Is it plantar fasciitis or insertional Achilles tendonitis? That’s what we’re talking about today on the Doc On The Run podcast.
Now, today’s episode actually comes from something I read in one of the running forums where someone actually was saying that they were confused. They had been to see a couple of different doctors and had a couple of different recommendations because they had heel pain.
The heel pain was in a little bit of an unusual area, the heel pain wasn’t exactly on the bottom, the heel pain wasn’t exactly on the back and it was sort of in the middle, right at the back of the heel where it curves around and they wanted to know what to do. So they were asking different runners, anybody on the forum to chime in and say what they thought because this person had actually gone and seen a doctor who said, well, it’s plantar fasciitis. Plantar fasciitis is on the bottom of the foot and the heel pain is typically on the bottom, but not the back of the heel.
Insertional Achilles tendonitis is where the Achilles tendon attaches or inserts to the back of the heel bone and so all kinds of people are making all different recommendations, all specific to those two things. In fact, the person that posted this actually said, well, the doctor that told me I had plantar fasciitis said, I should do these things. A chiropractor who I saw, who thought it was tightness in the calf muscle said I should do these other things. As is typically the case with runners, when they’re told they might have one thing or might have something else, and you even get different diagnoses and sets of treatments for those diagnoses from different doctors, you get really confused and then you don’t even know what to do.
No question, if you have the wrong diagnosis, if you think it’s plantar fasciitis, but it’s really insertional Achilles tendonitis, you’re not going to get better and get back to running very quickly. So it’s really important to think about the things that are in that area that could be causing the pain and then figure out whether or not you can get that thing quickly improving so that you can run sooner.
That’s really the key here. So the first thing is plantar fasciitis. Let’s talk about that real quick. Plantar fasciitis causes pain either in the arch or right on the bottom of the foot where the plantar fascia attaches to the bottom of the heel bone at this very specific lump of bone called the medial calcaneal tubercle.
We of course, as doctors have names for everything. The specifics aren’t important, but it’s the biggest bump on the bottom of the heel and when we look at you and we push on your heel, like how I show you to do in the Runner’s Heel Pain Course. Well, that’s where it typically hurts. So if you have pain right at the insertion or attachment point of the plantar fascia of the bottom of the heel, then it’s probably plantar fasciitis.
That’s different than this sort of transition where it goes from the bottom of the foot to the back of the heel. Plantar fasciitis does not hurt there. It really doesn’t. Even though when you look it up and you read that some of the fibers of the Achilles tendon wrap around the heel and are contiguous with and blend in with the plantar fascia on the bottom of the foot, well, it makes you think that you could have plantar fasciitis all the way around the back of the heel. It just doesn’t work that way.
So the second thing is insertional Achilles tendonitis, and this is where the Achilles comes down and attaches to the back of the heel. That typically though does not just hurt way down on the bottom where it curves around, that’s different. So it usually happens a little higher up than where this person was indicating, based on the image that was posted in the forum.
If you have pain right at that back part, I would think of a couple of other things and investigate those and see if it might be one of these other things. The first thing is a calcaneal stress fracture. Now, if you squeeze the heel bone and you have pain, when you’re squeezing the heel bone, the chances are good that you might actually have a calcaneal stress fracture or a stress fracture in the heel bone itself. Obviously, that would be bad. You do not want to make that worse.
The second thing is medial calcaneal neuritis. Now, you have a nerve that actually curves around the side of the heel bone, and it can be further back than where the plantar fascia actually is and higher up. So it might be neuritis where the nerve that goes around that area is actually causing discomfort.
The other thing it could be is infer calcaneal bursitis and bursa is a little fluid-filled sack, and you have one on the bottom foot. When you get infer calcaneal bursitis, it is further back toward the back of the heel bone, toward where the Achilles tendon is, but it is on the bottom of the heel. If you find it, you push on it and you find it in the spot where we know the bursa is located, well, that’s bursitis.
But all of these things are actually treated differently. So you have to make sure you have the right diagnosis. You have to just think about what are the actual things in that area, where it hurts and that’s the sort of stuff I walk you through in the Runner’s Heel Pain Course. How to actually push on the thing, how to squeeze the thing, how to test the thing, how to stretch the thing, how to figure out which of these things is causing pain, is really your problem because remember, if you’ve got the wrong diagnosis you’re heading down the wrong path real fast.
Make sure you figure out which of these things is actually causing the problem. And then you can pick the things that you think are going to be right for you to help you get back to running as quickly as possible. Now again, go check out the two reasons why some runners with plantar fasciitis don’t get better. So even if you have plantar fasciitis or Achilles tendonitis or something else, it’ll be helpful to figure out what to do, make sure you get on the right path, and move down that path as quickly as possible. Go check it out and I’ll see you in the training.