Heeling

This post is not really intended to be a celebration of overcoming an injury, because I’m not completely out of the woods yet, but more of a checklist of things I have tried and some additional information that will hopefully help any fellow runners out.

First, a description of the injury. This is both the most simple, and most complex issue I have dealt with. It is simply a sharp pain about the size of a dime, directly on the back of the heel. Despite x-rays, an MRI, along with visits to podiatrists and ortopedic specialists, I have not gotten a 100% conclusive diagnosis.

It could be any one or a combination of:

Retro-calcaneal bursitis – inflammation of the bursa that is nearest the achilles attachment

Insertional Achilles tendonitis – inflammation and damage to the achilles tendon where it attaches to the heel

Achilles tendonosis – degeneration of the achilles tendon

Equinus – basically super tight calves

Haglund’s deformity – the calcaneus (heel bone) has an extra bump on the rear that increases the distance to the achilles attachment

Heel spur – sharp bone growth

My best guess is a bit of the insertional tendonitis + bursitis along with a little bit of Haglund’s. Basically, it hurts when my left foot hits the ground running (although I am not really a heel-striker), and it REALLY hurts when I push off. That motion of planting my foot and then using it to propel myself forward lights it up. Having chronically tight calves has really made things worse as everything tugs at that one spot. Climbing hills aggravates it as that increases the distance along the back of the lower leg that the achilles has to stretch.

It all started at the Pueblo Half Marathon (Rock Canyon) in December of 2008. I didn’t notice anything during the race, or immediately after. When I got home after driving for two hours I couldn’t hardly walk. I had to use a severe limp to get around. I went through the normal routine of resting for a week or so, ice, etc. It improved very slightly, I started running again, and have been on a huge roller coaster of progress and setbacks ever since.

I have taken ~4-6 week rest periods three different times. I was on track for making a good comeback last year when I reinjured the spot at the Salida Marathon (8 mile climb right off the bat) in March. Doing speedwork is also a sure way to tirgger a relapse. The longer stride and harder push off put a lot of strain on that area.

So I became a shuffler. No, not really to that extreme, but I have had to limit my faster running and scale it back to something just above a jog a lot of times. No fun.

Here are the remedies I’ve tried:

Multiple rest periods

Ice

Heat

Compression

Elevation

Night splint

Strassburg Sock

3x/week physical therapy for 6 weeks

Iontophonesis

Anti-inflammitories (ibuprofen/naproxen)

Heel sleeve/brace

Heel lifts in shoes

Salonpas medicated pads

Extra padding inside shoe or sock

Surgically-altered shoes (cut out heel counter with razor knife)

Slant board

4 different foam rollers

3 variations of the ‘stick’

Stretches

Eccentric calf exercises

Homeopathic medicine (ruta-grav, arnica)

Massage

Barefoot/VFF running

Kinesio tape

Trigger Point tools

and endless Google and letsrun.com searches

Long list…

Out of that list, what has helped?

All of it, to some degree. And any one of those pursued longer, and with the addition of more rest, would probably result in good progress. However, some things have been more effective than others.

I think the root of the problem is still with my overly-tight calves. While a lot of things on the list treat the symptom, I believe the real cure lies in working on the calf issue. I can’t just do a few wall stretches and make it all go away, though. I come from a cycling background and have strong calves and quads, but when it came to weight-bearing stuff like running I was very weak. I am becoming a big believer in mixing in a bit of barefoot running into my routine. I just need to be careful with that and find the right balance. I had severe flare-ups last summer where I would have to stop in the middle of a run and limp back, but I could take my shoes off and run on the grass with hardly any pain at all.

While heel lifts are often prescribed for achilles injuries, I have actually had better results in dropping the height of the heel in my shoes. I have gotten myself into a little trouble with pain in the 2nd metatarsal on both feet after spending too much of my running time in low profile shoes on hard surfaces.

I think the eccentric calf exercises are worth doing (starting from a raised position and lowering the heel – rather than doing the traditional calf raise that promotes a contraction of the muscle). The eccentric motion focuses on strengthening the muscle while it is being lengthened.

Searching letsrun.com from their site is a pain, but letting Google do the work can have some good results (i.e. use the following syntax in your google search – site:letsrun.com “insertional achilles” ). There can be a lot of crap to wade through, and some generous doses of misinformation, along with occasional humor. I have found some good ideas that way, and if anything it is somewhat comforting to at least find other people that are dealing with similar issues.

