If your heel hurts on the bottom—especially with your first steps in the morning—the symptoms often fit the pattern of plantar fasciitis. If the pain is at the back of your heel or along the tendon just above it, Achilles tendinopathy, often called Achilles tendonitis, may be the problem.
But heel pain isn’t always that simple.
Stress injuries, bursitis, nerve irritation, and other foot and ankle conditions can cause similar symptoms. Where and when you hurt can provide useful clues, but an examination is the best way to know what’s actually causing the pain.
Every spring, as Metro Detroit runners ramp up marathon and half-marathon training, we see the same pattern come through our offices: mileage climbs faster than the foot and ankle can adapt, and heel pain shows up a few weeks later. Most of it responds well to the right plan—but the plan has to match the actual injury.
Try This Quick Heel-Pain Check
Pay attention to these three clues:
- Where does it hurt? Pain on the bottom of the heel, often toward the inside edge, commonly occurs with plantar fasciitis. Pain or tenderness at the back of the heel or along the Achilles tendon may point toward Achilles tendinopathy.
- When is it worst? Pain with your first steps out of bed or after sitting often fits plantar fasciitis. Achilles symptoms may be noticeable when you first start running, after a harder workout, or with hills and pushing up onto your toes.
- How does it respond to activity? Both conditions may temporarily feel better once you warm up, but that doesn’t necessarily mean the tissue is ready for unrestricted running.
These are clues—not a diagnosis.
If you heard or felt a sudden pop, felt as though someone kicked you in the back of the ankle, or can’t push up onto your toes, stop running and get evaluated promptly. Those can be signs of an Achilles tendon tear.
You Put in the Miles. Now Your Heel Hurts.
You built your mileage. Your fitness is finally where you want it. Maybe there’s even a race circled on the calendar.
Then every morning starts with a wince.
The question most runners ask isn’t simply, “What’s wrong with my heel?”
It’s:
Do I have to stop running—and am I going to lose everything I’ve worked for?
The good news is that many common causes of runner’s heel pain improve with the right treatment plan, and treatment usually starts with conservative care rather than surgery.
The key is figuring out what structure is actually causing the pain before deciding how to treat it.
Two Common Causes of Heel Pain—and Why Treatment Isn’t Always the Same
Plantar fasciitis and Achilles tendinopathy can both be described as “heel pain,” but they involve different tissues.
The plantar fascia is a thick band of tissue that runs along the bottom of your foot from your heel toward your toes. It helps support the arch and absorb forces as you walk and run.
The Achilles tendon is the strong tendon at the back of your ankle that connects your calf muscles to your heel bone. It handles significant loads every time you push off the ground.
There is some overlap in treatment—particularly load management, progressive strengthening, and addressing training errors—but the right approach depends on which tissue is injured and where the problem is located.
For example, certain stretches may help one type of heel pain while irritating another.
That’s why Eastside Podiatry’s heel pain care starts by identifying the source of the pain rather than treating every sore heel the same way.
Plantar Fasciitis vs. Achilles Tendinopathy: Where Does It Hurt?
Point to the painful area with one finger.
The location doesn’t provide a complete diagnosis, but it can give your podiatrist an important clue.
| Plantar Fasciitis | Achilles Tendinopathy | |
| Where it usually hurts | Bottom of the heel, often toward the inside | Back of the heel or along the tendon above it |
| When it may feel worst | First steps in the morning or after sitting | Beginning of activity, during harder running, or after increased training |
| Common aggravators | Long periods standing, increased running load, barefoot walking | Hills, speed work, jumping, increased mileage |
| Possible exam clue | Tenderness along the bottom/inside of the heel | Tenderness or thickening along the Achilles tendon |
| Common treatment components | Activity modification, stretching or strengthening, footwear support | Progressive tendon loading, temporary training modification, footwear changes |
Some runners can also have more than one problem at the same time.
Heel pain can come from other conditions as well, including a calcaneal stress injury, bursitis, nerve irritation, or problems involving the heel pad. If your symptoms don’t fit neatly into either pattern, don’t try to force them into one diagnosis.
Get them checked.
Plantar Fasciitis in Runners: Training Load Matters
Plantar fasciitis in runners often develops when the demands placed on the foot increase faster than the tissue can adapt and recover.
Factors that may contribute include:
- Increasing mileage too quickly
- Suddenly adding more running days
- Tightness or limited mobility in the calf and ankle
- Changes in running surface
- Foot structure and mechanics
- Worn or poorly fitting running shoes
- Sudden changes in footwear
- Long periods of standing or walking in addition to training
The solution isn’t always complete rest.
