The Surprising Reason You May Be Experiencing Back of Heel Pain When Running

Last updated on March 9th, 2024 at 02:26 pm

As a runner, you know that pain and discomfort can be a frustrating part of the sport. But one type of pain that can be exceptionally bothersome is back of the heel pain when running. If you’ve experienced this, you know how it can quickly derail your running routine and make it difficult to stay motivated.

While there are several known causes for back of heel pain when running, one surprising reason often goes unnoticed. And that’s tight calf muscles. That’s right, something as simple as tight calf muscles can lead to this pain and disrupt your running and reduce your performance.

In this article, we’ll delve into the science behind back of the heel pain, reveal the surprising reason for it, and provide you with some practical solutions to alleviate the pain and prevent it from happening in the future. If you’re tired of struggling with back of heel pain when running, read on to find out how to get back to running pain-free.

Understanding Back of Heel Pain When Running

Many runners have experienced this pain at some point in their running journey. It can be frustrating and often prevent you from achieving your running goals. Crucially, however, you must seek to understand what causes back of heel pain when running so that you can take the necessary steps to alleviate the pain and prevent it from occurring in the future.

There are several known causes of back of the heel pain when running, including Achilles tendonitis, pre and post-Achilles bursitis, Haglund’s syndrome and plantar fasciitis (plantar fasciitis causes referred pain), to name the main ones. However, one of the most surprising causes of this pain is tight calf muscles. Tight calf muscles can place undue stress on the Achilles tendon, which attaches inferiorly to the back of the heel bone. This stress can lead to micro-tears in the tendon, causing inflammation and pain.

Another cause of back of the heel pain that often goes unmentioned is wearing the wrong type of running shoes. Shoes that don’t offer enough support, have an inadequate heel cushion or lack a bevelled heel and toe spring can increase the risk of developing pain in the back of the heel. Shoes that are too tight or too loose can also contribute.

The Surprising Reason for Back of Heel Pain When Running

The most surprising cause of back of heel pain when running is tight calf muscles (to be honest, this revelation may not surprise seasoned athletes or runners). It may seem counterintuitive that calf muscles located up the leg can cause pain in the back of the heel, but the explanation is nevertheless simple. The Achilles tendon, which connects the calf muscles to the heel bone, can become strained (microscopical tears) and inflamed if the calf muscles are tight. This inflammation can lead to the back of the heel becoming painful and uncomfortable while running.

So why do runners tend to have tight calf muscles? The repetitive running motion can cause muscles to become tight and inflexible over time. There is repeated concentric calf contraction at the toe-off phase when running. Also, runners who mainly strike on the balls of their feet tend to run with more of a plantarflexed foot (foot pointing down). Over time the repeated contraction of the calves and the foot being in that position is believed to shorten the muscle heads, thus causing them to become tight. With this scenario, it is more likely for the tendon to stretch when force is required during running. This can cause microscopical tears at the insertion point on the calcaneus (heel bone), leading to pain. 

Other factors contributing to tight calf muscles include poor posture and running form or technique, overuse, and insufficient stretching. This is, however, more common in the amateur and weekend warriors categories of runners. 

Solutions for Tight Calf Muscles

Tight calf muscles can retard your running progress due to their influence on back of heel pain when running. The good news is that there are plenty of solutions available to help alleviate the discomfort. Here are some practical and effective solutions for tight calf muscles:

1. Stretching Exercises: One of the simplest and most effective solutions for tight calf muscles is stretching. Incorporating regular calf stretches into your daily routine can help to alleviate tension and prevent pain. Some effective stretches include the wall stretch, seated calf stretch, and the standing calf stretch. Remember to hold each stretch for a count of 10 or longer and repeat several times.

   

2. Eccentric Strengthening: The Achilles tendon tends to tear on the eccentric (stretching) phase during running. By incorporating eccentric Achilles strength training into your routine or the  Alfredson’s protocol if you have suffered an Achilles tendon injury, you help prevent or rehabilitate tendon injuries respectively.
3. Change Running Technique: Have a biomechanical assessment of your running technique done by a professional. If there are any biomechanical abnormalities, with the aid of a running coach or someone experienced in the field, seek to adjust your running style to aid in injury prevention. Doing this may also increase your mileage and help you achieve your long-term running or fitness goals. 
4. Massage Therapy: Massages can be an effective way to relieve tension in tight calf muscles. A professional massage therapist can help to loosen up muscles and increase blood flow, which can help to alleviate pain and discomfort.
5. Wear the Right Shoes: Wearing the right shoes while running can also help prevent back of the heel pain caused by tight calf muscles. Look for shoes that provide adequate arch and motion support, stability, cushioning, a toe spring, and bevelled heels (rocker bottom). Rocker bottom shoes can offload foot pressure which may help reduce strains and tension. 
6. Take Breaks: Taking regular running breaks can also help prevent and alleviate back of the heel pain. Resting and allowing your calf muscles to recover can help to prevent them from becoming too tight and prone to injury. Furthermore, write a training program and stick with it. Make sure the program gradually increases the training load over time. Additionally, review the program regularly to ensure it’s working to achieve your short, medium and long term running goals. 

