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Heel pain at back of foot- lower Achilles or something else? (Read 75 times)

mk885


    Hi

    I have had mild pain at back of my heel for over 2 months now- more sore when I get up from bed in morning...

    I have almost stopped running hoping that it would heal

    I have been doing more strength and calf drops but pain has stayed

    Possible triggers were either switching shoes or doing more strength (jumping jacks and calf raises)

    Surprised that it has not healed- perhaps I shouldnt be?

    Please looking for thoughts on if this is Achilles, which is what I think it is, or something else and any other suggestions?

    Anything different I should do if this is lower Achiles?

    I thought minor pain would heal quicker.

    I was previously running 4x per week- ~20 to 25 miles per week.

    Thanks in advance for your help or suggestions or further questions

    Mike

      I have no medical or physio background, but I'll tell you what I can from personal experience.  It could be a couple different issues.  One possibility is insertional Achilles tendonitis/tendinopathy, possibly from the increased strength training and jumping you described.  Another is retrocalcaneal bursitis, which could occur from a simple shoe switch, either a lower heel-toe drop or a heel cup that rubs against the back of your heel more than usual.  It's not a simple thing to identify which of those two things it is, and it's possible to have both occurring at the same time, which makes things even more complicated.

       

      As far as how to fix it, you'll find there are very different opinions depending on who you listen to.  Medical people will tell you to stop the physical activity you're doing for a while, ice the heel regularly, take NSAIDs "liberally", and elevate your foot, etc. for several days.  Some physios will tell you to avoid doing all those things, particularly the icing and NSAIDs, and instead do isometric holds, basically standing with your heel off the floor and holding in that position for maybe 45 seconds, then resting for 1-2 minutes, then doing the 45 seconds again, for a total of maybe 5 reps.  And doing that every 4-6 hours throughout the day.

       

      Eccentric heel drops are often recommended, avoiding dorsiflexion since the pain is on the back of your heel.  Heel lifts are often recommended, to take pressure off the Achilles.  If you Google "insertional Achilles" and "heel bursitis" you'll see how conflicting the advice and recommendations are.

       

      I've been dealing with back of the heel pain for 8 years now, and I've had a total of maybe 30 days pain-free running during that time.  So good luck.  Hopefully you'll find a cure for yours much quicker.

       

      Here's a web site I've referred to lately:

      https://www.sportsinjurybulletin.com/anatomy/anatomy/what-lies-beneath-relieving-fear-of-the-retrocalcaneal-bursa

      JMac11


      RIP Milkman

         

        I've been dealing with back of the heel pain for 8 years now, and I've had a total of maybe 30 days pain-free running during that time.  So good luck.  Hopefully you'll find a cure for yours much quicker.

         

        As someone now at 2+ years of this pain, this hits home. My only running injury that has truly turned chronic.

        5K: 16:37 (11/20)  |  10K: 34:49 (10/19)  |  HM: 1:14:57 (5/22)  |  FM: 2:36:31 (12/19) 

         

        Next Race: NYC Half (3/19)

         

        mk885


          Thanks so much Kennedy and JMac

          i have been concerned to run in case I make it worse- how have you got comfortable with running?

          I am going to physio tomorrow but great to get your perspectives from having dealt with it for so long already and continuing to run

          thanks again

          mike

            I think many people would advise you not to try to run through the pain.  Some people are able to get rid of that kind of pain by taking a couple weeks off or a couple months off.  I've taken as much as 6 months off and had it come back on my 2nd or 3rd short jog after the time off.  And I've taken time off on about 10-15 different occasions during the last 8 years, so obviously time off is not going to fix my injury.

             

            Generally, I've tried to keep the pain level at 3 or lower (on a 1-10 scale), and if the pain level goes higher than that, I either slow down or stop and walk home.  There have been two times I was able to run pain-free in the last few years.  One time it lasted 11 days, the other time 3 days.  On both occasions, I was running 70-80 miles a week, and the pain came back just as quickly and unexplainably as it went away.