I had pretty good luck with the Salonpas medicated patches. Much better than swallowing handfulls of pills and seemed to be effective at treating just the spot of the injury while leaving everything else alone. I just bought them at Safeway.

My best purchase has been the TriggerPoint brand of products. While I do like the grid roller they came out with a while back, the ‘quadballer’ and ‘footballer’ are by far the most effective things I’ve used.

Setting the ‘footballer’ up on the foam block and then rolling your calf on that is very good. While a normal foam roller will have some benefit, this thing is amazing. I love how I can go extremely slow and changing position by just a millimeter or two can make a huge difference. When I find a good spot I really take my time and work it over.

So, things are looking better. I am able to walk somewhat normally when I first get out of bed these days. In the past, I would have to shuffle 4-5 inches at a time until things started to loosen up. I am back into regular training. Still not as much as I would like, or as hard as I would like to push on some days, but building some good consistency while mixing in some decent days on the bike as well.

If you are suffering from anything like this… good luck!  It has been a tough couple of years.  I have had some great experiences and decent results (running Boston, Leadville big buckle, etc.) while dealing with this, but there is always a huge feeling of being held back.  I have to alter my stride to compensate for the pain and that has led to various other injuries.  I am rarely able to truly just run free.  For now, I’m being patient and taking what I can get while building towards the future.

This post is not really intended to be a celebration of overcoming an injury, because I’m not completely out of the woods yet, but more of a checklist of things I have tried and some additional information that will hopefully help any fellow runners out.

First, a description of the injury.  This is both the most simple, and most complex issue I have dealt with.  It is simply a sharp pain about the size of a dime, directly on the back of the heel.  Despite x-rays, an MRI, along with visits to podiatrists and ortopedic specialists, I have not gotten a 100% conclusive diagnosis.

