Heel pain is one of the most common issues that brings runners into our podiatry clinics. Whether you are training for the Adelaide Marathon, preparing for the City to Bay, or simply getting out for a morning jog along Henley Beach, heel pain can stop you in your tracks. At Pod Fit Podiatry in Modbury, Findon and Glenelg, we work with runners every week who are dealing with stubborn heel pain.
The causes of heel pain in runners are often complex and involve more than just “overuse.” Factors such as foot posture, strength imbalances, running technique, and footwear all play a role. In this article we will cover the top seven causes of heel pain in runners and outline how you can fix it so you can get back to doing what you love.
1. Plantar Fasciitis (Plantar Fasciopathy)
The plantar fascia is a thick band of tissue that runs along the bottom of the foot. In runners it can become overloaded and irritated, especially during longer training blocks or when increasing mileage too quickly. Pain is often sharp under the heel with the first steps in the morning or after sitting for a while.
How to fix it:
- Reduce aggravating activities and modify training load
- Stretching and strengthening of the calf and foot muscles
- Supportive footwear to reduce strain
- Custom orthotics to offload the plantar fascia if foot posture contributes
- Shockwave therapy, which can help stimulate healing in stubborn cases
2. Achilles Tendinopathy
The Achilles tendon connects the calf muscles to the heel bone and is a frequent site of pain for runners. Symptoms usually include stiffness in the morning, pain during running, and tenderness at the back of the heel.
How to fix it:
- Gradual loading program focusing on calf strength
- Avoid sudden spikes in training or hill sessions when symptoms are high
- Shockwave therapy to improve tendon healing response
- Running assessments to check for biomechanical contributors like overstriding or poor footwear choice
3. Heel Spurs
A heel spur is a bony growth that forms where the plantar fascia attaches to the heel. Contrary to popular belief, the spur itself is not always the cause of pain. Many runners with heel spurs are completely pain free, while others with no spur can have significant discomfort.
How to fix it:
- Manage the underlying plantar fasciitis with load modification, stretching, and orthotics
- Ensure correct footwear with good heel cushioning
- Address biomechanics through running assessments to prevent ongoing overload
4. Sever’s Disease in Adolescent Runners
In younger athletes, particularly between the ages of 8 and 15, the growth plate at the back of the heel can become inflamed. This condition is known as Sever’s Disease. It is very common in junior footballers, netballers, and young runners. Pain is usually worse after training or games and improves with rest.
How to fix it:
- Relative rest from high impact activities until pain settles
- Heel lifts or cushioned shoes to reduce load on the growth plate
- Stretching tight calf muscles
- Custom orthotics for kids with flat or pronated feet to reduce strain
- Education for parents and coaches that this is a temporary but very manageable condition
5. Fat Pad Bruising or Atrophy
The heel has a natural fat pad that acts as a shock absorber when running. Repeated impact or poor footwear can bruise this fat pad, leading to pain directly under the heel. In older runners the fat pad can thin over time, reducing its natural cushioning ability.
How to fix it:
- Footwear assessment to ensure adequate heel cushioning
- Heel cups or custom orthotics to redistribute pressure
- Avoid running on hard surfaces during recovery
6. Nerve Entrapments
Sometimes heel pain is caused by irritation of nerves that pass near the heel bone. One example is Baxter’s nerve entrapment, which can mimic plantar fasciitis. Nerve pain often feels burning, tingling, or sharp and may radiate into the arch or the side of the heel.
How to fix it:
- Careful diagnosis through podiatry assessment
- Footwear and orthotics to reduce compression around the nerve
- Strengthening of intrinsic foot muscles to improve stability
7. Stress Fractures
Although less common, a stress fracture of the heel bone (calcaneus) can occur in runners, especially when training loads increase suddenly. Pain is often deep, persistent, and worsens with running or even walking. Unlike plantar fasciitis, stress fractures usually hurt all the time, not just first thing in the morning.
How to fix it:
- Immediate load reduction and rest from impact activities
- Imaging to confirm diagnosis
- Short term use of a moon boot if required
- Gradual return to running once healing confirmed
- Running assessments post recovery to identify risk factors such as poor footwear, high weekly mileage, or biomechanical overload
How Pod Fit Podiatry Can Help
At Pod Fit Podiatry we specialise in keeping runners moving. If you are dealing with heel pain, here is how our team in Modbury, Findon and Glenelg can help:
Running Assessments
We use treadmill analysis including advanced Zebris pressure mapping to understand your running technique. This allows us to pinpoint whether stride length, cadence, or foot strike pattern is contributing to your heel pain.
Shockwave Therapy
For stubborn cases of plantar fasciitis or Achilles tendinopathy, shockwave therapy can be highly effective. It helps stimulate healing and reduce pain when other treatments have not worked.
Custom Orthotics
Orthotics can reduce strain on the heel by improving foot posture and redistributing pressure. We design orthotics specifically for runners to fit comfortably in training shoes and racing flats.
Running Shoe Assessments
The right shoe makes a huge difference. We assess your current footwear, training load, and biomechanics to recommend shoes that suit your running style. This reduces stress on the heel and helps prevent recurrence.
Strength and Conditioning Plans
Working closely with our physiotherapy team, we develop strength programs that address calf weakness, foot stability, and overall running resilience.
Final Thoughts
Heel pain in runners has many possible causes, from plantar fasciitis and Achilles issues through to fat pad bruising or even stress fractures. The good news is that with the right diagnosis and management plan, most runners make a full recovery and return to training without long-term issues.
If you are struggling with heel pain, do not ignore it. Early treatment is always easier and prevents the problem from becoming chronic. Book a running assessment at Pod Fit Podiatry today and let our team in Glenelg, Findon and Modbury help you get back on track.
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