By incorporating these solutions into your daily routine, you can effectively alleviate the pain and discomfort caused by tight calf. Again, improving your overall running performance.

Other Possible Causes of Back of Heel Pain When Running

While tight calf muscles are a surprising cause of back of heel pain when running (again, a surprise for some runners), it’s also essential to consider other possible causes. Here are some other reasons for back of heel pain when running:

1. Plantar Fasciitis: This condition causes inflammation of the plantar fascia, a thick band of tissue that runs along the bottom of the foot. Plantar fasciitis usually elicits pain in the medial heel and arch of the foot, not directly at the back of the heels. However, the plantar fascia and Achilles tendon are connected, and problems in one area can often lead to problems in the other. So please be mindful of this. 
2. Haglund’s Deformity: This bony growth develops on the back of the heel bone. It can cause pain and inflammation due to rubbing against shoes. For this reason it is sometimes referred to as pump bump. The condition is often associated with wearing tight or ill-fitting shoes and can cause pain on the back of the heel when running.
3. Pre and Post-Achilles Bursitis: In this condition, the bursae, small fluid-filled sacs that act as cushions between bones and soft tissues, become inflamed. Bursitis can occur in several locations in the foot and ankle, including the back of the heels. Again, this can cause pain in the back of the heel when running.
4. Os Trigonum Syndrome: This condition leads to the development of an extra bone called the Os trigonum. It forms behind the ankle bone and can induce pain when running at the back of the heel, as well as limited range of motion. The condition is due to repetitive or forceful movements, such as those commonly found in ballet, soccer or running. Os Trigonum syndrome can also cause impingement syndrome at the back of the heels.
5. Stress Fractures: Stress fractures are tiny cracks in the bone caused by overuse or repetitive impact. They can cause pain and discomfort in the back of the heel and other parts of the foot. The calcaneus, talus and posterior malleolus are the likely bones to emit pain if fractured.
6. Improper running Technique: As mentioned earlier, poor running technique can contribute to back of the heel pain. Landing for example, can place undue stress on the heel. Causing pain over time, and may even lead to a stress fracture.

By identifying the underlying cause of back heel pain when running, you can take steps to alleviate the pain and prevent it from happening. Seeking professional medical advice can help determine your pain’s root cause and develop an effective treatment plan.

Prevention Tips for Back of Heel Pain When Running

There are several ways to help prevent back of the help pain when running from happening in the first place. Try these prevention tips:

1. Warm-Up Properly: Before starting your run, it’s essential to warm up properly. This will help loosen your muscles and prepare your body for the activity. Start with light jogging or walking, then include dynamic stretches focusing on your calves and other lower leg muscles.
2. Wear the Right Shoes: I probably sound like a broken record now, but wearing the right shoes can make a big difference in preventing back of heel pain. Look for shoes that offer adequate cushioning in the heel. Ensure they fit correctly and provide enough arch and motion support to prevent overpronation. Shoes with a rocker bottom are also helpful in taking pressure off the foot.
3. Maintain Proper Running Technique: Proper running technique can also help prevent back of the heel pain. Try adjusting your landing to more of a mid to forefoot strike instead of the heel. This will help to reduce heel impact.
4. Rest and Recover: It’s essential to allow your body to rest and recover between runs. Regular breaks can help prevent overuse injuries and reduce the risk of heel pain.
5. Incorporate Strength Training: Strength training can help build up the muscles in your lower legs. This can prevent tightness and help to mitigate heel pain when running.
6. Be Consistent: Try your best to be consistent with training over time. Stopping and starting your workout is a recipe for injuries. It will also make it less likely to achieve your running or fitness goals. 

Remember to listen to your body and seek professional medical advice if you experience persistent pain or discomfort.

Final thoughts

Back of heel pain when running can be frustrating and discouraging for runners. However, by understanding the common causes and implementing the appropriate solutions, you can alleviate pain or prevent it from happening in the first place. For some runners, a surprising reason for back of the heel pain is tight calf muscles. You can address this effectively through stretching, massage therapy and the tips mentioned earlier. 

Other possible causes for back of the heel pain are plantar fasciitis, Haglund’s deformity, bursitis and Os Trigonum syndrome. For this reason, seeking professional medical advice is crucial if you are experiencing persistent pain or discomfort. This will help you to enjoy a pain-free running experience and achieve your running or fitness goals. Good luck, and remember, your health is your wealth!

References

1. Stevens, M. and Tan, C.-W. (2014). Effectiveness of the Alfredson Protocol Compared With a Lower Repetition-Volume Protocol for Midportion Achilles Tendinopathy: A Randomized Controlled Trial. Journal of Orthopaedic & Sports Physical Therapy, 44(2), pp.59–67. doi:https://doi.org/10.2519/jospt.2014.4720.

2. Rabusin, C.L., Menz, H.B., McClelland, J.A., Evans, A.M., Landorf, K.B., Malliaras, P., Docking, S.I. and Munteanu, S.E. (2019). Efficacy of heel lifts versus calf muscle eccentric exercise for mid-portion Achilles tendinopathy (the HEALTHY trial): study protocol for a randomised trial. Journal of foot and ankle research, [online] 12, p.20. doi:https://doi.org/10.1186/s13047-019-0325-2.