It could be any one or a combination of:
Retro-calcaneal bursitis – inflammation of the bursa that is nearest the achilles attachment
Insertional Achilles tendonitis – inflammation and damage to the achilles tendon where it attaches to the heel
Achilles tendonosis – degeneration of the achilles tendon
Equinus – basically super tight calves
Haglund’s deformity – the calcaneus (heel bone) has an extra bump on the rear that increases the distance to the achilles attachment
Heel spur – sharp bone growth
My best guess is a bit of the insertional tendonitis + bursitis along with a little bit of Haglund’s.  Basically, it hurts when my left foot hits the ground running (although I am not really a heel-striker), and it REALLY hurts when I push off.  That motion of planting my foot and then using it to propel myself forward lights it up.  Having chronically tight calves has really made things worse as everything tugs at that one spot.  Climbing hills aggravates it as that increases the distance along the back of the lower leg that the achilles has to stretch.
It all started at the Pueblo Half Marathon (Rock Canyon) in December of 2008.  I didn’t notice anything during the race, or immediately after.  When I got home after driving for two hours I couldn’t hardly walk.  I had to use a severe limp to get around.  I went through the normal routine of resting for a week or so, ice, etc.  It improved very slightly, I started running again, and have been on a huge roller coaster of progress and setbacks ever since.
I have taken ~4-6 week rest periods three different times.  I was on track for making a good comeback last year when I reinjured the spot at the Salida Marathon (8 mile climb right off the bat) in March.  Doing speedwork is also a sure way to tirgger a relapse.  The longer stride and harder push off put a lot of strain on that area.
So I became a shuffler.  No, not really to that extreme, but I have had to limit my faster running and scale it back to something just above a jog a lot of times.  No fun.
Here are the remedies I’ve tried:
Multiple rest periods
Ice
Heat
Compression
Elevation
Night splint
Strassburg Sock
3x/week physical therapy for 6 weeks
Iontophonesis
Anti-inflammitories (ibuprofen/naproxen)
Heel sleeve/brace
Heel lifts in shoes
Salonpas medicated pads
Extra padding inside shoe or sock
Surgically-altered shoes (cut out heel counter with razor knife)
Slant board
4 different foam rollers
3 variations of the ‘stick’
Stretches
Eccentric calf exercises
Homeopathic medicine (ruta-grav, arnica)
Massage
Barefoot/VFF running
Kinesio tape
Trigger Point tools
and endless Google and letsrun.com searches
Long list…
Out of that list, what has helped?
All of it, to some degree.  And any one of those pursued longer, and with the addition of more rest, would probably result in good progress.  However, some things have been more effective than others.
I think the root of the problem is still with my overly-tight calves.  While a lot of things on the list treat the symptom, I believe the real cure lies in working on the calf issue.  I can’t just do a few wall stretches and make it all go away, though.  I come from a cycling background and have strong calves and quads, but when it came to weight-bearing stuff like running I was very weak.  I am becoming a big believer in mixing in a bit of barefoot running into my routine.  I just need to be careful with that and find the right balance.  I had severe flare-ups last summer where I would have to stop in the middle of a run and limp back, but I could take my shoes off and run on the grass with hardly any pain at all.
While heel lifts are often prescribed for achilles injuries, I have actually had better results in dropping the height of the heel in my shoes.  I have gotten myself into a little trouble with pain in the 2nd metatarsal on both feet after spending too much of my running time in low profile shoes on hard surfaces.
I think the eccentric calf exercises are worth doing (starting from a raised position and lowering the heel – rather than doing the traditional calf raise that promotes a contraction of the muscle).  The eccentric motion focuses on strengthening the muscle while it is being lengthened.
Searching letsrun.com from their site is a pain, but letting Google do the work can have some good results (i.e. use the following syntax in your google search – site:letsrun.com “insertional achilles” ).  There can be a lot of crap to wade through, and some generous doses of misinformation, along with occasional humor.  I have found some good ideas that way, and if anything it is somewhat comforting to at least find other people that are dealing with similar issues.
I had pretty good luck with the Salonpas medicated patches.  Much better than swallowing handfulls of pills and seemed to be effective at treating just the spot of the injury while leaving everything else alone.  I just bought them at Safeway.
My best purchase has been the TriggerPoint brand of products.  While I do like the grid roller they came out with a while back, the ‘quadballer’ and ‘footballer’ are by far the most effective things I’ve used.
Setting the ‘footballer’ up on the foam block and then rolling your calf on that is very good.  While a normal foam roller will have some benefit, this thing is amazing.  I love how I can go extremely slow and changing position by just a millimeter or two can make a huge difference.  When I find a good spot I really take my time and work it over.
So, things are looking better.  I am able to walk somewhat normally when I first get out of bed these days.  In the past, I would have to shuffle 4-5 inches at a time until things started to loosen up.  I am back into regular training.  Still not as much as I would like, or as hard as I would like to push on some days, but building some good consistency while mixing in some decent days on the bike as well.

Posted on February 1, 2011, in run, training. Bookmark the permalink. 9 Comments.

  1. >I believe the real cure lies in working on the calf issue

    I think you nailed it 🙂 I haven’t had the exact same injury, but I’ve had PF before and occasional Achilles issues, and things don’t heal until the pressure comes off, which means keeping the calf muscles soft.

    It also seems to make a difference to me when I stretch. If I stretch after cool-down, it’s nearly useless. I have to stretch right after running, while the muscles are warm.

    I have those same TriggerPoint tools (I got the set) but I still find I use a foam roller the most. I actually use that ball on my back up against a wall. Sure lets you know when you have tension! Ouch.

    Hope it gets better.

    • Hey mtnrunner2, thanks for the link to your post! That picture is incredible, there is no way I could get even half of that distance right now. Very informative comments, too. I am really focused on the strength aspect as well, from the calf down through the foot. I think things tend to get tight because they are overworked. That happens because they are not strong enough, or because of poor form (likely due to fatigue).

  2. Chris – great post. Thanks for sharing the data/experience. I think my left heel issue also is the result of overly tight left calf. I’ll look into the Trigger Point stuff. Seem to be having some benefit from an old night splint my wife had laying around five nights in it and things are better. Also now giving some acupuncture a go to see if I can get some of the calf tightness issues to let go. Will do my second of three planned rounds this week. Other than that…ice, stretching and finger-crossing. Hope to see you out there…running free!

    • Jim, thanks. I saw you mention the splint the other day, but didn’t have time to address it that much in my post. I found it very helpful as well. I just couldn’t use it consistently. If it was tight enough to hold my foot in place, I would end up thrashing around and ripping it off at about 2 in the morning as my circulation was cut off. If I kept it loose to avoid that issue, I would get zero benefit because my foot could move around too much. I am typically a stomach-sleeper, so that really keeps the calves balled up as well.

