Why do I get heel pain when I start to run?

A lot of runners/sportspeople experience pain at the back of the heel as they get going on a run. Sometimes it can feel like your shoes are on too tight and digging into your heel. More likely, it could be a condition called achilles tendinopathy.
Achilles tendinopathy (AT) is when the tendon that joins your calf muscle to your heel bone develops small microtears and there is a build up of proteoglycans in the tendon, they make the back of the heel painful when you first start to run, can cause swelling or a lump behind your heel/ankle, and usually makes your achilles stiff first thing in the morning.
AT can be stubborn, but with an accurate assessment and a few simple strategies it can be resolved.

Step 1: Reduce pain

  • Stop stretching. Stretching often makes achilles tendinopathy worse as it compresses the tendon over the attaching heel bone.
  • Oral anti-inflammatories or topical anti-inflammatory gel. Subject to approval from your pharmacist or medical practitioner, ibuprofen (commonly sold as nurofen) has shown to have the best effect on mitigating the cellular response in tendinopathy and staving off the
    proteoglycans.
  • ICE: over the painful area for 2 x 20 mins at night if time allows. Remember to use a wet tea towel over the skin. Have a 2 hour break between icings.
  • Reduce the aggravating load or training factors. This is key, we can help you figure out what might be aggravating you and tell you what to do and when.
  • Tendon loading exercises. There are specific exercises used to strengthen the tendon that will vary depending on your presentation and what we determine is causing your tendon issue based on our detailed assessment.

Step 2: Strengthen the tendon

The good news is that the answer to fixing achilles tendinopathy is strength. We want to strengthen the tendon because (a) tendons love being strengthened, it ‘squeezes’ the proteoglycans out and reduces pain and (b) because a strong, durable tendon makes it less likely that the tendon will become overloaded again.
There are a series of specific exercises that we can take you through to strengthen your tendon and each treatment progression will vary depending on the client and presentation.

In summary

Whilst the steps in this blog are useful to start fixing your tendon problem, it is important to note that the longer these symptoms have been present, the harder the tendinopathy is to fix. Regardless of how long you have had symptoms it is important to seek professional help from a physio. At Willunga Physio we would be happy to take you through our detailed assessment to establish what caused it and show you how to fix it. We’re here when you’re ready to get fixed.