Unexplained heel pain

Discussion in 'Ask the Docs' started by Clark, Sep 28, 2018.

  1. Clark

    Clark
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    I've had a heel pain that's been puzzling me and my PT for about three weeks. The pain is sensitive to pressure low on the medial side of my right heel. There is no bruising or discoloration or swelling. Simply pressing on other parts of the foot does not cause any pain. Plantar ball causes no pain, massaging calves/achilles causes no pain.

    Pain came on very gradually for a week and was easily dismissible until late in a two-mile rune about three weeks ago. Pain feels a lot like a deep bruise from hitting a rock but I have no memory of any trauma that might have caused it. I run with a forefoot strike and tend not to let my heels down as much as I should when not paying attention to form.

    Standing on right foot only, with heel lifted hurts more. With weight on both feet and heels lifted, no additional pain. Pushing off when walking hurts after a while. A flat landing and lift doesn't hurt as much or as quickly. I catch myself adjusting (limping) to accommodate, which aggravates my left calf and the lateral side of my right foot.

    Heel hurts most in the morning, or during/after a run or longer walk (mile or more), or after sitting too long or when getting out of bed especially on the day after a run. Standing for more than 15 minutes caused pain a couple of weeks ago but I seem to be past that. Now, when heel hurts, standing makes it hurt more but when it doesn't hurt much, standing doesn't make it hurt more. After a two day rest, pain is barely noticeable but recurs when running. Ice and heat don't seem to make much short-term difference. Sleeping with a Strassburg sock might be helping a little, but if so, it's very little. Dorsiflexion of foot before getting out of bed helps. Heel has improved but not enough to resume regular training.

    PT suggests that it's not plantar fasciitis, might be related to chronically tight calves/Achilles tendon, might be a stress fracture and recommends imaging if it's not significantly better after a couple more weeks. This is really cutting into my HM training.

    Any ideas or suggestions?
     
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  2. migangelo

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    I take it your explaining the calcaneus and it's posterior, medial, and inferior? Now I know why medical terms are so precise! If so sounds like the gastroc attachment. Very end of the achilles fibers. I would try a few things. Pin and hold, pin and stretch, instrument assisted myosfascial release (Graston), trigger point therapy in the upper gastroc.

    Those would be my guesses to try. Report back please.
     

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  3. Clark

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    After much improvement but still some recurring pain, and having no more committed races, I finally visited my doctor who diagnosed medial calcaneal nerve entrapment, most likely due to compensating for a calf pull that occurred a few weeks before symptoms began. He recommended continued rest, ice and anti-inflammatories. Dr. suggests that since the condition has improved quite a bit, it probably would have improved completely if I had given it proper rest and that it will probably continue to improve if I rest now. If it doesn't improve, the next step is a steroid injection. So feet up for the holidays.
     
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  4. migangelo

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    Did you try any of my suggestions? There's also nerve flossing to try if it is trapped. Steroid shots are feel good now pay for it later. They destroy tissue. You'll maybe reduce the pain now but could end up paying for it later. Best to exhaust manual therapy before you go that route.
     

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  5. Clark

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    PT worked the calves for several weeks and they are much improved, but the heel pain persists. While both she and my primary agreed that my tight calves had something to do with the heel pain, both also agreed that it's not coming from the plantar facia or the achilles insertion. They suspect, as do I, that I changed something in my gait to compensate for the pulled calf and that change did it.
     
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  6. Anne-Louise

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    I have a few weeks ago got the trigger point acupuncture in my calves for pains that sounds like the same to your pain. It helped SO much.
     
  7. Clark

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    After seven weeks of rest, then two weeks of walking but not running, Heel was just a little sore after walks of two or three miles but it didn't last long. I tried running to gauge progress. Not much progress. A slow running mile and heel hurt almost as much as it did two months ago. Calves were fine, plantar facia was fine, achilles tendon insertion was fine. Everything felt good except the heel. Same heel pain in same spot. Still sore after a few days of rest, ice, ibuprofen and rolling calves.
     
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  8. flammee

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    Pain is not necessarily coming from the lack of rolling and stretching, those activities can even be detrimental. You could try strengthening soleus muscles, they are bit overlooked. Over half of the achilles is attached to soleus, so it's actually pretty important muscle to pay attention to. When you strenghten soleus and calf muscles, it also strenghtens achilles tendons. For example, doing calf raises with bent knees targets soleus muscles. Also sitting on chair and putting some heavy weight plates on top of knee and doing heel lifts is great exercise for soleus. And according to new recommendations, no need to avoid little pain when doing those ecercises, on pain scale of 1-10, 5-6 is just ok. This bit of information was from finnish running magazine.
     
  9. Anne-Louise

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    Hi. How are your heelpain?
    I have just found out that my heel fatpad i destroyed. Thats why I have pain in my heel. Difficult to cure...the Osteopath wanted me to change my minimalist shoes to shoes with cusion and footcorrection, but I refused.
    I will eat a lot of strong c-vit and tape my heel and be patient.
     
  10. Barefoot TJ

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    They're doing fat injections for fat pad atrophy now. Look it up. I have FPA in both fore feet due to all the surgeries and so-called treatments I've had to correct damage done by shoes, but I'm chicken to do anything new again.
     
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