             

            A couple things I would recommend against - I've had much more pain if I static stretch the calf muscle, even just slightly.  I've also had increased pain when I've tried to run barefoot on grass a couple times.  I think the compression of the Achilles against the heel bursa aggravates things and causes a flare-up.  I've also cut the back out of several pairs of shoes, or at least cut out the hard heel counter and left the fabric in place, but that has never really helped matters long-term.

            marunr


              It's almost certainly Plantar Fasciitis. The telltale sign is the pain in the morning, or when you try to walk after sitting for a while. I had this twice...and it lasted for 2 years each time. It's the runner's lyme disease. I bought 2 pair of custom orthotics (they didn't work) and tried every single thing I could find to get rid of it. I had an entire drawer full of over the counter inserts. It's a bad deal. The only thing that I ever found to get rid of it was wearing a night splint (there are several different kinds but the night sock worked best...google it) and soaking my foot in ice water . Find a cooler or something you can put your whole foot in, and fill it with water up over your ankle. Dump in a tray of ice and keep your foot in until the ice is all melted. I wish you the best. In my opinion, this is one of the worst injuries a runner can experience.

              JMac11


              RIP Milkman

                I think many people would advise you not to try to run through the pain.  Some people are able to get rid of that kind of pain by taking a couple weeks off or a couple months off.  I've taken as much as 6 months off and had it come back on my 2nd or 3rd short jog after the time off.  And I've taken time off on about 10-15 different occasions during the last 8 years, so obviously time off is not going to fix my injury.

                 

                 

                This fits my bill too. I've actually found sometimes it's even worse with time off! The best it's felt in the last 2 years? When I started hitting 80+ MPW in the fall.

                 

                ETA: I just wrote that and then saw you said almost the same thing! Wow.

                 

                I've had success with night splints, at least temporarily. I would take a look at those, like marunr mentioned.

                5K: 16:37 (11/20)  |  10K: 34:49 (10/19)  |  HM: 1:14:57 (5/22)  |  FM: 2:36:31 (12/19) 

                 

                Next Race: NYC Half (3/19)

                 

                  It could also be Haglund's deformity. The dreaded Hag is fairly common among runners.

                   

                   

                  namdosan1409


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                      Consistently Slow

                        I have had plantar fictitious for 4 years. Scarping is the only thing that has worked for me.

                        Run until the trail runs out.

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                        Eweis


                          It could also be Haglund's deformity. The dreaded Hag is fairly common among runners.

                           

                          This is what I have.  Here's my story and it may help you.

                          I had that rear heal pain and went to physical therapists and they diagnosed it as an achilles tendon issue and gave me a number of the typical exercises.  I continued to have heal pain in the morning, any time I got up to walk around and during the first 1 to 2 miles of my daily runs.  It was sensitive to the touch and it would hurt intensely if I happened to barely bump my heal on something like the leg of a chair.  Then, I realized that wearing open back sandals helped a lot.  I started wearing them all of the time.  I realized that the pain diminished a lot.  So, it finally occurred to me that the rubbing of my shoes on my haglund's bump (right heal) was what was causing the pain and tenderness.  I also noticed that when I wore my racing shoes that only have a fabric heal, that the pain was reduced.

                           

                          So, I started cutting the heal counter out of the back-rear of my running shoes.  The heal counter is a (very) hard plastic insert that I suppose is supposed to be for the support of the shoe.  I have no idea why the plastic has to be so firm/rigid though.  I have Saucony Endorphin Pro 2's that do not have that hard plastic heal counter, or cup, you might call it.  What I do is cut open a 2 x 2 inch panel or door in the material, cut out the plastic that is in between the outer material of the shoe and the inside light lining of the shoe.  As such, I fold back and sew back the outer material and one cannot even tell that I've modified my shoe.  Removing that plastic prevents anything firm from rubbing up against my heal....it is only soft fabric remaining.

                           

                          I had that sore achilles for about 2.5 years.  I continued to train through it as it wasn't really getting worse and it wasn't getting better so I managed it.  I managed it by using pillows at night to occasionally prop up my foot so my heal didn't take the pressure of laying on the bed (yes..that hurt it).  I would typically run 6 or 7 days a week and continued to run but I took the first 1-2 miles really slow and easy until the blood flowed and relieved the pain.

                           

                          Now, for the last several months I've been nearly 100% pain free.  I have 4 or 5 pairs of shoes where I've cut out the rear heal panel as described and it's been a game changer.  So, think hard and carefully about what and how your pain is arising.  Perhaps it is what I've had.  There are surgeries where they can go in and shave down the haglund's bump and often even do so without detaching the achilles tendon which is much less invasive than having to reanchor the tendon.  And, the recovery is much shorter on the order of months rather than 18 months or something like that.  But, I have no plans for pursuing that as this solution has been like magic.

                           

                          Good luck.