Today on the Doc on the Run podcast, we’re talking about plantar heel bursitis, misdiagnosed as plantar fasciitis.
Today, I was doing a telemedicine call with a runner who has had a long history of plantar fasciitis, that’s just not getting better and she has been doing all of the right stuff. She’s been doing stretches. She tried icing. She even had an injection of corticosteroids around the plantar fascia, which only helped for a very short period of time and then the pain was right back. And so we were doing a second opinion telemedicine call to talk about what’s really going on.
We talked about her whole history. She’d been keeping a pain journal. She’d been keeping track. She had all of her notes and during this one hour call, we figured out that she’d been misdiagnosed. It is possible, I will say, that she did at some point have plantar fasciitis, but her problem at least as we found out during the second opinion telemedicine call was that she actually had bursitis on the bottom of the heel.
Now, to be clear, what we’re talking about is a problem with a bursa or a little fluid filled sack underneath the heel bone between your heel and the ground when you’re standing up. This is not the bursitis you get at the back of the heel where the Achilles tendon attaches to the heel bone. That’s different, completely different things. So if you have bursitis of the back of the heel, this is not what we’re talking about. That is not going to get misdiagnosed as plantar fasciitis.
So the first thing is that I listen to their story very carefully when somebody has one of these second opinion telemedicine calls. And in her case, her story did not match that with plantar fasciitis. Somebody who has plantar fasciitis will typically have pain first thing in the morning when they get up and step out of bed and start walking, because you stretch the fascia, it has fluid all around the fascia. It compresses that area. It hurts, but every time you step on it, it moves some of the fluid away and it starts to improve.
So by the time that you get to work, or in many cases, by the time you can get to the coffee pot, your pain is basically gone. And then you start walking around throughout the day and it doesn’t really hurt. It doesn’t maybe even hurt when you run, but it seems to hurt when you sit still and get up and start walking again. And bursitis doesn’t do that. Bursitis really doesn’t hurt that much with most of these people when they get up out of bed and start walking. It really doesn’t hurt that much if they sit down and watch a movie and then get up and start walking. But it does hurt the more they stand on it.
In her case, she was saying the most painful thing is that when she’s done her whole day, she went for a run in the afternoon, and then she’s at home. She gets her kids set up to do their homework. And then she starts cooking dinner, that when she is actually standing at the stove on a tile floor and starts cooking, it starts to ache more and more and more. Plantar fasciitis does not do that. It does not just ache more and more and more as you stand on it. It’s these momentary jolts of pain, but the bursa being a little fluid filled sack, that’s been irritated and aggravated by all day of moving around, walking around, doing stuff at work, going for a run, going to the gym.
All of those activities that put pressure and irritation on the bursa, make it swell up and become more inflamed. And then if you’re standing without shoes on a hard floor, like tile or hardwoods, then it actually starts to compress it, aggravate it, and it hurts even more.
And so in her case, I had her show me where her heel hurt and it’s in the center of the heel right in the middle. And when I had her put her thumbs on either side of it and poke around in the same way that I would show somebody how to do in the runner’s heel pain course, to figure out how to tell the difference between these conditions. She actually said, “Yep, that’s it. That’s where it hurts.” That’s not even where the plantar fascia attaches.
So in her case, by her doing this self exam, in fact I actually showed her the video on how to do this from the runner’s heel pain course, while we were doing this talk about her plantar bursitis. And she was able to figure it out right then that that was definitely the problem. So we came up with some solutions to take the pressure off of it.
Again, the same stuff I show in the runner’s heel pain course and now she knows what to do, she’s going to be able to reduce the stress and strain on the bursa and it’ll start to calm down. But if you think you have plantar fasciitis and it’s misdiagnosed and you actually have bursitis, it’s not going to get better.
Even if you inject the plantar fascia with corticosteroids, you’re injecting the wrong area. So you’ve got to make sure you know what the problem is. So if you have plantar fasciitis that’s not getting better, you might want to check out the runner’s heel pain course. But you’ve got to do something to figure out what is really going on, if you really want to get back to running as quickly as possible.