I know that because of the title of this thread, people might automatically think plantar fasciitis. I know that's the most common cause of pain in the bottom of the heel. But I've gone through a lot of resources over the last day and a half since having this nagging irritation and it just doesn't sound like PF. I'm hoping someone here might recognize my symptoms.
On Wednesday night, I had this seemingly random ache just show up in my heel. I ran that morning and before this sudden onset of aching in the evening, and there was absolutely nothing wrong with it. I've never had problems with my feet. I was actually sitting down when I started feeling it. Then, I got up and it ached when I walked around. Since then, it has not gone away. It is at the front of the heel bone right before my arch begins. Except for when I initially felt the strange feeling while seated on Wednesday night, I have not felt anything else while in a seated position. I only feel a mild ache/tender spot when I walk/put pressure on the area with my fingers. I did also run yesterday morning and I felt it very mildly for a little bit but then for the rest of the run, the ache disappeared. It did come back afterwards, though. But it hasn't gotten worse.
There has been no significant trauma to the area. I am not a heel striker and I do not land heavily on my feet. I strength train and practice good form. It almost feels like a bruise, but like I said, there has been no extreme force or trauma. I know running is repeated stress on the bottom of the foot, but I've never had an issue before and it happened several hours after a run while I was resting. I should also mention that there is no horrible, sharp pain upon my foot's initial first steps in the morning after getting out of bed. That is another tell-take sign of PF that I don't have. It's just a dull tenderness/ache that's stayed the same and has not gone away. I don't believe it's a stress fracture, either.. Based on the knowledge I've gained about those, it should have gotten more painful as I continued to run on it yesterday (Thursday).. In short, does anyone have any idea what this could be? Is it just one of those things and I'm overthinking it? I have a half marathon in two weeks that's I've been training for for months and I'm hoping it's just one of the aches and pains we can inevitably get when we run. Thanks in advance for any responses!
Almost guaranteed to be PF, pretty mild at this point. PF is not particularly associated with trauma, or heel striking, or how lightly you land on your feet. I never had a sharp pain on first getting out of bed either. It would often be a little stiff and achy for those first few steps. Same with running, it would usually not bother me after the first quarter mile or so. I used an OTC plastic 3/4-length orthotic (Spenco, I think) for additional support while running, and all the usual recommendations. The other thing I've noticed is slight onset of pain sometimes if I am "clawing" my toes. In that event I consciously stretch them out and the pain quickly goes away. I think if you treat it kindly and well over the next couple weeks you should be able to do your half-marathon with no trouble.
Thanks for the response, Len. Although I was unsure of it being PF, I've still been treating it as such. Icing, rolling my calves, scrunching a towel up with my toes, picking stuff up with them...all of those things. I will continue to do these things a lot these next few weeks, as well as regularly after the race. I also have been thinking of giving low-Dye taping a shot. Have you ever had experience with that?
I've never used taping. Pretty amazing when I think about it, but I'm one of those lucky people who rarely gets injured. And even then it's rarely serious. Just the way I'm built, I guess. My case of PF was a lot like yours, fairly mild. Though I didn't know that at the time. It took me a few months to get over it completely, and I continued to run through it. It was a long time ago, pre-internet, and information was by word of mouth or what you could get out of your collection of Runners World magazines.
I've used Low-Dye taping a few times. I'd say it works pretty well. It's not a silver bullet - but then again there are no silver bullets when it comes to PF.
I recommend it enough to at least give it a try and see if it helps.
"Kick off your high heel sneakers, it's party time."
-- From the song FM by Steely Dan
A bruise is what it felt like for me when P.F. first hit and it took about 3 months to get it behind me.
I've got a couple of suggestions and an observation. First, P.F. can be difficult to heal because it's so easy to re-injure. It starts to heal, you step just right and tear it again. Over time, this constant re-injuring results in a build-up of scar tissue that's weaker than normal tissue and sets you up to deal with this injury for a long time.
If you're not experiencing pain the first few steps after sitting for a while or when getting out of bed in the morning, you probably can this behind you pretty quickly. I'd avoid walking barefoot and anything that causes pain in your heel, an indication you've re-injured your Fasciia.
I kept a pair of traditional running shoes with their high heel beside the bed and stepped into them as soon as I got up in the morning, they worked for taking the pressure of my arch those first few steps in the morning.
Lastly, don't take this injury lightly, deal with it now before it gets out of hand...
Enjoy life, this ain't a rehearsal...
I know I've mentioned this many times in the Med Tent forum, but it's always worth repeating, because much of what we now know about the genesis of pain is counterintuitive. This means that many without specific training will reach false diagnoses that seem to make perfect sense initially.
