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Retrocalcaneal bursitis (heel/achilles bursitis) - help!
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I have chronic retrocalcaneal bursitis (originally started when I was doing eccentric calf exercises). It was ok for most of last year, and then really flared up this summer. I didn't (couldn't) run for 2 - 3 months and there was no improvement at all during this time. I then had a steroid injection which was amazing but only worked for a couple of months so I am now a bit wary of this technique. Does anyone know of any other injections or techniques that can help bursitis to heal? (besides the usual - rest, ice, heat etc. etc.).

It has been diagnosed on an MRI (which also diagnosed bone stress odema on the calcaneal despite me hardly running i.e. from cycling!). I am worried as I have been referred to a surgeon and am keen to try anything before going down that route!

I am looking into getting some fore foot wedges for running and cycle shoes as I'm a fore foot runner with high arches and very flexible/lax ankles who lands on the outside of the foot and pronates inwards - the pain seems to be when my heel gets to its lowest point.

Thanks for any advice on anything that may help!!!!!!
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Re: Retrocalcaneal bursitis (heel/achilles bursitis) - help! [SarahLouise] [ In reply to ]
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retroachilles/retrocalcaneal bursitis is easy to deal with ice, steroid injection/pills, but if you don't address your biomechanical issues that lead to it, return is likely. This is NOT the same as achilles tendinosis wherer eccentrics, stretching, etc. is helpful.

This is more common in people with high arch/rigid feet, tight posterior calves and with direct shoegear irritation. Do you have a large calcaneal spur at the achilles tendon insertion or a Haglund's deformity? Forefoot running isn't helping matters either.

As for cycling issues - make sure your heel counter on your cycling shoe isn't directly irritating since cycling shoes have pretty rigid counters. Move your cleats all the way back and make sure you seat isn't too high.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: Retrocalcaneal bursitis (heel/achilles bursitis) - help! [rroof] [ In reply to ]
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Thanks much appreciated! Strangely I've never really had the feeling that pressure is causing the pain, although I guess it may be possible that I have not realised this? The MRI apparently confirmed that I don't have heel spurs or haglunds deformity, although looking at it myself I think that the bone sticks out more than usual on the lateral side where the pain is and I had "severs disease" in the same spot as a kid.

Have you ever heard of the inflammation going away on its own with rest (it doesn't seem to for me), and are you more likely to make the injury even more chronic if you wait say a couple of months to get a (second) steroid injection? I've heard that it can stop the other injury (bone stress) from healing which I'm guessing will take about 6 weeks.

I've heard of other treatments...shock wave therapy, viscosupplements (although maybe not in relation to bursitis?), natural traumeel injections, castor oil heat packs etc. but am pretty skeptical and most of these are really expensive so as you suggest I'm trying to figure out the biomechanical issues when running and cycling. Bizarrely my saddle has always been really low.

Have you heard of any "motion control" running shoes for people with highish arches? Bit confused as they only seem to be for people with flat feet...although mine definitely pronate and are definitely pretty flat at the end of the running gait!
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Re: Retrocalcaneal bursitis (heel/achilles bursitis) - help! [SarahLouise] [ In reply to ]
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Try running in the Saucony Kinvara after some rest. Seriously, that shoe fixed me, improved my gait and has a flexible heel so won't rub on your heel. I am convinced these low drop shoes are the way to go, esp if you are a forefoot runner.
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Re: Retrocalcaneal bursitis (heel/achilles bursitis) - help! [SarahLouise] [ In reply to ]
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Of course, the bursitis will resolve in time. But most type-A individuals never give it enough time. Your corticosteroid injection resolved it as well, much quicker of course, but it still cam back. I think what you are asking is will it go away permanently if given enough time - not enough info to tell, but likely. Yes, the local corticosteroid injection can slow down bone healing (the questionable stress reaction you have described on your MRI findings).

As for ESWT (shock wave), traumeel injections, etc. these are for chronic tendinosis type injuries, not an inflamed bursa or stress reaction/fracture. In fact, ESWT might likely make things worse!

I'm not a big fan of "motion control" shoes for *most* people (and I guessing for you), but some type of biomechanical control might be likely with your history. That is definitely something you are going to want to discuss with your treating physician (although your referral to a "surgeon" isn't likely going to help you there in the UK).

Best of luck!

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: Retrocalcaneal bursitis (heel/achilles bursitis) - help! [SarahLouise] [ In reply to ]
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Hi SarahLouise, Interesting that you say the bursitis started from doing eccentric calf raises. I also have this and I was doing those exercises as well but never made the connection. Mine started the morning after I fell during a trail run and I thought that was the cause. At the time of the fall, my achilles were healthy (pinch test) and still are, it's just the bursa behind the achilles insertion. I also had a steroid injection end of August (pain started July 3rd). The injection helped right away so 'naturally' I returned to running. I just saw my sports med. dr on Monday and went over xrays to rule out bone/heel spurs or stress fx (I have the bursitis on the right heel and bruised sesamoids on the left foot). He recommend I see a podiatrist and to get physical therapy with ultra sound for the bursitis. He did not recommend injecting the heel again. It sounds as though you have had a running gait analysis done but if not, maybe try that as a next step and seek advice on shoe selection. I too would be trying everything to avoid surgery. Good luck!
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Re: Retrocalcaneal bursitis (heel/achilles bursitis) - help! [comfort zone] [ In reply to ]
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Thanks rroof, everything you have said makes sense, very useful..."As for ESWT (shock wave), traumeel injections, etc. these are for chronic tendinosis type injuries, not an inflamed bursa or stress reaction/fracture. In fact, ESWT might likely make things worse! " It is great to have someone write these off (rather than recommend them as a potential cure for bursitis and suggest that I come in for treatment). I'm booked in to see a podiatrist next week.

Comfort zone - I'm not an expert but get the feeling that eccentric calf exercises are probably over-prescribed at the moment (all over the internet etc. as the solution to any achilles area injuries). My original injury was a small, one off achilles tear for which I started doing reasonably aggressive eccentric exercises (as I was told to). It DEFINITELY caused the bursitis as I was not running at all during these months. I continued doing the eccentric exercises as the pain was in a similar spot so I thought that I still had the achilles tear. The bursitis has now turned out to be a much more difficult injury to get rid of! I am guessing that shoes with a lower heel / higher forefoot can also contribute to the problem once you have it e.g. Newtons (as your heel can potentially drop further when you run and cause a similar eccentric load)

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Re: Retrocalcaneal bursitis (heel/achilles bursitis) - help! [SarahLouise] [ In reply to ]
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Hi all,
I've had (and got) problems with my achilles tendon and also noticed stretching my calf muscles makes it worse. So does cycling. I just posted a new thread but thought I'd ask here too. I'm worried I have a tear in my tendon, is there any different approach to healing with a tear/tendonitis?
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