      Very interested to hear about your acupuncture experience. That is one of the few things I have not tried. I am intrigued by the concept, though. Mostly from a standpoint of causing little bits of damage to encourage the body to send healing energy that direction. I know there’s a surgery option that basically takes it to a higher degree and perforates the tendon dozens of times, all in an effort to promote a healing response.

      Good luck!

  3. I have what’s considered one of the worst cases of Haglund’s deformity, with very large inflamed bursae and associated achilles tendonitis – I’ve had it for 30 years and everyone but me says I should have surgeries for it. Two things I’ve learned: starting to run fast rather than long starts the pain process (probably due to running furth up on my toes and not on my heels) and only rest, weeks of rest, cures it. Cutting holes in the heel counter around the inflammation seems to help as well.

    Best of luck!

    • Steve, thanks for that input. I have seen photos of extreme cases and am thankful to be nowhere near that bad. I feel for you having just a taste of what that must be like. I’m very prone to building up extra bone at places that have been stressed or bumped. I have growth at the top of my tibia from a bike crash, and a pretty good lump on the head from getting hit by a rock while climbing. I’m sure my heels have reacted in the same way to the pounding they’ve gotten.

      I have become a fairly proficient shoe surgeon, but find that for me that is not really the fix (every little bit helps, though). I agree 100% on the running fast, and am taking a much more relaxed approach to the training this year. Still going to do a lot, but getting stronger, lighter, and more efficient will be the focus. Can’t be forcing the speed, have to let it happen after the other things develop.

      Good luck to you as well!

  4. I could have written this word for word…

    I can’t tell though, if I should be using a higher drop shoe and heel lifts.

    Or a nearly zero drop shoe with lifts.

    In theory wouldn’t the zero with lifts just be similar to a regular shoe?

    I ran for years with 4mm drop and nothing — then one day I bought shoes too big for me and that started the whole problem

  5. Thanks for the post. Wondering how things are going for you now. I ahve been dealing with this on my right heel for about 7-8 yeras now and am desparately to avoid surgery. Check out the website for sockdoc.com. Some interesting stuff. The guy has the same bump and seems to live with it comfortably by keeping the calves free of any trigger points. Diet is huge with him.
    I do have to say I belive there is a relation between the calcium build up and the calium metabolism. not sure what, I am not a chemist but what I have read makes a lot of sense to me. When I got this bump I had already been running so much and not looked after myself nutritionally, that now in hindsight I think that is partially what caused this. I had developed calcium deposits in my breast which showed up in a routine mammogram and a bone scan cam back with the diagnosis of osteopinia. The calcium deposits in my breast have gone away after taking good supplements and getting my diet back on track. So putting all this together I am convinced of the correlation between diet and this nasty affliction. Currently runnning 2-3 times a week, cycling , using Nike Free 4.0 (4mm drop). Walking barefoot whenever possible and using flats at work. Also have purchased the TP set, but not used regularly. I have tried tried prety much every possible therapy, Graston I think might be worth a try to get rid of any junk built up around the achilles.

    • Heidi,
      Thanks for stopping by and sharing your experiences. It has been a long haul for me as well, just passed the 5 year mark. Things are infinitely better than they were in year one, but still quite difficult at times. I think the calf & trigger point combo is the number #1 culprit for me – but like you mentioned, my TP set does not get used regularly. I think it would help out a great deal, but I just do not get motivated to spend time on it (plus it is painful!). Thankfully, I am able to train at an almost normal level now. Hills are still very problematic at times, but I manage and am thankful for the amount of training I am able to do. It sure beats sitting on the sidelines.

      I am concentrating on working in some bike riding and rowing machine workouts into the mix, which seem to help. I found your mention of calcuim deposits interesting, as I seem to be prone to that sort of thing as well. I have a few places where I have been whacked by a rock or involved in a bike crash that have developed a raised bump on the bone in response. I have taken calcium supplements at times, but never really long enough to notice any difference.

      I have considered Graston and it seems to have good potential for helping, but always come back to thinking I should just spend the time on the TP set and slant board I already have.

      Good luck getting through this and I hope you continue to see improvement.
      Chris

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