The first important fact is that a pain in the heel may have little or nothing to do with your heel. The example I always use is that a pain in your arm may have nothing to do with your arm. In that case, it is a classic sign of a heart attack. In your case, the strange on/off pain in your heel is likely to be a sign of tight calf muscles.
This becomes more likely in light of information you supplied that would be used to build your medical history in an interview with a competent healthcare professional. You said you are planning a Half in two weeks, which means you are at the end of your aggressive training and entering your taper. For many, this is the time when the wear and tear of their training is felt the most.
Not to completely dismiss the possibility of PF, but many "healthcare professionals" think of pain in terms of firm tissue structures such as bone, ligamentation, tendons, and fascia. This limited view is buttressed by the common availability and use of X-ray and MRI images, which show firmer structures in greater contrast and detail than soft tissue such as muscle. Aha! We saw it.. or did we?
As you walk or run, you are rarely aware of any feedback from firmer tissues, because they often have little or no nerves to supply such feedback. It can take a major event such as a broken bone or ruptured tendon to feel anything from these tougher structures at all. The gradual degradation of something like the plantar fascia can be quite painless. It is the surrounding soft tissue, such as muscle and golgi tendon organs that can mitigate or accentuate movement dysfunction and cause pain to appear and disappear in other parts of the anatomy in a protective way (Note how the article explains why a simple muscle stretch can be quite dangerous under certain circumstances). In a sense, the perception of pain can easily be passed from one structure to another without the initial involvement of the brain. When the brain finally comes on-line, the switcheroo is complete. In such a case, you've got a pain in your heel that did not start there, and will not be solved there.
In short, your muscles are rich in nerves that are constantly supplying feedback to the spinal cord and brain. While the brain may be aware of a handful of painful messages at any given time, the spinal cord communicates directly with muscle constantly, adjusting tension and altering movement in often subtle ways to avoid further injury. We runners, at least our conscious selves, are often the last to become aware of what is going on, at which time we often ignore it, don't we? I know I have. It's pretty difficult to get through a major running event while paying complete attention to healthy movement and the pain of unhealthy movement. So now, at long last, you are very much aware of what has been going on down there throughout your training.
Many protocols for treating heel pain and other foot pain diagnosed or misdiagnosed as "fasciitis" (a misnomer if the cause is actual breakdown of the tissue, correctly called "fasciosis"), involve a calf muscle stretch. Why treat the calf muscle if the problem is supposedly inflammation of fascia? Because the problem tends to originate with a tight muscle, or group of muscles, in the rear of the calf. These muscles morph into tendons that wrap around the heel where they become the Plantar Fascia. Yup, it's all one continuous chain. The purpose of the fascia is to pull the bones of the fascia into the shape of an arch, to better enable the foot to absorb shock.
Since by itself, the fascia cannot do this job, it must be tensioned by the muscles above the heel (the heel acts as a pulley to divert the tension from vertical to horizontal). The heel must perform this pulley function whether you choose to land on it or not, and becomes the locus of pain when there is something wrong with this power train. The takeaway message is that this is a continuous band of fascia that controls the foot and absorbs shock, and it only makes sense to treat it as such rather than focusing on discreet components of this chain.
I mentioned earlier that it is common to feel these anatomical complaints toward the end of a productive training regimen, but some never have this problem. Why do you feel it when others don't? This may be part of your conditioning if you are fairly new to the sport, or a sign of a possible future chronic condition if you have been at it a while. You may have pushed yourself harder than others do, or perhaps there is something different about your biomechanics that stresses this area more than usual.
There are some with a lot of experience, like Len, who keep going and going when others give up the sport. Why will some survive while others wimp out? Is it simply pain tolerance, or sustainable wear and tear? Of course, I pick the latter, as should you. This incident, if it is happening after years of running, should teach you that you may have approached the limits of your training method or style, or body mechanics if there is room for improvement there. We are not all built the same, nor do we (or should we) all run the same. Some runners can handle excess pronation, and some cannot. Those who cannot often experience problems related to rear calf muscles, among others.
Excess pronation can evolve due to problems in the structure and function of core/hip muscles, or due to variations in foot structure. As mentioned earlier, the tension and function of muscles related to running or other repetitive tasks is regulated unconsciously in response to the stresses placed on them, and some win this hidden chess game of body mechanics, while others do not. Sometimes mere anatomical pawns are sacrificed, and for others, major structural failure is the eventual result. Don't give up your Queen for the temporary joy of running through pain.
In the mean time, there is pain to inform us of what is at stake. Pain is not the same as structural failure, and should not always be interpreted as such. It is often the only way we can avoid failure. Learn to read these pains instead of focusing on specific pathology and treating symptoms.
