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Sunday, August 9, 2020

Heel Bursitis: Email Advice

Hi Dr Blake, 
I'm a former patient from years back who is active and actively working on improving my feet as well as the rest of my 61 year-old self.  

I have what I thought originally was plantar fasciitis in the L foot after some heavy lifting / carrying,  clearing out some old furniture for our "bulky waste pickup" over the July 4th weekend.  The following week the soreness came on, and I took it a little easy on the running.  Then it would feel better, so I would do a longer run (only 3+ miles though) and then it would be sore again.  

I'm wearing zero-drop shoes (Altra) exclusively now with splayed toe box so my  feet can get back to their natural shape. I love them for many reasons, but I realize they are not ideal for a sore heel.  
Dr. Blake's comment: This is very true, zero drop shoes make the knee slightly more stable, and take some pressure off the front of the foot, but add stress to the heels, ankles, achilles, and shins. I like my runners to alternate between shoe types to vary the stresses. We have wonderful choices for this option now. Rich 

An active tissue release chiropractor I see prodded around the foot and released a lot of tight hamstring and calf. He has confirmed that it's NOT the plantar fascia, so I'm left hoping for bursitis. I really don't think it's a stress fracture; I don't do a lot of any one thing.  I was running daily (1.75 daily, 3-4 mi on the weekend), and am able to continue floor Pilates, Zumba 3x weekly, and strength work 2x weekly. 

Dr. Blake's comment: First, here is a link to my video on heel pain. Secondly, running every day at our age is not advisable and may be the whole reason you are hurt. I always find that it takes 3 things (or more) to team up to produce an overuse injury: daily running (so no adequate recovery time), tight achilles which weakens the achilles and prolongs the time your heel is on the ground, zero drop shoes also increasing your time the heel was on the ground thus stressed, and doing something that irritated the heel in your cleaning project perhaps. 

I have not been to a podiatrist yet, as my Health Insurance encourages us to deal with some of these things at home.  I'm also off arch supports since I'm working hard to strengthen my feet.  But I would come in to see you in a New York minute. 

Apart from icing, contrast bathing and not running for a while, any additional suggestions for suspected heel bursitis?  I am playing with offloading using 1/8" adhesive padding in a donut shape around the sore spot and will (grudgingly) get some shoes with a little heel elevation to take the weight off if it doesn't start improving.  I am getting fretful with no running! 
Dr. Blake's comment: Heel bursitis hurts the most when you try to walk on your heels barefoot, and no pain at all walking on your toes. Heel pain is tricky with heel pads, some work and some do not. You are trying to cushion the heel, and transfer the weight forward. Some heel cushion do that and some just increase the heel pressure. I personally do not like the donut idea, as I am afraid the hole will allow the swelling to collect which it sometimes does. But, you have to experiment which what makes it feel better. Run every other day. Walk for several blocks first to warm up the tissue and then run a mile (or even a half mile) as rest does not help. You of course can not have pain during, and no limping. Ice after the run. Can you get some cardio some other way? Bike? Elliptical? Ocean swimming (avoid sharks)? To break down the bursitis, freeze water in a sport bottle. Initially fill half way as it expands when frozen. Put a towel on the ground to protect your floors and massage the heel area only, not the arch, for 5 minutes progressively pushing harder. This is done sitting and is the most useful thing for the home for heel bursitis. Straight ice packs, without the massage, just controls inflammation, but will not get rid of it. I like some sort of OTC arch support of course to transfer weight off the heel--a temporary help while you reduce the bursitis until you do not need it. Rich 

Many thanks for your book (which is on my Kindle) and your blog. I'm a big fan. 
Dr. Blake's comment: Thank you, and I honored to help!!


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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.