From Plantar Fasciitis to Achilles tendon bursitis

[cmb7684]

I was born with flat feet. I wear prescription arches in my work shoes but off of work I usually wear crocs. My work shoes are not the best either (myfault). They are slip on type tennis shoes made by Dr. Scholls with elastic near the tounge. They do not tie.

My feet are hard on shoes as they wear on a slant on the bottom heel of both feet with a slant on the heel part on both feet where the thinner or worn part on the both shoes are at the back of the heel on the outer side of the shoe. Becuase i have flat feet I tned to walk with my feet angles out somewhat similar to a ducks feet.

My mistake seems to be wearing the crocs as normal everyday foot wear for the last 3 years without replacing them. My foot has not had any discomfort until a few weeks ago. It started with both Pantars in both feet. The symptoms were text book. That lasted a few weeks and went away and 2 days later it seems I have Achilles tendon bursitis in my right foot. With work I'm not on my feet a bunch however if I report it and go to the doctor and they knock me off the work my family just cannot afford to have that happen right now. So until I can go get treatment what is the best source of home treatment? I have read that I should not go barefoot but it hurts to put on and wear shoes when it hits the red swollen lump on the right side (outer part of the heel) and has me limping as it hurst to put pressure on the heel when I walk. I have started to put ice several times a day. What is the best over the counter anti iflamatory to take and is it ok to wear new crocsuntil this heals? I cannot think of another shoe that has an open back for a male to wear and i have read you should not wear shoes that are going to contact the swollen lump.

[Dr. D]

It is difficult to say exactly what your diagnosis is, but if you do have a painful, swollen bump on the back of you heel, this could be Haglund's deformity. Haglunds deformity is an enlarged bony area on the back of the heel that is typically associated with an inflamed bursa.


It's also possible you have insertional Achilles tendonitis.



Both conditions can present with similar symptoms. With a history of plantar fasciitis and flatfeet, the Achilles tendonitis would be more likely. Haglunds generally (but not always) occurs in high arched feet individuals.

Although Crocs are good because they have an open heel and will keep pressure off the swollen area they offer little support and for Achilles tendonitis will worsen the condition.

Initial treatments are similar for both conditions and you have taken the correct first steps. Icing, contrasting between hot and cold packs (alternating each for 5-10 minutes and ending with the coldpack for 30 minutes) and decreasing any rub or irritation on the area will all decrease inflammation.

If there is an enlarged bursa (red, swollen, painful bump on the back of the heel) padding the heel will also help keep pressure off of the painful area in your work shoes. It's important not to place padding on the bump, as this will increase pressure. Build up padding around the bump to displace pressure on the painful area. Felt adhesive pads can be cut out and placed on the heel. In some cases, padding in shoes will also work.

Adding a heel lift to your shoe and starting a calf stretching routine will both decrease the pull of the Achilles tendon on the heel bone.

Addressing your foot mechanics will be important as this is most likely the root cause of the problem and an appointment with a podiatrist or foot and ankle orthopedist will be important when you have that option.

Check out our blog for more treatment information on Haglunds.

Check out our foot info section on Achilles tendonitis/tendinosis for more diagrams, images as well as diagnosis and treatment information.

[cmb7684]

Thanks for the response Dr. D. After looking online at pictures of Haglund's it appears the bump is much higher and bigger on the pictures then from what I have. The bump I have is to the right of the Achilles.

As a layman comparing it to the diagram at the following link it is the exact location in the diagram marked "it hurts right here".

http://3.bp.blogspot.com/_nHi2I8o9X3...s400/bursa.jpg

Comparing both feet I have the same lump on both feet but my right foot lump is swollen (bigger) and hurts to the touch. It has improved with ice and has gone down some but has never been much bigger than the circumference of a nickel when most swollen. The bump and tender spot is at the bottom of the heel bone to the right of the heel bone on the right foot. The only shoes I wear is crocs and regular tennis shoes for work and neither have a high arch or offer much support to force my foot to do anything ( I now know this is how i most likely ended up here).

Last night I had purchased new crocs and had a lot of errands to run so a lot of walking was in my future. I did just fine and it actually did not hurt much to walk but after a while it did start to hurt and I could feel a slight burning in the bottom of my right foot (the hurt foot) when I took a step all the way to the ball of the foot near the toes. The burning feeling was similar to the feeling when you stretch a muscle. It stopped as soon as I got off my feet. I put a cold pack last night before bedand while it still hurts and does not allow for extended periods of walking or being on my feet it has improved.

[Dr. D]

The calcaneal/Achilles bursa it a broad bursa which sits between the Achilles tendon and the skin and the function of the bursa is to reduce friction between the tendon and skin (typically caused by tight or poorly fitting shoes). Abnormal foot mechanics in combination with poor quality shoes, tightly fitting shoes or shoes with a rigid heel counter can cause inflammation of this bursa, but it is often associated with a Haglund's deformity. It's less common to have inflammation of this bursa in isolation and it generally appears as a more diffuse, inflamed area as opposed to a small, isolated lump or mass with pinpoint tenderness. It's possible this is what you have, although difficult to say. It's also possible it's insertional tendonitis, again hard to say. Both the bursa and Achilles insertion extend down to the area of your pain. The image below points to what you described as your area of pain. The highlighted red area is generally the area of pain associated with bursitis.



The cause of both these problems is not the same even though the initial treatment steps are similar. Another problem which occurs in this area is a retrocalcaneal exostosis. This is a bone spur at the insertion of the Achilles tendon. Insertional tendonitis may or may not accompany this spurring, but it presents with a lump on the back of the heel and routinely causes pain from rubbing and pressure.



You have taken the appropriate initial steps by decreasing friction and rub on the area and reducing inflammation. An isolated bursitis will respond more to anti-inflammatory measures than biomechanical control (rigid shoes/orthotics) but in many cases the cause of the bursitis is a mechanical one and until it's addressed, the problem persists. Although bursitis and tendonitis may be confused, they can also occur together, especially if the foot mechanics increase the susceptibility of the development (ie: flatfeet, pronation, tight heel cord). Hopefully you'll have the opportunity to see a doctor soon.