Often, it’s load management—temporarily reducing the stress on the foot, allowing symptoms to settle, and then gradually rebuilding your running tolerance.
For some runners, that may mean:
- Shortening or reducing runs rather than stopping completely
- Replacing some runs with lower-impact activities such as cycling or swimming
- Temporarily reducing hills or speed work
- Following an appropriate stretching and strengthening program
- Reviewing running shoes and recent footwear changes
- Gradually rebuilding mileage rather than jumping back to your previous training volume
Some runners may also benefit from arch supports or orthotics, particularly when foot mechanics or pressure patterns are contributing to symptoms.
Not every runner needs custom orthotics. Your podiatrist can determine whether supportive footwear, an over-the-counter insert, or a custom device makes sense for your particular foot and training goals.
Surgery is rarely the first treatment for plantar fasciitis.
Achilles Tendinopathy: Why Stretching Alone Isn’t the Answer
When your Achilles hurts, stretching can seem like the obvious solution.
But Achilles tendinopathy isn’t simply a “tight tendon,” and aggressive stretching isn’t appropriate for every type of Achilles pain.
This is particularly important with insertional Achilles tendinopathy, where pain occurs near the point where the tendon attaches to the heel bone. Deeply dropping the heel below the edge of a step can increase compression at this area and aggravate symptoms in some patients.
Complete rest isn’t necessarily the answer either.
Achilles tendons often respond to progressive loading—gradually rebuilding the tendon’s strength and tolerance rather than suddenly returning to full training.
Depending on your diagnosis, treatment may include:
- Temporarily reducing hills, speed work, or long runs
- Progressive calf-strengthening and tendon-loading exercises at a level your tendon can tolerate
- Temporary footwear modifications or a heel lift when appropriate
- Gradually rebuilding running volume over weeks rather than days
The exact program matters. Achilles pain at the tendon insertion may need a different approach than pain farther up the tendon.
When imaging is clinically appropriate, diagnostic ultrasound can help evaluate tendon structure and identify findings such as thickening or partial tearing.
For more significant injuries or problems that don’t improve with appropriate conservative care, your podiatrist can discuss additional treatment options.
Training Mistakes That Can Contribute to Both
One of the most common patterns we see in runners is simple:
Too much, too soon.
Watch for training changes such as:
- Large mileage jumps during race training
- Adding hills and speed work at the same time
- Suddenly increasing the number of running days
- Running in worn or poorly fitting shoes
- Switching abruptly to a very different shoe or lower heel-to-toe drop
- Skipping recovery days because you’re feeling good
- Moving quickly from treadmill running back to pavement when Michigan spring finally arrives
Your body adapts to training—but it needs time.
Small, steady changes are generally easier for your feet and ankles to tolerate than sudden jumps in distance or intensity.
If you’re not sure where your training plan went sideways, a foot and ankle evaluation can help identify whether training load, biomechanics, footwear, or an underlying injury may be contributing to your symptoms.
Race Week and Your Heel Starts Hurting—Now What?
A heel flare-up days before a race can feel like terrible timing.
You’ve trained for months. You’ve tapered. You’re ready.
This isn’t the week to panic—or to start experimenting with every stretch, insert, shoe, and treatment you can find online.
A safer race-week approach:
Don’t introduce major changes. Avoid suddenly switching running shoes, adding new inserts, or beginning an aggressive stretching program days before the race.
Back off the aggravating training. Skip speed work, hills, and unnecessary mileage while you determine what’s causing the pain.
Don’t aggressively stretch a painful Achilles. Particularly if your pain is close to where the tendon attaches to the heel.
Don’t use race week to test how much pain you can tolerate. Pain that changes your gait, keeps getting worse, or comes with swelling or bruising needs evaluation.
Get evaluated early. The sooner you know what you’re dealing with, the better conversation you can have about whether racing is reasonable.
Missing a race is disappointing.
Turning a manageable injury into a problem that affects months of running is worse.
Can You Keep Running With Heel Pain?
Not every sore heel requires you to immediately stop all activity.
Depending on the diagnosis, some runners may be able to continue running at a reduced load.
You may be able to continue with modified activity when:
- Pain remains mild
- Your running form stays normal
- You aren’t limping
- Symptoms don’t progressively worsen during the run
- Pain isn’t significantly worse later that day
- Symptoms aren’t worse the following morning
These guidelines aren’t a substitute for diagnosis, particularly if the pain is new or persistent.
Stop running and get evaluated if:
- You’re limping or changing the way you run
- Pain is worsening despite reducing your training
- Your heel hurts significantly at rest or at night
- You notice swelling or bruising
- You develop numbness or tingling
- Deep heel pain or tenderness raises concern for a stress injury
- You have diabetes or another condition that may affect sensation or healing
Seek prompt medical attention if:
You felt a sudden pop or snap, felt as though someone kicked you in the back of the ankle, or suddenly can’t push up onto your toes.
