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Jogging and Heel Pain

Heel pain is by no means a strange encounter to the jogging population.  As a clinical condition, it is often both perplexing and frustrating to adequately manage. On the one hand, we have a serious, well-intentioned athlete, determined to continue the very activity, which is the aggravating source.  On the other hand, we have a sports medicine doctor who is attempting to treat the condition while maintaining the athlete in his or her training program. Often times, these factors become locked in a position of uncompromising opposition, and a temporary withdrawal from continued training is frequently necessary.


In evaluating a running patient with the complaint of heel pain, a thorough history and clinical examination is of the utmost importance.  X-ray studies, gait evaluation, and a biomechanical assessment are essential in properly evaluating the problem.  Occasionally, other diagnostic tools will be employed such as laboratory work, photographic studies, and muscle testing, which add to the sum total of information necessary to classify or categorize the condition.  From my experience in encountering a large number of these heel ailments, I offer the following as a common picture of the so called “runner’s heel syndrome”.


The condition usually demonstrates a sudden or acute onset, and frequently, without the patient’s recollection of any specific injury. The heel is neither swollen nor discolored, although pressure from deep palpation will often produce pain.  In many cases, the heel condition will become most bothersome either at some point in the run or shortly thereafter.  The pain is often described as a severe throbbing, but non-radiating sensation seemingly confined to the heel area.  Although the condition does not affect any particular age segment or sex more than another, it does seem to be more common in two basic groups of runners.  First; in those joggers new to the activity who are just embarking upon an unguided, unsupervised, and often times, unwise program.  And second; in those runners who have recently increased either training distances and/or times most often as part of a marathon race preparation. 


It appears to me that a common denominator in the various types of painful heel conditions is that of excessive impact or compression upon ground contact.  As of yet, it is unclear why one heel can more adequately dissipate the involved shock better than another.  But yet our greatest success to date has been in dealing with this supposed shock absorption deficit.  The individual new to the activity is particularly vulnerable to impact stress problems since his or her entire program and method may well be makeshift in nature.  Most likely, this may well account in part for a high number of disillusioned, injury-ridden, early dropouts from the lasting joys of running.  If only they had been properly guided into the activity with the sound supervision so often necessary at the start. 


The marathon runners who suddenly increase their training distances often encounter the so-called “overuse syndrome” which results from  too much training and/or at too great a pace.  The heel, from repetitive ground impact, is a focal point for this type of problem.


As far as treatment is concerned, I have had a good deal of success with various lightweight, shock absorbing materials which fit into the shoe and adds a protective layer to the heel.  Very few running shoes contain what I would consider to be an adequate heel seat or pad.  By supporting the foot with such an absorptive material, a rapid management of this complex and debilitating problem is often attainable.


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