If I have bursitis of the heel, should I do aggressive Achilles tendon stretches with wedges for my Haglund’s deformity? That’s what we’re talking about on the Doc On The Run podcast.
This episode comes from a house call I just did with a runner, who actually has some heel pain and particularly what he’s got is a condition that we call Haglund’s. Haglund’s is actually a funny name, but it’s probably named after some podiatrist named Haglund, I would guess. But anyway, it’s where you get inflammation and irritation at the back of the heel, right here.
There’s a little bursa that’s in between the Achilles tendon, where it attaches on the back of the heel, and that little part of the heel bone that can protrude on the back. And so, if you get inflammation of the bursa, there are actually two. So you can get a condition called retro Achilles bursitis. You can get a condition called retrocalcaneal bursitis, but they all are inflammation at the back of the heel, which is where the retro part of that term comes from, and they’re both around the heel bone, or the calcaneus, and the Achilles tendon.
Now, if you get inflammation of the bursa, it can be really painful. It can swell up. It can become red. It can get really irritated. Part of that, of course, gets worse when it rubs on the inside of your running shoe, at the back of the heel counter. He had a really great question. He said he knew that he had really tight Achilles tendon, and he was doing some stretches to try to make his Achilles tendons more pliable, because he had read that a tight Achilles tendons can cause a lot of different problems, including heel pain of all varieties, including plantar fasciitis. He did not want to get plantar fasciitis. This is a completely reasonable approach. But what he was doing is he was using some of those wedges, where you put your foot on the wedge and it allows you to really crank and really stretch the Achilles tendon and he was wondering whether or not that was a good idea or a bad idea.
And this is a great question, and it’s really important, because if you have a tight Achilles tendon, there are lots of ways to stretch it. Now I’ll talk about some of those and some of the ways you can do it that are high risk and low risk and all that in the Achilles tendon masterclass that you can sign up for, but we also talk about them in the runner’s heel pain course and the Achilles tendon course. But the runner’s class for runners on Achilles tendon issues is free, and you can sign up for it, if you want to check that out.
But the thing is this, if you think about it, if the back of the heel, if you’ve got this little bursa, little fluid filled sac right here, that’s getting inflamed and irritated, and then the Achilles tendon is sitting there in front of it, and you really crank up to stretch the Achilles tendon while it pulls the tendon right against the bone, and it basically crushes and squishes the bursa in that area, and it just really smashes it in between the Achilles tendon and the back of the heel bone.
So that little tender fluid-filled sac, that’s already irritated, can become way more irritated, if that’s the one that’s actually causing your pain. So, there are lots of different kinds of bursitis, but if that’s the one that’s giving you trouble, and you do wedges or you do the stretch where you put your foot on a step and you drop all the way down, well, that really cranks the Achilles tendon back around the back of the heel bone, and that can really inflame the bursa and actually make that problem worse.
Remember, the goal with all of this is to keep running to maintain your running fitness and keep running as long as possible and if you have one problem, like a tight Achilles tendons, and you’re doing wedge stretches or eccentric stretches, by default put a lot of stress and strain and compression on an inflamed bursa, it’s just going to make that problem worse.
So you certainly want to get the primary problem calm down first, and then address something like a tight Achilles tendons, that might be more of a preventative measure. But you really got to get that first thing under control, and using wedges when you have Haglund’s or that issue on the back of the heel can really slow down the process of actually getting that better and helping you get back to running.