The Center for Podiatric Care and Sports Medicine

Achilles Tendinitis or Plantar Fasciitis? Examining 4 Types of Heel Pain and Treatment

Posted by on Tuesday, July 8th, 2014

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In Greek mythology, it was foretold that the great warrior Achilles would die young. To prevent this tragic fate, his mother Thetis dipped him into the magical River Styx, but she held him by the heel, which remained untouched by the waters. Later in life, the mighty Achilles survived many great battles, but finally perished when a poisonous arrow became lodged in his heel.

achilles heel
This photo depicts the triumph of Achilles in Corfu Achilleion. Sufferers of heel pain likely feel this victorious when they finally beat it once and for all.
Image source: רנדום via Wikimedia.org

Today, the saying “Achilles heel” refers to an area of weakness, in spite of great strength. Many Americans suffer from debilitating heel pain that can sometimes bring us down. One study found that 492 people out of 1,082 suffered from heel pain. The American Podiatric Medical Association (APMA) reported that 6 in 10 heel pain sufferers say their condition “interfered with daily activities.” While plantar fasciitis is the most common association, there are actually several different causes of heel pain we treat here at The Center For Podiatric Care & Sports Medicine in New York.

Plantar Fasciitis

The NY Times estimates that 1 million Americans see a podiatrists for plantar fasciitis each year. Even more cases go undiagnosed for extended periods of time before the pain becomes incapacitating. This condition occurs when small tears and inflammation affects the plantar fascia — a wide band of ligaments and tendons that connect the heel to the ball of the foot. Usually people feel the worst pain in their first few steps each morning or after long periods of sitting. Pain begins in the heel and radiates along the arch. The exact cause is unknown, but runners and high-impact athletes often suffer this type of pain. It’s also believed that calf inflexibility, ill-fitting shoes, and uneven strides contribute to the worsening of plantar fasciitis.  Treatments may include daily stretches, anti-inflammatory medication, night splints, and custom shoe inserts. Cortisone injections can provide temporary relief for severe cases of acute pain. Here at our NYC podiatrist office, we also offer newer therapies like extracorporeal shockwave therapy, which uses low-dose sound waves to trigger the body’s natural heeling processes. Surgery is reserved for chronic and severe cases. An instep plantar fasciectomy can relieve nerve pressure by removing part of the plantar fascia.

Achilles Tendinitis

The second most common condition we treat is inflammation of the tendon connecting the calf muscle to the heel bone. There is pain and stiffness along the tendon in the morning that worsens with activity, and is especially severe after a run. Sometimes the tendon is torn. We see a lot of tennis and racquetball players and runners with this condition. People born with a shortened Achilles tendon or who pronate as they walk can also suffer from Achilles tendinitis. Wearing high heela is not considered a cause of Achilles tendinitis, but it can certainly exacerbate the pain. Ice and anti-inflammatory medication are often first line defenses, but cortisone injections may be needed to relieve more severe pain. Stretching is a mainstay of treatment as well. Chronic inflammation may cause the Achilles tendon to make a “pop” sound and rupture. If that happens, casting or surgery may be needed. Active people generally undergo surgical intervention to avoid ruptures in the future.

Bursitis of the Heel

Bursitis occurs when a small sack of fluid beneath the heel bone (the bursa) becomes inflamed. People who run, walk, and jump a lot tend to develop this type of injury. Aggressive “weekend warriors” who rush into exercise without proper conditioning fall prey to bursitis as well. The heel may hurt to the touch and gets worse when standing on tip-toe. Generally, anti-inflammatory drugs, icing, and massage help tremendously. We also recommend inserting a heel cup or additional padding into the heel of the shoes to reduce impact. Steroid injections may also provide some relief. In rare cases, wearing a cast for a few weeks clears up any problems.

Haglund’s Deformity

We’ve all had a pair of shoes that rubs against the back of the heel and aggravates us until we throw out the old footwear and buy a new pair. Yet, if this happens often enough, a person may develop posterior calcaneal exostosis (a.k.a. Haglund’s Deformity or “Pump Bump”). A bony growth develops on the back of the heel, with tender tissue surrounding it. High heel wearers most frequently suffer this condition. We recommend anti-inflammatory drugs and orthotic devices to control pain. In severe cases, the bony growth can be removed in surgery, but this is viewed as a last resort since recovery is long.

Heel Pain Treatment in New York

We welcome you to visit The Center For Podiatric Care and Sports Medicine in New York to see a team of board-certified heel pain specialists. We can guide you through physical therapy or minimally invasive treatment options or discuss surgery options with you as well. Book your appointment today.

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If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.