The Center for Podiatric Care and Sports Medicine

Is Your Nagging Heel Pain Tendinitis or Bursitis? Here’s How to Find Out

Posted by on Monday, December 21st, 2015

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When you think of heel pain, “plantar fasciitis” may be the first medical term that comes to mind. While we do treat many cases of inflammation in the plantar fascia ligament, we treat even more cases of inflammation in the Achilles tendon. Not all Achilles tendon injuries are related to inflammation — some are caused by tissue degeneration (tendinosis), which is a whole other story. We generally treat two types of Achilles heel inflammation in our NYC podiatry centers: tendinitis and bursitis.

tendinitis or bursitis
The location of your heel pain is the first clue as to whether you have tendinitis or bursitis. Image Source: Wikimedia.org

 Achilles Tendinitis

What are the symptoms? Achilles tendinitis pain is located a few inches above the heel, where the heel connects to the calf muscle. It begins as a mild ache after an activity and is exacerbated by movements like stair climbing, sprinting, or distance running. Tenderness and stiffness in the mornings is commonplace.1http://www.mayoclinic.org/diseases-conditions/achilles-tendinitis/basics/symptoms/con-20024518

What causes it? Achilles tendinitis is typically caused by overuse. We treat a great number of avid runners, tennis players, and basketball stars for this type of injury.

How is it treated? Generally, you can treat Achilles tendinitis at home by resting from the activity that has caused you the pain in the first place. You can reduce pain and inflammation through the use of aspirin, naproxen, or ibuprofen, and by icing the injured area for 15-20 minutes every 4 to 6 hours for 3 to 5 days. (Note: Once the injury becomes acute, ice is no longer an effective treatment.) Gentle stretching, massage, and physical therapy to build up your strength and take some of the load off the tendon are also very helpful. When the tendon has actually torn, you may need surgery that requires up to six weeks of recovery time.

To distingush Achilles tendinitis from plantar fasciitis, see our post on types of heel pain.

Achilles Tendon Bursitis

What are the symptoms? Bursitis pain hurts most when rising up on one’s toes or while walking and running, but is also tender to the touch. The skin is often red and warm feeling. Most importantly, the pain is experienced at the lowest point of the heel.

What causes it? Achilles bursitis is also most commonly spotted in runners. It occurs when a fluid-filled sack between the tendon and heel bone is continually squeezed through repetitive motions, causing damage and inflammation. Sometimes bursitis is associated with arthritis, gout, thyroid disease, and diabetes.2http://www.niams.nih.gov/Health_Info/Bursitis/#6

How is it treated? Largely, Achilles bursitis is treated in much the same way as tendinitis, although you may need antibiotics if the bursitis was caused by infection, rather than overuse. Proper-fitting shoes and full-length flexible orthotics are a common first recourse.3http://www.nydailynews.com/sports/more-sports/achilles-tendonitis-bursitis-article-1.1387447 From there, physical therapy, stretching, and anti-inflammatory medication helps. Chronic cases may require injections of depomedrol, a corticosteroid that prompts faster healing. This treatment must be done by a very experienced professional, however, to prevent future ruptures. Extreme measures like surgery to cut away inflamed bursa sacks are very rare.

Haglund’s Syndrome

Sometimes it’s not a matter of tendinitis or bursitis, but of both problems at the same time. When both conditions are present, it is called Haglund’s Syndrome, Haglund’s Deformity, or — more colloquially — “Pump Bump.”  When conservative treatments like icing, ibuprofen use, stretching, and heel pads do not help, surgery and six weeks of recovery time may be necessary.

NYC Tendinitis or Bursitis Treatment

Suspect something funny is going on with your heel? It’s best to visit a true professional who can get you set up on a conservative rehabilitation regimen right away. If you’ve already tried many of the basic treatments but still suffer from chronic, debilitating pain, we also offer more advanced therapies to help you heal. We’ve seen excellent results from the FAST Tenex procedure, which uses ultrasound waves to break down damaged tissue. Injection therapies using platelet rich plasma or natural “biopuncture” ingredients have also successfully treated many cases of Achilles inflammation. If you live in the NYC area, please contact us to learn more.

 

 

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1. http://www.mayoclinic.org/diseases-conditions/achilles-tendinitis/basics/symptoms/con-20024518
2. http://www.niams.nih.gov/Health_Info/Bursitis/#6
3. http://www.nydailynews.com/sports/more-sports/achilles-tendonitis-bursitis-article-1.1387447

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.