Question
I started training for a marathon 5 weeks ago.  The program is a 24 week program where you start by running only a mile or two a day and then gradually increasing.  At the end of week 4 I ran a three mile run and noticed some tenderness in my left heel on the lateral side in an area about the size of a penny.  

After a few days of rest the tenderness had subsided almost completely so I ran two miles.  The tenderness returned but only mildly and again subsided overnight.  I ran 3 miles the next morning and noticed the tenderness along with some swelling.  I again rested, this time taking some ibuprofen to help with inflammation.  My training program said to run two miles then have a day of rest and then run 5.  I did not run the two mile day, took the rest day, and then ran the five miles.  So I had about three days of no activity.  The pain was almost non existent so I ran the 5 miles.  While I felt a little tenderness toward the end of the run, I finished it and the pain was relatively dull.  As the day progressed the area become more swollen and more tender.  The area of the pain is still no larger than a nickel.  After icing and taking ibuprofen for another day, it is still there, though the swelling has gone down some.  

I am using New Balance 1124s for my running shoe, I have a history of overpronation and thought these would help with that.  I have given myself a full week of rest, but I would like to get back to training next week.  

The area of tenderness and swelling is below the end of the fibula and toward the back of the heal, with the lower part of the pain reaching just above the insertion of the achilles tendon.

I have full range of motion with no pain without bearing weight and very little pain when walking or running, though it has some tightness due to swelling, I still have the full range of motion.  It does however, have a significant amount of tenderness when I press on the swollen area (rating of 3 of 10 on the pain scale).  

What is causing the pain and how do I treat it effectively and how do I keep it away while I continue my training for the marathon?

Eric

Answer
Eric,
My suggestion, to help you reach your goal of running the marathon, is to consult with a podiatrist who specializes in sports medicine.  This is something that will likely require biomechanical control with an orthotic and addressing it sooner than later will make all the difference in your recovery and training.

What can it be?  Could be a form of plantar fasciitis, could be peroneal tendinitis, impossible for me to say for sure.  Yes, ice, NSAIDs, and OTC insoles could be helpful, but if you're serious about running the marathon, don't play around with that.  Visit a podiatrist and get the appropriate treatment.

All the best,
Andrew Schneider, DPM

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