Retrocalcaneal bursitis?? Inflamation where the acchiles meets the heel bone.

Despite feeling fine the next day about 24 hours after I finished my 28.5 mile hike last week my left heel became really tender to the touch and stiffened up.
If I completley stay off it (like the doctor says to do) the inflamation starts to go down, but I'm not very good at inactivity, and I cant stay home from work. I'm practicing R.I.C.E treatment the best I can, but now a week later I'm still in alot of pain when I try to walk. Anybody on here have issues with this before? Any tips? How long before you could hike again?

I've "enjoyed" heel bursitis for many years... It used to be bilateral, but the inactivity enforced by my broken leg (11 weeks non-weight bearing) allowed it to heal on the broken side. It continues on the good side.

From what I have read, it often co-occurs with Achilles tendonitis. Stretching the Achilles tendon helps as does ibuprofen and RICE. (Generally, light activity is better than no activity.) Proper foot support (Superfeet in my case) makes a big difference for me. I also have to avoid too much (shoe) friction on the heel.

In my case, it may hurt just after and the next day after a hike, but generally goes away by the second day with the above treatments.

Doug

How is that diagnosed? I have heel pain, have had X-rays that were first read as heel spurs. The podiatrist said I do not have heel spurs, that I have plantar fasciaitis. I also have inflamation in my right hand ring finger, right elbow, now as of today left elbow and this ongoing back of the heel pain that hurts all the time. I want to claim my movingable feast of pains as being mostly related to ongoing Lyme.

Signed, Nearly Crying in Pain

erugs said:

How is that diagnosed? I have heel pain, have had X-rays that were first read as heel spurs. The podiatrist said I do not have heel spurs, that I have plantar fasciaitis.

Click to expand...

The primary symptoms are pain at the attachment point of the Achilles tendon to the calcaneous (heel bone) and potentially visible swelling ("pump bump"). There may also be calcification which would likely show on an X-ray. IIRC, it can be hard to distinguish from (but may co-occur with) Achilles tendonitis.

Plantar fasciitis typically presents as pain under the foot just forward of the heel-ground contact point. (Heel spurs may co-occur.) Heel bursitis typically presents as pain at or just above the back "point" of the heel.

Plantar fasciitis is usually an overuse injury; heel bursitis is usually caused by shoe friction. Women's pumps are a frequent cause, thus the swelling is often called "pump bump".

Most of the above info is from: Cailliet, Rene, MD, "Foot and Ankle Pain", F. A. Davis Co, Philadelphia, 1968. http://www.amazon.com/Foot-Ankle-Pa...OZ5K/ref=sr_1_5?ie=UTF8&qid=1344875802&sr=8-5

Doug

Interesting, Doug. My heel pain is in neither of the locations mentioned, but right in between.

DougPaul said:

From what I have read, it often co-occurs with Achilles tendonitis. Stretching the Achilles tendon helps as does ibuprofen and RICE. (Generally, light activity is better than no activity.) Proper foot support (Superfeet in my case) makes a big difference for me. I also have to avoid too much (shoe) friction on the heel.

Click to expand...

I should add that weight lowering exercises have been shown to be helpful for Achilles tendonitis, perhaps they are also helpful for heel bursitits. (One way to perform these exercises is a modified standing heel lift: lift with both feet and lower with one foot.)

Doug

My mild case was treated with a boot (not the hiking type) for 4 weeks (NSAIDs for the pain) followed by no hiking for 3 more months in clogs with heel lift, then light hiking (read= slow short hikes) with pre-activity stretching. I'm still in the clogs except when I hike and it can still can be painful if I stretch too far.

erugs said:

Interesting, Doug. My heel pain is in neither of the locations mentioned, but right in between.

Click to expand...

Medicine would be much easier if problems presented with only the classic symptoms...

(And, of course, I'm only an interested layman posting on the internet. Reader beware...)

You might find find the referenced book to be worthwhile--the chapter on heel pain is 9 very readable pages. (The book is part of a well-known series on pain*. I have found the books to be very helpful in understanding and dealing with some of my own problems.)

* Pain series, all by Rene Cailliet, MD
- Foot and Ankle Pain
- Low Back Pain syndrome
- Knee: Pain and Disability
- Hand: Pain and Impairment
- Neck and Arm Pain
- Shoulder Pain
(All are available as inexpensive paperbacks.)

Doug

surf88 said:

Anybody on here have issues with this before? Any tips? How long before you could hike again?

Click to expand...

I have had some mild to severe foot, ankle and heel pain over the years, sort of free floating like Erugs. (*I am not a Doctor and what follows is not medical advice*): I have often used a little over dose of Aleve, maybe 6 pills at once, once or twice in a couple days, to knock out the severe pain. After that it becomes more manageable and tolerable. Longer term: staying active, in shape, stretching, maybe perscription orthotics, etc will help.

Amongst almost every other foot injury known to man, I have been battling achilles tendonitis over the last 15 months. When it flares, the pain is immense. I have a boot the dr. gave to me that I've had to wear on three separate occasions since I first got it. I wear it for about a week, and then go back to stretching, and all is OK. HOWEVER...if I start to feel it, and go right to stretching, it doesn't help and in fact, with my last flare up, I think it actually brought it on. So, wait until after the swelling goes down to do the stretching.

