THE CLINIC: Calceneal Bursitis in the Heel?

QUESTION:

I am a 55-year-old male weighing 175 to 180 pounds, and I have chronic pain at the back of my right heel. I do not recall a specific injury but have been aware of discomfort for at least the past six months. A podiatrist I spoke with advised heel lifts, but they did not help. She then made orthotics for me and I believe my pain is worse; it is now starting in the left heel, in fact.

I began running two to three years ago, and have since dropped about 30 pounds. At that time I had shin splints, and I was told that I overpronate. I’ve completed two marathons and four half-marathons, with a regimen of about four miles after work two days a week, then running long on the weekends. I run at 10:00 pace, perhaps slower, when I train. I do a lot of running on local streets and cement biking trails. I do try to run on crushed limestone when I can.

The physical therapist (and fellow runner) whom I recently saw thought I had calcaneal bursitis and has been doing friction massage, stretching my gastroc muscles and iontophoresis. I try to ice massage when I have time.

In June of last year I had arthroscopic left knee surgery for a torn medial meniscus, and then open removal of a Baker’s cyst on the left knee.

Steven Creska

Ward, ME

ANSWER:

If your problem is calcaneal bursitis then I am assuming your pain is near the Achilles tendon insertion. I would recommend you get x-rays and MRI to rule out calcification or bone spurring, but more importantly an Achilles tendon tear. Many people can walk and run with a small tear of the Achilles. Unfortunately in my experience, rest with immobilization for two to three weeks is the only way this completely heals. After rest I would continue with therapy in the manner you described. You should be able to resume running in due time.

Lori Barnett, ATC, DPM, FACFAS

New Tripoli, PA

ANSWER:

 Although it is hard to diagnose without seeing your heels, I would tend to agree with your PT’s assessment. However, you do not say whether the treatment is helping. If your pain is near a bony bump on the back lateral (outside) aspect of your heel next to the area where the Achilles tendon attaches, then you may have a Haglund’s bump. This is a benign growth of bone that can become painful with friction from shoes. I suspect that the reason your pain got worse after using the orthotics is that the bump was lifted higher in the heel cup of the shoe and was therefore subjected to more pressure and friction.

Look inside the heel counter of the shoe to see if the fabric has worn away near the area of your pain. If it has, purchase some moleskin from the local pharmacy and place a horseshoe-shaped pad around the area in the shoe. Do not pad on the wear spot, as this will only increase pressure.

Paul Langer, DPM

Minneapolis, MN

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