PM rroof

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http://www.mountainmettle.com

    Only guy I knew that had the problem had surgery to remove it/them. That was a bunch of years ago, so maybe there's some better options now.

I have had heel spurs on both feet for over two years now. The left foot is healing on its own but the right is still uncomfortable. especially bothersome while and after running. I was seen by three sugeons (one of the benefits of having a wife who the clinic administrator). First one is a general orthopedic surgeon, the second a sports medicine surgeon and the third is the chief of orthopedic surgery. All three agreed that surgery is the only way to go to remedy the problem. They differed a little on the expected recovery time but all agreed that it can vary depending unpon the surgery/rehabilitation etc... The surgery is to remove the achilles from the heel, hammer off the growths, grind down the bone a little to allow for re/overgrowth, re-attach the achilles and keep in a rigid cast for 8 to 10 weeks for the achilles to mend. Rehabilitation can start after that. The complete deal could take up to six months or so.

I ran the Houston marathon in 3:32 and the surgeon said if I run like that I am not a candidate for surgury at this time. He said run laps instead of out and back so that if I broke something (leg/achilles) I would not be too far from help.

In the meantime, I cool the spurs with ice at least twice daily and fine that shoes with minimum padding in the heel cup help out. The reduced padding in the cup reduces pressure on the back of the heel where my spurs located.

I hope that this info was helpful.

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Once, I was fast. But I got over it.

I know several runners who have used a slantboard religiously with good results. They sell adjustable slantboards at sources like performbetter.com and PT supply sites. Stretching the achilles tendon, from what I can tell, alters the mechanics of the foot. I use a slantboard while standing up against a wall 2x per day at 10 minutes per session. I am now up to the highest setting (45 degrees) and I have been problem free for years.

6 months of recovery time? I think I'll just live with the occasional pain in my heel.

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http://trainingoferic.blogspot.com/

I am surprised that reducing the padding helps. My ortho thinks I have to increase the padding. Does not seem to help at all. Maybe I'll give it a try. I am also getting my 2nd shot of Cortisone next week within 6 month. It helped the first time but not permanently.
Stretching, nite splint etc does not seem to do much.
Any other advice is appreciated - I am desperate.
Axel

Question to all posting in this thread - are you talking about heel spurs or Haglund's Deformities? Sounds like the original poster is talking about heel spurs, not too clear what the rest of you are describing.

The ulrasound that I had done showed boney growths on the back of the foot where the achilles tendon attaches to the heel bone. I was under the impression that heel spurs can be at the back of the foot like mine or more forward and under the foot causing conditions such as plantar fasiciitis. Is this not correct?

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Once, I was fast. But I got over it.

You sure these are heel spurs? Even if they are, the first answer isn't surgery (it rarely is in this type of situation). It could be scar tissue from your PF. Stretch the hell out of your calf/foot and work on massaging the "spurs". I highly doubt from the location you describe that it's a bone growth, but simply scar tissue from the PF damage/ healing. Either way, I would do what I can to lengthen the tissue on the plantar side of the foot through rolling it over something like a TP roller/frozen bottle of coke/etc. Also, stretch your calf like crazy.

Actually most of us older folks have heel spurs, but they generally don't hurt. They are where the plantar fascia attaches to the heel, and they are visible on Xray. As I understand it, it's the PF that hurts and the heel spur is only infrequently the real issue. The treatment is generally just the same as for PF. Do PF stretches, golf ball under the foot, ice, rest. I suspect that heavy footed landing and low cadence are big contributors.

BUT, I'm probably full of _____!!! See what Rod (rroof) says.

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Dick

Take everything I say with a grain of salt. I know nothing.

It may be scar tissue, but this stuff has been around for awhile now. Also, this stuff is pretty hard and it isn't soft at all. Also, it's pretty much at the exact spot where I read it should hurt with heel spurs.

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http://trainingoferic.blogspot.com/

Well, that makes sense since I do land heavy when I'm run because I am somewhat heavy and I do have a low cadence. However, the heel spurs don't hurt that often, but I just have bumpy heels.

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http://trainingoferic.blogspot.com/

Well, the old "heel spur" issue -

I hate this topic since I have to play "myth buster" each day with my patients.

