Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

Pain up back of heel -- is this just PF?

Posted by Valerie S on 5/19/01 at hrmin (048325)

Hi.

I have been getting a new pain at the very back of my heel for several weeks. I asked my doctor about it, and he said it's probably from the night splint. That was weeks ago, and the pain is not going away. I have this burning pain that goes up the back of my heel (not under but on outside), and up the sides a few inches. The pain comes when resting or when walking, usually but not always in combination with the super-charged 'broken glass' or 'stone bruise' feeling that also comes and goes regularly.

I have been diagnosed with PF, and am worried that something else might be happening.

I still have the 'classic' PF pain, with it's usual ups and downs. I am getting my orthotics back early next week, am still using the night splint (have had it for about 6 weeks or so), doing gentle stretching (not so much since having this increasing pain up the back of my heel), and foot/ankle strengthening exercises as tolerable. I have also recently started bike riding, which hasn't seemed to help or hurt the pain. (Only on the bike am I able to move around without pain in my feet!)

I have also been having severe stiffness and pain in my ankles if I walk for longer than 10 minutes, which the doctor told me should go away with exercise. I have accepted this answer for the time being, but am worried about the burning stripes up the back of my heel. I also have this tearing sensation in my arches, which I assume IS just part of the PF, telling me to tape and rest more.

Should I be worried about this burning pain, or is it normal with PF? What questions should I ask my doctor about this? Last time he didn't seem to think that this was an indicator of anything serious. I would rather be safe than sorry ... I learned the hard way, letting the heel pain get so far in the first place.

Thanks for any insight... Val.

Re: Pain up back of heel -- is this just PF?

Dr. Zuckerman on 5/20/01 at 07:18 (048340)

Let's review that excercises that you are doing. This could be causing you the burning up the back of the leg and the arch. pain

Re: Pain up back of heel -- is this just PF?

Julie on 5/20/01 at 08:14 (048341)

Val, could there be a connection between your cycling technique and your new pain? Has the pain come on since you started cycling? How do you use your feet in pedalling - toes down or heel down at the bottom of the cycle? I'm not sure which would be more likely to cause problems, but if you can say, I'll try to figure it out. It sounds to me as though something may have irritated your achilles tendon.

Also, what about your stretches? What exactly are you doing?

Re: Ankle exercises

Valerie S on 5/20/01 at hrmin (048343)

Hi Dr. Z.
First let me admit that I haven't been very religious with the exercises.

I am doing the same exercises that I did when I was in PT. Sitting on the floor, using theraband - move foot against resistance of band in sets of 20: pull up and out, pull up and in, push down and out, push down and in, pull straight out. These are the same ones that my PT had me doing a couple of months ago. I have also done some of the towel-scrunching and the picking up marbles, but it's hard for me because my toes are really short... hee hee.

The pain is worst when I roll my my ankle around... It is either right on the back or just inside, starts at the very bottom of my foot and just goes up about 3 inches. (It's not up the back of my leg.) I have the pulling/tearing sensation in my arch almost directly in front of the insertion point, along with very sharp PF heel pain when I step on it.

Thanks for listening.
Val.

Re: Cycling technique

Valerie S on 5/20/01 at hrmin (048350)

Hi Julie.

Please don't anyone tell me that this is from riding my brand new bike! I will be very upset if I have to give this up too (the walking was enough to lose)... hee hee.

But seriously, the pain started long before I got the bike, but definitely don't want the bike to irritate the PF or anything else. While riding the bike, I have NO foot or ankle pain.

I ride with the center/ball of my foot down on the pedal. My leg extends almost fully but not totally as I pedal.

When I got the bike at the local bike shop, they checked the seat height for me and watched me ride. They were very helpful. I wanted to make sure I was doing everything correctly... even though they say you never forget how to ride a bike...heehee. I am riding this bike as a substitute for riding the stationary bike that I rode in PT. It's a lot harder to ride a real bike, moving yourself through space!... My PT told me that increasing the blood flow was supposed to speed healing. I am also riding in order to burn calories, as part of a weight loss plan... hoping that losing weight will make my feet feel better, and that improved muscle tone will take some stress off my ankles and feet.

This pain started several weeks ago, without any specific incident. I had developed severe ankle pain, which my pod told me was compensatory pain.

Sorry to go on and on... thanks so much for caring, and for helping me.
My feet hurt really bad today... I skipped the night splint last night to see if I woke up worse or better without it... I think worse, but can't tell because my heel was very irritated when I went to bed. I am hoping that it is from going out suit shopping with my husband, and not from my bike riding. My legs are tired, but I can't wait to go again today: we're gonna try the 2 miles of hills that lead to the frozen yogurt shop, hoping that I will have the energy to climb the hills and get home... hee hee. Better leave early, since I can't walk my bike home. :)

The only time my feet don't hurt really is when I am riding my bike.
Thanks again, and have a great day!
Val.

