Discussion: Heel pain

A week ago the back of my heel was sore, particularly when the foot was flexed up towards the knee. It went away after a day of rest and although I could faintly feel it during the week, it didn't interfere with activity. Yesterday it flared up again after running hard at Cliff Cave. I'm limping a bit today.

From a brief review of symptoms, my best guess is that it's Retrocalcaneal Bursitis - an inflamation of the bursit gland at the attachment point for the achilles tendon. If so, I'm not too worried about it because with a bit of rest and vitamin-I it should go away.

I couldn't find anything on the web indicating that my symptoms required professional attention at this point. Just in case, I thought I'd check here and see if any AP'ers knew of a reason why I should be concerned about this.

It could be plantar fasciitis which to me feels like a pain in the heel when I get it. Mine is exacerbated by o-shoes because they have a lower heel. There is a lot written up on it, so I suggest you start doing some web searches for self diagnoses (to see if you have it) and therapy.

That was my first thought, but the pain seems to be too high up on the heel. Plus, anytime the plantar acts up on me, I can feel it on the bottom of the foot if I press hard. No discomfort there at all. Still, it's a possibility that I'll keep watch for.

Back of the heel doesn't sound like PF.

Back of the heel could be PF, but there are other more likely explanations. I had a bad bout of pain in the back of the heel about 20 years ago that was caused by running shoes with too stiff a heel counter. Before I figured it out, it was enough of a problem that I went to a podiatrist about it. He rather cheerfully volunteered to do some surgery! Anyway, the good news was that switching from Nike to Asics fixed the problem almost immediately. And I never went back to that guy again.

Eric, this is what I had after the Winter Training Camp in January and continue to have now and then 6 weeks later. It comes from running in soft ground and/or stiff shoes and/or hilly terrain (ie., orienteering in snow and mud in winter). Dr. Sandy HJ looked at it and thought it was most likely achilles bursitus since the calves weren't tight but still suggested calf stretching some achilles eccentric loading exercises, heel raise exercises and ice baths. PG also suggested gel heel cups and changing shoes. I did all of this and was running within a few days. I can now run every day with limited pain but have only worn my O shoes twice since (bought ice bugs instead). The O shoes shrink after use so on Sudden's advice I put newspaper in them to keep them stretched. Since I also wear active ankle I was getting lots of rubbing on the back of the heel.

I saw the stretching advice on a few websites with respect to bursitis. That surprised me as I've always heard you should never try to stretch out an injury. Are you supposed to stretch as prevention after it heals or during the healing?

The shoes explanation is holding some water. Both times the flare up has followed running hard in my O-shoes. I've used these shoes for a while without trouble, but I'm thinking I'll stick to my trail shoes for a few weeks.

Yes, I believe the problem I had was due to the shoes rubbing on the heel and causing the inflammation.

re: stretching....
It is not a muscle injury but can become inflammed by tight calves so stretching them is important.

I had something similar a few years ago. hurt to wear shoes, but not to be barefoot. changing my training shoes fixed the problem almost instantly.

I think I mentioned a while ago that Icebugs were a far better choice :)

Be careful with the stretching. If indeed it is a retrocalcaneal bursitis, stretching the calf will actually crush the bursa that lies behind the tendon and flare it up even more. Stretching should only come AFTER the bursa has healed, if that's the right diagnosis of course. Other possible diagnosis include Achille's tendonitis (where you describe the pain is the point of attachement of the tendon), pump bump (repetitive pressure on a bone inflames the outer layer of the bone and eventually a bump develops), stress fracture of the calcaneus (seems unlikely but still not impossible) and plantar fasciitis - but as mentioned by others, typically the heel pain of a plantar fasciitis will be underneath the heel and not the back of it. But having said that, the plantar fascia does have expansions that do come up on the back of the heel, so not impossible.
The 2 most likely diagnosis in my opinion are irritation/inflammation of the bone or bursa from the pressure of the heel counter of the shoe - VJ shoes are particularly renouned for doing that, or Achille's strain/tendonitis (from tight calves, overtraining, minor strain or malalignment of the calcaneus from pronated feet).
You must figure out the cause of your problem, eliminate it and begin treating it. Ice ice ice, much better than vitamin I as it has no side effects and acts locally only. 10-12 minutes, wrapped in wet towel as it penetrates the skin better.
Voila!

I switched from Jala to VJ last fall. Didn't have trouble until recently, but I was a little light on my O-training last fall due to an ankle injury. I'll run a few weeks in my trail shoes and see if things clear up. Maybe I need to go back to the Jalas.

Today the pain is much less and I can walk without a limp. The area of pain is now quite localized to the attachment point so some trouble with the bursa seems the best explanation. I don't think it's a problem of tight calves.

Thanks all for the comments!

Stretching the calf is not necessarily a good idea as Barbie suggests, but if it is due to tight calf muscles/ p.fascia etc then stretching the hamstring can take some of the pressure off the tight calf muscle. Your calf may get tighter too, due to 'babying' it, so stretching the hams may be more important anyways. Sounds like a bursa thing to me too.