Let us just keep it simple: there are 2 main types of "heel spurs" (or more correctly termed enthesopathy). The original poster is describing an infracalcaneal spur, thought be at the plantar fascia attachment (now proved to be at the long plantar ligament). As docfuel says, these are actually, bony spurs, but are commonly found on plain film X-rays in all ages, body morphs/types, and are usually asymptomatic. 20+ years ago, these were thought to be the cause of inferior heel pain (most commonly now known as plantar fasciitis) and lots of heel spur surgery was done. The "myth" was perpetuated since these heel spur surgery patients mostly improved after surgery. Later, some surgeons from Texas (Barrett and Day) decided to just release the plantar fascia and leave the spur (if present) - those patients also got better. In other words, to resect an infracalcaneal spur, one has to transect the plantar fascia. Today, less than 5% of people with inferior heel pain syndrome (plantar fasciitis most commonly) go to surgery at all with out current understanding of the pathology.

#2 however is a traction enthesophyte at the Achilles tendon attachment at the BACK of the heel (no, NOT a Haglund's deformity - that is yet another issue). This is also commonly seen, but is a bit more of a problem. These are definitely more common in what were teach residents as the 4 "F's": Fat, Fourty, Fertile, and Female (this pneumonic goes with other things as well). Also seen in people with very tight posterior muscle groups (similar to plantar fasciitis). This spur tends to get more physically irritated with shoegear, running, hills, etc. causing chronic achilles issues and posterior heel pain with retrocalcaneal bursitis, etc. These more commonly require surgery (I just did one yesterday in fact) for full resolution of symptoms if conservative therapy fails.

There are also some other rare calcaneal spur entities that I won't get into - in fact, if you have read this far, you must be suffering from one of the above for sure ... LOL!

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Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

I am having trouble with a sharp pain on the back of my heel when I reach down to touch my toes, or point my toes upward pushing the heel down. What would that be...

Insertional achilles tendinopathy

Caused by ... ? interstitial tear(s), posterior equinus (tightness), spur, retrocalcaneal and/or retroachilles bursitis, tarsal tunnel syndrome is a remote possibility as well.

I see lots of stretching and ice in your future ...

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____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

Do I have #2? I have pain at the very tip of the heel, not the bottom, not the achilles. I thought it might be bursitis from what I have read. The rather acute pain starts right when I begin running. I walk a little bit at about a quarter mile and then at about mile two it goes away for the rest of the run until I subsequently sit down for a while at my desk. It's like PF in that regard but only at the point of my heel. It responds well to ice and beer (I ice it while I suck suds at night) and not running. What do you think?

Here's what I recommend:
1. Try the Strassburg Sock. http://www.thesock.com/ It is more important to wear it every night than to put it on too tight. Every night when you go to bed you take the tension off the PF and it starts to heal. Then when you get up in the morning and reload it, the incomplete healing breaks down. The sock helps it heal with a little tension. It is about 80% effective. You'll be tough because you've had it so long.
2. Also use an orthotic. I like the Spenco 3/4 Length Thin Sole Orthotic available off the shelf. http://www.hocks.com/ You probably already have a set or two. Arch support helps take tension off the pf.

Use the above regularly and faithfully for at least a few weeks. If you aren't making progress consider adding physical therapy. Then consider an injection. You'll need to rest for 2 weeks after the injection. Lastly consider surgery. That's the short version.

I've tried the Strassburg Sock before. I didn't like it but I ended up getting a night split from rroof and I wear that about 4 nights a week. I also wear a custom orthodic as well. This isn't like it's just cropped up. This is something that I've had for awhile and it isn't going away completely. Of course, I'm still running on it and keeping it in check so I'm pretty sure that's part of the problem, too.

Thanks for the suggestion, but it won't help in my case.

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http://trainingoferic.blogspot.com/

Likely insertional achilles tendonitis/opathy.

Good google fodder for ya' ;-)

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____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

"I've tried the Strassburg Sock before. I didn't like it but I ended up getting a night split from rroof and I wear that about 4 nights a week. I also wear a custom orthodic as well. This isn't like it's just cropped up. This is something that I've had for awhile and it isn't going away completely. Of course, I'm still running on it and keeping it in check so I'm pretty sure that's part of the problem, too. "

Exactly the same for me. Should I stretch while injured? What about cortisone, should I get a 2nd shot? I usually have little pain in the morning surprisingly.
thx for your help
Axel

Can't comment without more info - I have no idea what your dx is! You mentioned a "cortisone" shot, but why/where? Did it help? 2nd? Sure if the first worked for 6 months. Just too many holes to fill. Generally avoid corticosteroids around the Achilles, but common practice at the plantar fascia insertion (lots of debate in the literature though - despite being "effective"). Stretch while injured depends upon where as well - with PF, yes. With Achilles tendonitis - carefully during the acute phase.

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____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

Thanks. Looks like this is my problem. I guess I'll have to drink more beer :)