Re: Pain up back of heel -- is this just PF?

Dr. Zuckerman on 5/20/01 at 10:33 (048352)

It sounds like a tendonitis of the posterior tibial tendon. How about cutting down on the theraaband resistant workout. Let try only ten times instead of 20. May have to stop this if the pain isn't reduced . So cut back with this one

Re: Pain up back of heel -- is this just PF?

bg cped on 5/20/01 at 10:56 (048357)

What kind of shoes did you wear to the mall? how old are they? did your Doc or Therapist say if you over pronate or have flat feet? If you have not done so go out and buy a good pair of running shoes or cross trainers. Got to a decent store where they will measure your foot and fit you properly. Tell them you are getting orthotics soon and to fit you a little on the bigger side.

You prob have not had your foot measured the correct way in some time you may be bigger size thn you want to think, but get them bigger if they measure that way. If it is achille or post tib tendon as Dr Z said the shoe should help.

If you are wearing flexible walking shoes like rockport, easy spirit, keds, or similar and you have those 2 conditions it will get better sooner by changing shoes. What shoe have you been wearing and if you know what model?

Re: Shoes

Valerie S on 5/20/01 at hrmin (048377)

Thanks for bringing that up.
I have been wearing Birkenstocks exclusively for many years. I let my pair of Londons wear out before I went to the podiatrist in the first place, which might have been a contributor. He tells me that I do overpronate. The pair that I am wearing consistently right now is Boston. I also have a pair of Arizona sandals, but really need a new pair because they flop around a little and I can't get the straps right anymore.

I have very short wide feet, and my toes like to sprawl out... that's why I started wearing Birks in the first place many years ago. All running shoes that I have tried, even wide widths seem to pinch my toes together, and the way that they push my foot forward aggravates my ingrown toenails. I guess I should try another type. I am getting my orthotics back from the shop early next week. This is my 2nd adjustment, and I have little faith that they will fit me this time either. I just don't want to spend the money out of my pocket. I have Aetna PPO, and they told me that they will only pay for one pair of orthotics. Why don't they make running shoes with big square toeboxes?

Thanks again... Val.

P.S: We made it to the yogurt shop! 2 miles up and down long hills... feels so good to ride bike again.

Re: Cycling technique

Julie on 5/20/01 at 14:57 (048381)

Hi Val

I didn't mean to worry you with my question and am sorry if I did. I certainly don't want you to discourage you from bike riding. I was just wondering if there might be a connection, as you didn't mention the new pain before you started riding, but you say it started long before. And it doesn't sound as though the way you pedal could be putting a strain on your achilles. If you were pedalling fully dorsiflexed or fully plantarflexed it might, but you say you're extending almost but not totally fully, so I don't see a problem there.

So it sounds from what you say as though biking has nothing to do with the pain, and it's great that you can do it and enjoy it. It's so important to be able to do something you really love, and that you and your husband can do together. Go for it.

All the best.

Julie

Re: Shoes

Dr. Zuckerman on 5/20/01 at 15:29 (048392)

There is a new balance model that is extra depth for wide feet. Just ask any store that sells the New Balance shoes and they will show them to you.
Maybe even go online and take a look at the New Balance web site

Re: Shoes

bg cped on 5/20/01 at 16:01 (048398)

Try a new bal 810 they make them in x wide for women, if your toe is hitting the end your shoes are too short. Brooks also makes a wide shoe for pronators that is also a straight last and wide. Have your orthotic guy measure both your arch length and heel to toe length. Go to a little bigger shoe and have him thin out the last 2 inchs of your orthotic, it will give you more wiggle room in the toes

Re: Pain up back of heel -- is this just PF?

ellen w on 5/20/01 at 19:55 (048418)

Val --

some of this sounds like symptoms, especially the stiffness in the ankles, I had when I was diagnosed with retrocalcaneal bursitis, and the inflamed sac was pressing against the tendon. There was also a very hard, red area at the back of my heel. The inflammation was visible with an x-ray, but not on MRI. You might ask your doc if this is a possibility.

ellen

Re: Pain up back of heel -- is this just PF?

Dr. Zuckerman on 5/20/01 at 07:18 (048340)

Let's review that excercises that you are doing. This could be causing you the burning up the back of the leg and the arch. pain

Re: Pain up back of heel -- is this just PF?

Julie on 5/20/01 at 08:14 (048341)

Val, could there be a connection between your cycling technique and your new pain? Has the pain come on since you started cycling? How do you use your feet in pedalling - toes down or heel down at the bottom of the cycle? I'm not sure which would be more likely to cause problems, but if you can say, I'll try to figure it out. It sounds to me as though something may have irritated your achilles tendon.

Also, what about your stretches? What exactly are you doing?

Re: Ankle exercises

Valerie S on 5/20/01 at hrmin (048343)

Hi Dr. