e.g. pain-producing) inefficient walkers. How you walk (w/your dog or without) can play a huge role in the perpetuation of soft tissue and joint irritation of the feet. Once irritated, it doesn't take much inefficiency to keep the pain cycle going.

      Joint mobility and nerve tension. How stiff is the mid- and rear-foot? Also, how is your back? I get about 1-2 patients per month whose foot pain is predominantly driven by referred lumbar/nerve pain (or at least it is a major magnifier).

      Good luck!

  36. jeff

    Thank you so much for this info. In the last 2 years I have gone to 2 sports PT chiros, 2 podiatrists, cortizone shots, acupuncture, tons of reading, I have amassed a drawer full of massage tools. All to get rid of this pain and it just took some standing on my navicular to alleviate the pain haha, thank you!!

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