The Tradeoff Between Heel Pain Injury and Higher Performance in Runners

Heel pain nyc

Since Ancient Greece, physical culture and human performance have been valued and celebrated in competition, and immortalized in art. Yet even after millennia of athletic training and record-breaking performance, today’s athletes continue to wow us with ever-greater feats of athleticism.

Athletic achievement and the evolution of sports does not come without a price, however. The human body only adapts in response to imposed challenges, a principle called overload, and pushing the human body to its limits inevitably increases the risk of injury. As athletic injuries go, heel pain in runners is among the most common.

Mitigating Heel Pain Through More Informed Training

Being aware of injury risk when upping the ante in training is important, but many injuries are the result of avoidable training errors. Some of the most common training errors that lead to heel pain and injury in runners include:

  • Increased training intensity (speed)
  • Longer training distances
  • A change in running terrain
  • Running on hilly terrain
  • Worn unsupportive running shoes

The problem is not so much that changes in training are made, but that they are often made too suddenly, with inadequate recovery time for the body to adapt, and with inadequate equipment (in this case shoes) to provide support and stability. Essentially, by changing too much, too soon, you push your body’s structures to the breaking point and beyond.

Understanding Foot and Ankle Mechanics

When you consider the force loads sustained and the torque generated by the foot and ankle complex during running, you get an idea of how very strong and resilient those structures are. Nevertheless, overuse injuries are common in runners, especially in the plantar fascia and the heel.

During running, the plantar fascia, the thick band that attaches the heel to the toes, acts as a sort of spring that enables the foot arch to rebound and generate force. The foot arch is supported by intrinsic and extrinsic muscles that lend it stability and strength. The repetitive motion of running places demands on the plantar fascia that are especially offset by intrinsic muscle strength. When intrinsic muscle strength is inadequate to meet those demands, the plantar fascia bears more of the load and becomes subject to injury.

Likewise, the Achilles tendon that attaches the calf muscles to the heel is vulnerable to repetitive overuse, which may provide an additional source of heel pain. Achilles heel pain may begin as inflammation, or tendinitis, but over time, if ignored, it can progress to tendinosis, a chronic condition that requires treatment.

Treatment and Therapy for Heel Pain

A number of therapies offer short term relief for heel pain, including:

However, short term pain relief is of limited value if you do not address the most common underlying causes of heel pain, which are weak intrinsic foot muscles and mechanical deficits at critical points along the kinetic chain. Moreover, steroid injections have been found to actually weaken the fascia tissue and increase the risk of rupture.

Physical therapy exercise aimed at building foot core strength and stability, coupled with running gait analysis and retraining to improve mechanical efficiency are key to resolving heel pain over the long run.

Heel Pain Treatment NYC at NYDNR

At NYDNR, our clinic features state-of-the-art technologies and innovative therapies rarely found in private rehab clinics. Our running gait lab features 3D Video Force Plate Technology, C.A.R.E.N (computer assisted rehabilitation environment) and real time ultrasonography.

Our goal is to not only manage pain, but eliminate its source while improving your overall running performance. If you want to run smarter, better and longer, visit NYDNR and realize your peak potential running performance.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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