Pain in the heel that comes and goes can be a direct result of problems in the following muscles, without any involvement of the Plantar Fascia at all:
Soleus: This largest muscle of the rear calf is the principle plantarflexor of the foot and runs from just below the knee to the Achilles tendon. It forms the lateral edges of the calf muscle group and lifts the apple-shaped Gastrocnemius to greater visibility when the Soleus is well-developed. A knot in the lower end of the Soleus, just above where the Achilles begins, produces pain in the heel that is often misdiagnosed as inflammation of the Plantar Fascia, or Plantar Fasciiitis. Let them label on, you now know better.
Quadratus Plantae: This is not a rear calf muscle, but is listed here because it assists the rear calf muscle Flexor Digitorum Longus tendons in the bottom of your foot. It is located deep in the bottom of your foot, along with the rest of many other important muscles arranged in four layers on the bottom of your foot. Too bad the PF gets all the attention, because QP knots are felt directly in the heel as a bruise-like pain that can make it very tender to walk on. Does that mean a deep foot massage can help the QP help you? Sure does.
Tibialis Posterior: Located deep between the two bones of the lower leg, this long thin muscle pulls upwards on the arch to maintain its shape. When it fails to act (as it can according to the principles outlined in the above article on Golgi Tendon Organs), there is more load placed on the PF to maintain the arch. Wonder what happens if that goes on too long?
Gastrocnemius ("Gastroc"): Though this prominent superficial upper rear calf muscle dives into the Achilles along with the Soleus, its function is more complex, and assists knee flexion and jumping with the knee straight. While it shares a common insertion around the heel, its neuromuscular pain contribution is primarily felt at the arch of the foot, in front of the heel.
Abductor Hallucis and Abductor Digiti Minimi: Not to be confused with "Mini Me" from Austin Powers, The ADM is located on the outside of the heel to leverage the little toe/fifth metatarsal to spread the foot for stability, and can produce pain in the outside of the heel and foot where it resides, sometimes all the way along the side of the foot where its tendon slides. The AH, other the other hand (or side of the foot), causes the Big toe (Hallux in Latin) to spread out for stability there. If there are structural issues with your foot bones that require more action here, the inside of the heel where this muscle is located can start to hurtin'. Excess pronation places more load on the AH to bolster the foot from collapse during the pronation phase. Also, excess fatigue, including muscular inhibition as outlined in the GTO article, can require the AH to pull more than its normal load. In extreme cases, it can cause pain and/or numbness along the inner side of the foot from the ankle through the heel to the big toe.
So, when talk comes to foot and heel pain, please take the often fictional PF shoot-from-the-hip diagnoses with a grain of salt. Add the rest of the electrolytes while you are at it, for optimal muscular functioning. Then, get some targeted massage to the lower leg and foot, which you can easily do yourself if necessary. Why massage? Knots in muscles involve not only inhibition at the neuromuscular level, but chemical changes in muscle tissue. Exercise has a price, but the payback is in recovery, and recovery can be fun.
Sure, you can try to affect these often microscopically finite muscular malfunctions by treating your entire bloodstream and vital organs with chemicals that are widely available to address "pain," if only temporarily. You can also get your hands (or someone else's) dirty and directly affect the physiology where it actually is. Your choice, but the latter can actually change pain syndromes with minimal side-effects, and usually feels good right away (warning: it can hurt before it feels good, which shows you are on to something). Don't stop with merely identifying the sore spot and resorting to remote control, as many medical folks often do. Stay on it until you have actually changed something for the better.
There is a lot of stuff down in that foot that isn't discussed much, especially in detail, but it is very important nonetheless. From structure, to function, to symptoms, to solutions, you are right... There is a lot more to know than "PF."
Thanks for the reminder, James, of the many muscles (etc.) that most of us are only vaguely aware of that can contirbute to various aches and pains. I know that lower leg muscles can be part of foot pain and pretty consistently forget to mention it. Treatment should be comprehensive enough to consider all of these areas. There, I have to rely on expertise such as yours.
Then, I got up and it ached when I walked around. Since then, it has not gone away. It is at the front of the heel bone right before my arch begins. Except for when I initially felt the strange feeling while seated on Wednesday night, I have not felt anything else while in a seated position. I only feel a mild ache/tender spot when I walk/put pressure on the area with my fingers. I did also run yesterday morning and I felt it very mildly for a little bit but then for the rest of the run, the ache disappeared. It did come back afterwards, though. But it hasn't gotten worse.
This part of your post is what reminded me of the bout I had with P.F., especially the part about the pain being at the front of the heel bone, right before your arch begins. Since P.F. can sneak up on you, is a very common running injury and since James didn't rule it out, I'll say it again, be very careful with this injury...
And good luck!
Enjoy life, this ain't a rehearsal...
James: Awesome write up ! Having delt with PF myself I can attest that the root cause had nothing to do with the bottom of my foot. Thanks for taking the time to put the details out there.
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