I noticed a dull ache in my left heel while doing a 13 mile run last Sunday. Felt like my heel was bruised (I had a heel bruise years and years ago and still remembered that feeling). When I was walking around in the hour or so after the run I felt a sharp jolt on a very specific spot in the middle of my heel when I stepped down on it. It went away immediately, I stayed off it, and have not been able to reproduce the sharp point-source jolt again. But it doesn’t feel right.
I did not run again (deliberately) until this past Thursday (so 3 days off), and did a planned 8 mile run with some speedwork mixed in. Felt the bruised (but not the sharp pain) feeling while striking my left foot but it wasn’t too bad, but clearly not right either. I’ve pressed and prodded on the heel pad trying to locate the spot and, with GREAT difficulty and hard pushing, I can find a small area in the middle of my heel (almost dead center) that is tender to hard pressing. Best description is it feels like a bruised spot on my heel. I cannot recreate the pain while pressing from both sides of the heel, which I’ve read is one way to help assess a possible stress fracture. I have an A race at St. Anthony’s in two weeks, and I probably will just ease off the running and shift whatever was left in terms of training to the bike for that one, as I’m not giving that race up. I’ll take time off after if necessary.
I’ve seen some posts from a few of you who are familiar with heel issues. I do not believe this is PF - though I’ve never had it - but I don’t think it’s in the right location. It doesn’t feel like a pebble like others have described, but it does seem to be fairly point specific.
Naturally, I’ll be seeing my orthopedic guy, but I thought I’d toss this out there and see if something emerges in the meantime. Appreciate whatever you might offer.
calcaneal stress fractures typically have pain with lateral compression, especially along the lateral wall. There is also usually some subtle heel swelling and pretty consistent pain with walking, esp barefoot on harder surfaces.
You are describing infracalcaneal bursitis - but nothing beats a good clinical and imaging exam.
Thanks for the post. I’m fairly new here (been lurking till recently) and I know you’re in the profession so I appreciate the take. I’ve got a Dr. here in Colorado (Keith Fujimori) that I have seen for my (thankfully ocassional) issues. I’ll have him check me out next week.
Just out of curiousity, IF it’s bursitis, what’s your experience in having athletes run through it with gel pads, etc. vs. extended periods of non-running etc? I’ll switch to ellipticals or water running if I need to, but I’m curious as to how long an issue this can be.
Rest, ice, a gel pad and oral NSAIDs work pretty well for it (assuming the dx is correct) - NOT stretching/massage. Occasionally a corticosteroid injection into the bursa can be done for quicker resolution (preferably under ultrasound guidance if possible) if an ‘A’ race or game is looming …
Interesting and timely post for me as well. I have had similar symptoms on my left heel. About a week before the ING Georgia Marathon, I was noticing a little pain in my left heel while running, generally on a hill and as I was pushing off with my foot. When sitting at rest, there is no pain at all. If i push on the outside of my heel just above the bottom of the foot, I feel pain. I am still limping some when I push off on my left foot, but not as bad as it was.
I rested and iced for a few days before the marathon and then ran a marathon. I was pretty good for 8 miles and then it began to hurt. By mile 16 I was in pretty good pain and limped in the rest of the race…at which point I am sure I crossed the line between strong minded/determined and stupid. It was tough to walk for a couple of days after the marathon due to the heel pain. After about a week I went to see a chiropractor and a Foot and Ankle Ortho, and came back with two diagnoses… the first from the chiropractor was a sprained ligament, the second from the ortho was a possible stress fracture, although it did not show up on an x-ray. Apparently with stress fractures it may take a while to show up on the x-ray due to the calcification/repair taking a while.
Both told me that I should be OK to race St. Anthony’s in two weeks with rest, and ice, and both said that running before the race will not be a good idea. So the plan to be ready for St. Anthonys is to rely on the marathon base training, do a lot of biking an swimming, and elliptical running to be ready for the race. Interestingly enough, my ortho guy is also a Triathlete that will be doing St. Anthony’s, so I will have local support The good news is that I am feeling progress in my heel, but it is slow, just a little bit better every day.
I had a calcaneal stress fracture about three months ago. One day I ran a ten miler on the treadmill with no issues (been running about 50 miles a week). Next day, couldn’t do a recovery run, didn’t make it 1/4 mile. I rested for 5 days, no running, went to ortho, stress fracture. You could see an inflammation cloud on the xray, five weeks off, been back to 40-50 miles a week now in preparation for im cda. it hurt to walk on the foot, no it really sucked alot. doesn’t sound like you have a stress fracture in my opinion, but what do i know, i didn’t think i had a stress fracture myself. take it easy…
Rest, ice, a gel pad and oral NSAIDs work pretty well for it (assuming the dx is correct) - NOT stretching/massage. Occasionally a corticosteroid injection into the bursa can be done for quicker resolution (preferably under ultrasound guidance if possible) if an ‘A’ race or game is looming …
Hey Rod - I had a question about your advice and figured the whole community could benefit from the answer.
I agree that a calcaneous stress fracture is usually easy to diagnose with pain with lateral compression, but normal radiographs. I, however, have a harder time distinguishing a bony contusion from a infracalcaneal bursitis.
For other bursitis, I commonly recommend NSAIDs, but I usually recommend against them for bony contusions (really only based on the theoretical risk of disordered remodeling with prostaglandin inhibition). So, for cases like the one in this thread, I usually only recommend ice and protection (usually just good shoes and no barefoot time, but occasionaly a walking boot or gel pad). Agree that for big events, an US guided injection gives enough relief to allow RTP.
You obviously see more feet than I do. Do you have any recommendations for clinically distinguishing a contusion from bursitis (without resorting to MRI or US)?
Excellent question Andy (distinguishing “true” infracalcaneal bursitis from bony contusion). Interesting thought about po NSAIDs since we have used these for years w/ these types of injuries until the (relatively) newer data out there. I don’t use many in practice either except for significant inflammatory issues (i.e. gout) and have completely stopped in stress fracture treatment.
This is one reason I have a diagnostic ultrasound in the office. I have ordered MANY fewer X-rays and MRIs since getting proficient with it. Clinically, they can present so similar as to be impossible and you just go by history and clinical intuition. You can sometimes actually palpate a large adventitial bursa if you feel around very closely (once typical medial calcaneal tubercle/plantar fascia pain issues are unlikely). Also, in general the acute bursitis is usually far more tender to focal palpation and the patient will general be limping if you have them walk down the hallway barefoot. Some will limp with a bad heel contusion, but usually then the history helps - fall from a height, etc. not just running trying out the lastest Nike Zero or minimal shoes or some such.
That’s good - can’t say I have ever been able to feel the bursa and I don’t think I realized that bursitis is more likely to be tender. That right there folks is the benefit of seeing a podiatrist instead of a sports med doc for a subtle foot problem.
No US in our offices, but MSK radiologists right down the hall - cost has gotten to the point where it isn’t that much cheaper than MRI (but then again, we have a special arrangement with GE and their newer MRI scanners here in Madison).
Wow. These responses are just great to see and very informative. I’m pretty well trained at this point for St. Anthony’s and had planned on shifting more into biking (I could always use that anyway), and either pool run or elliptical run. I actually did a 9 mile elliptical run today and I think it will work to keep my running fitness. First time I’ve ever done that. I’ve got about 3 different kinds of heel protection, ice up the wazoo, my own ultrasound wand, and my wife is shaking her head and rolling her eyes. I’ll be dammned if this gets in my way at this point but I don’t want to make it worse either. I’m optimistic.
The good news is that I am feeling progress in my heel, but it is slow, just a little bit better every day.