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Tuesday, September 7, 2010

Heel Bursitis (Plantar/Bottom of Heel): Typical Physical Therapy Regimen

Hi Dr. Blake!
I hope you have a fun-filled long weekend planned!.
I'm checking in at the two week mark as we discussed. My stubborn little
calcaneous bursitis is still causing me grief. I did try the contrast bath -
but it seemed to irritate it, so I've stuck with icing. I have not been jumping
in dance class or standing in spin. In fact, releve seems to bug it as well, so
I've eliminated turning. Since I wasn't making the progress I'd hope to on my
own, I thought I'd finally book the PT. I work in SF, so I would
consider coming over to St. Francis, but if you know of another good place in
the East Bay, it might be more convenient.
Thanks so much! It really is wonderful having someone I've known for 24 years
(!!) I can come to with these bothers. And even though it's an injury that
brings me in to see you, it is always great to see you! ;-)
Have a fabulous weekend and talk soon,


Tracy, Physical Therapy for calcaneal bursitis (under the heel) should be done twice weekly for 4 weeks and should include in this order: Ultrasound as a way of producing deep heat to the bursitis tissue making it vulnerable to the next two treatments. The ultrasound is following by deep friction massage to break down the bursae. The deep tissue work is following by 5 minutes of vigorous ice massage to calm down any aggravation of the inflammation and further the breakdown process. Since plantar fasciitis is normally part of the problem, the PT may address part of the treatment for that also. If calcaneal bursitis is a major part of the pain, make sure that the 3 components in the order of ultrasound, deep friction massage, and icing are the central part of the treatment. I will see you following the first 4 visits to make sure we are all on the same page. Good luck, and great to see you again as always. Rich

PS. During the time you are in physical therapy, you must continue to ice massage 3 times a day (since the contrast bathing did not help), and do as much physical activity as you can without flaring up the symptoms. It is normally a mistake to go to physical therapy at the same time you are resting an injury completely. The physical therapist never gets a good feel of your improvement, or lack of improvement. Use the information on the post Good Pain vs Bad Pain to base your Activity Modification Program.

Also, the next step with calcaneal bursitis is cortisone shots, but that requires 2 weeks off activity/shot, and could require up to 3 shots (the response to the shot is evaluated in 2 weeks), so most athletes try to avoid with a passion. Please see the separate post on the thought process behind cortisone shots.

Good luck Tracy, email me after 4 physical therapy visits.

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.