Case Study – 24th APRIL 2026 - HEEL PAIN AFTER increasing the running volume

A 44-year-old male presents to the clinic complaining of heel pain in his right foot. He reports discomfort under the heel for approximately 5 weeks, with symptoms most noticeable when getting out of bed in the morning. He describes a sharp pain on the first few steps, followed by a gradual easing after several minutes of walking. He also notes a dull ache developing through the arch of the foot later in the day.

This patient had recently increased his running volume in preparation for a half marathon. He transitioned from gym-based training to outdoor road running over a short period of time. At the same time, he began wearing lightweight running shoes with a softer midsole and reduced structural support. He also spent more time barefoot at home on hard flooring. This combination of increased load and reduced support is a common pathway to the development of heel pain and Plantar Fasciitis.

History and Self Management

The patient had not sought professional advice prior to attending the clinic. He had researched his symptoms online and believed he had Plantar Fasciitis. He had been stretching intermittently, focusing mainly on the foot itself rather than the calf. He also used a massage ball under the arch each evening, reporting short-term relief but increased soreness the following morning. Ice packs had been applied inconsistently.

He continued to run through the pain for the first two weeks, believing it would settle. As symptoms worsened, he reduced his running frequency but replaced it with longer walks, which continued to aggravate the condition.

Impact on Activity

The patient reported difficulty with his usual morning routine. He would limp from the bedroom to the bathroom and required a few minutes before walking normally. He had stopped running completely in the past 10 days due to pain. Standing for long periods at work also became uncomfortable, particularly by the end of the day.

Clinical Findings

Examination revealed tenderness on palpation at the medial calcaneal tubercle, consistent with Plantar Fasciitis. There was notable tightness in the calf muscles, with reduced ankle dorsiflexion. The plantar fascia was sensitive through the arch. There were no signs of nerve involvement.

Treatment for this Patient’s Heel Pain

Initial treatment involved low-dye strapping to reduce load through the plantar fascia. The patient reported immediate improvement when walking within the clinic. The purpose of the strapping was explained clearly, with emphasis on load redistribution rather than cushioning.

Footwear was reviewed in detail. His current running shoes were considered too soft and lacked the necessary structure for his foot type. He was advised to transition into more supportive footwear for both daily use and running. It was explained that even high-quality running shoes can contribute to heel pain if they do not provide adequate support.

Home Management Strategy

The patient was instructed to stop using the massage ball, as this was likely contributing to ongoing irritation. Ice was recommended in a controlled manner, applied with compression for 20–30 minutes while the foot was elevated.

A structured calf stretching program was introduced, focusing on consistent and correct technique. Emphasis was placed on frequency and duration rather than intensity.

He was advised to temporarily avoid running and instead use non-weight bearing exercise such as cycling or swimming to maintain fitness.

1 WEEK FOLLOW UP

The patient reported approximately 40% improvement. Morning pain had reduced, and he was walking more comfortably throughout the day. He had been compliant with footwear changes and stretching. Strapping was reapplied.

2 WEEK FOLLOW UP

Continued improvement was noted. The patient reported minimal discomfort on first steps and increased confidence with daily walking. Calf flexibility had improved.

3 WEEK FOLLOW UP

The patient reported a setback. He had attempted to sprint across a road unexpectedly and felt a sharp return of heel pain during the push-off phase. Over the following 48 hours, morning pain increased and he described a return of limping on initial steps.

This type of sudden increase in load is a common trigger for a flare in Plantar Fasciitis, particularly when the condition is still in the early stages of recovery.

On assessment, there was a mild increase in tenderness at the heel, but no new structural concern. This was explained as a load-related flare rather than a new injury. Strapping was reapplied and activity levels were adjusted. The patient was advised to return to strict load management and avoid sudden explosive movements.

4–5 WEEK FOLLOW UPS

Symptoms settled again with adherence to the treatment plan. Morning pain reduced steadily and the patient reported improved confidence with walking. There was no further aggravation. Calf range continued to improve.

6 WEEK FOLLOW UP

The patient reported no heel pain during daily activity. There was no pain on palpation of the heel. He had resumed light jogging without symptoms.

He was advised to gradually increase running volume in a controlled manner and to avoid sudden increases in intensity. Ongoing attention to calf flexibility and appropriate footwear was reinforced to reduce the risk of recurrence.

This case study is meant for informational purposes only. If you are experiencing heel pain or if you think you have Plantar Fasciitis you should seek the help of a suitably qualified sports podiatrist.

Written by Karl Lockett

Sports Podiatrist

Sydney Heel Pain Clinic