Those symptoms can occur with an Achilles tendon rupture.
Continuing to train through worsening pain can allow some injuries to become harder to settle and may lengthen your recovery.
How Eastside Podiatry Helps Metro Detroit Runners Get Back to Running
We understand that for runners, the goal isn’t simply to make the pain disappear.
You want to get back to running.
At Eastside Podiatry PLLC, our podiatrists evaluate foot and ankle injuries with your activity level, training history, biomechanics, footwear, and running goals in mind.
Dr. Hatim T. Burhani, DPM, FACFAS; Dr. Siraj Panchbhaiya, DPM, FACFAS; and Dr. Bhavik Patel, DPM provide comprehensive foot and ankle care for patients throughout Macomb County, Wayne County, and surrounding Metro Detroit communities.
Our approach starts conservatively whenever appropriate.
Your evaluation may include:
- A detailed history of your pain and training. We’ll look at where your pain started, recent mileage or intensity changes, footwear, running surfaces, and what makes your symptoms better or worse.
- A thorough foot and ankle examination. Your podiatrist will evaluate the painful area, movement, strength, foot structure, and other findings that may help identify the source of the problem.
- Imaging when appropriate. Digital X-rays or diagnostic ultrasound may be recommended when clinically necessary to help evaluate certain injuries.
- A personalized treatment plan. Treatment is built around the diagnosis, your symptoms, and your goal of returning to activity safely.
Our goal is to reduce pain, address the underlying problem, and help you return to the miles you love with a plan built around your needs.
Frequently Asked Questions About Runner’s Heel Pain
How can I tell if my heel pain is plantar fasciitis or Achilles tendinopathy?
Location and timing provide useful clues. Pain on the bottom of the heel that is especially noticeable with your first steps in the morning commonly fits plantar fasciitis. Pain at the back of the heel or along the Achilles tendon may point toward Achilles tendinopathy.
However, other conditions can cause similar symptoms, so persistent or worsening heel pain should be professionally evaluated.
Can I keep running with plantar fasciitis?
Sometimes.
Depending on the severity of your symptoms and diagnosis, you may be able to continue shorter or easier runs if the pain remains mild, doesn’t change your running form, and isn’t worse later in the day or the following morning.
If you’re limping or the pain is progressively worsening, stop running and get evaluated.
Should I stretch my Achilles if it hurts?
Not aggressively without knowing what type of Achilles problem you have.
Certain stretches—particularly dropping the heel below the edge of a step—may aggravate insertional Achilles pain. Progressive strengthening and tendon loading are often important parts of rehabilitation, but the right exercises depend on the location and severity of the problem.
How long does runner’s heel pain take to improve?
There isn’t one recovery timeline for every runner.
Recovery depends on the diagnosis, severity of the injury, how long symptoms have been present, your training demands, and how the tissue responds to treatment. Early evaluation can help identify the problem and establish an appropriate return-to-running plan.
Do I need custom orthotics for running?
Not every runner does.
Some runners benefit from supportive inserts or custom orthotics when foot structure, mechanics, or pressure patterns contribute to symptoms. Your podiatrist can determine whether an insert is appropriate and whether an over-the-counter or custom device makes the most sense.
Does insurance cover a running injury visit?
Coverage depends on your insurance plan and the services required. Contact our office to confirm participation and benefits for your specific plan.
Where can I see a podiatrist for running injuries near Fraser or St. Clair Shores?
Eastside Podiatry PLLC provides foot and ankle care at our Fraser and St. Clair Shores offices, serving runners and active patients throughout Macomb County, Wayne County, and surrounding Metro Detroit communities.
Virtual visits may be useful for selected consultations and follow-ups. New or persistent heel pain—particularly pain associated with limping, swelling, weakness, or a suspected injury—may require an in-person examination.
Get Back to the Runs You Love
Running is more than exercise for many people.
It’s your morning routine. Your stress relief. Your time outside. Your training partners. Maybe it’s the race you’ve spent months preparing for.
Heel pain doesn’t automatically mean all of that has to stop.
But pushing through an injury without knowing what you’re dealing with isn’t a training plan either.
Get a clear diagnosis. Build the right treatment plan. And work toward getting back to the miles you love safely.
Book a running injury assessment with Eastside Podiatry PLLC today.
St. Clair Shores 24025 Greater Mack Ave. #101 St. Clair Shores, MI 48080 (313) 884-7566
Fraser 31046 Utica Rd. Fraser, MI 48026 (586) 368-3112