My diagnosis seemed to be more based on the fact that I did a big milage day, and this had never been an issue before, and the way that it was tender to the touch in a very specific spot. After resting it for 4 days straight it was starting to feel better. Walking without a limp was still impossible at this point, but I found I could pedal my mountain bike on flat terrain with no pain. So I went out for a few miles on the local rail trail yesterday. Although the activity felt fine at the time, when I woke up this morning it felt just as inflamed as it initially did last week. I've never had and problems with tendons before and really hope this doesnt become a chronic thing.

I was once hiking with a sports medicine doctor who what telling me about a patient who was a compulsive runner. This runner injured his achilles tendon. The doctor told me that the injury would heal in 6 weeks with no activity. But he knew that this patient would fee good after 3 weeks and start to run again and reinjure it. And in the end the runner would be faced with a 6 month healing process. The moral of this story is that tendon injuries require enough time to fully heal or the complications could be chronic issues.

Chip said:

I have often used a little over dose of Aleve, maybe 6 pills at once, once or twice in a couple days, to knock out the severe pain.

Click to expand...

My ulcer starts to hurt just reading that statement.

surf88 said:

Walking without a limp was still impossible at this point...

Click to expand...

I will not limp, I will not limp, I will not limp. Then others don't remember I am in pain and when I make mention of my great distress I hear of their's, as though it is worse.

The reason I try not to limp is that I don't want the awkward gait to put other parts of my skeleton out of alignment. Should I limp if I am in extreme pain? (And wishing I had taken 6 instead of 5 Aleve?)

erugs said:

I will not limp, I will not limp, I will not limp. Then others don't remember I am in pain and when I make mention of my great distress I hear of their's, as though it is worse.

The reason I try not to limp is that I don't want the awkward gait to put other parts of my skeleton out of alignment. Should I limp if I am in extreme pain? (And wishing I had taken 6 instead of 5 Aleve?)

Click to expand...

sounds like these are questons for a real doctor,

walking with a limp mean two different things if your talking about hobbling down the hall to the toilet or climbing a 4000 footer.

surf88 said:

My diagnosis seemed to be more based on the fact that I did a big milage day, and this had never been an issue before, and the way that it was tender to the touch in a very specific spot. After resting it for 4 days straight it was starting to feel better. Walking without a limp was still impossible at this point, but I found I could pedal my mountain bike on flat terrain with no pain. So I went out for a few miles on the local rail trail yesterday. Although the activity felt fine at the time, when I woke up this morning it felt just as inflamed as it initially did last week. I've never had and problems with tendons before and really hope this doesnt become a chronic thing.

Click to expand...

This is classic behavior for tendonitis (and many other wear-and-tear injuries). Just because they have become asymptomatic does not mean that they have fully healed. And, of course, people generally rush back to doing the same thing that injured them in the first place without altering the behavior (eg different shoes, better support, etc).

I have fought numerous wear-and-tear problems (including tendonitis, heel bursitis, chondromalacia patella, etc) at one time or another. They require enormous patience--you have to rest far longer than the pain suggests and then rebuild up slowly. (Remember that you decondition while resting.) They are very easy to reinjure until fully healed. You may also have to modify the system or behavior in some way to prevent reoccurence.

Given the choice of tendonitis or a broken bone, take the broken bone...

Doug

John H Swanson said:

sounds like these are questons for a real doctor,

Click to expand...

Unfortunately these wear-and-tear injuries are just minor nuisances to the doctors and can easily fall between the cracks.

Unfortunately they can also be lifestyle threatening (or destroying) to an active individual...

Doug

Heel pain, in spite of there not being a lot of structures in the area, can be difficult to diagnose. You'd think it'd be a no-brainer but plantar fascitis can present like Achilles tendinopathy and vice versa. The exact location of pain can vary from person to person. There's also the possibility of a stress fracture. Heel "spurs" on X-ray don't really mean anything. The asymptomatic side is just as likely to show a "spur" as the painful side. (the spur has the consistency of milky tooth-paste I've been told).

Note the usage of the term tendinopathy instead of tendinitis.

Re the above post, personally, I would limp. It's a question of prioritization. Also, one's heel area is always better off when one plants the entire foot and not just the forefoot when ascending. Hiking poles are good too.

I have had episodes of heel area pain (never diagnosed in spite of imaging and probing ) that have made me cease all physical activity for months. I attribute the high frequency of heel area pain in Northeastern USA hikers to the lack of switch-backed trails of gentler pitch and in my case to Adirondack slide climbing.

erugs said:

I will not limp, I will not limp, I will not limp.

Click to expand...

Believe me I hate to limp, it totally throws off my air of indestructability that I like to put on. I stood there for about 5 minutes afer getting out of my car at the grocery market sunday going over the mechanics of walking with out a limp, but I was still not able to do it.

DougPaul said:

Given the choice of tendonitis or a broken bone, take the broken bone...

Doug

Click to expand...

Funny. That's what my podiatrist said during my visit.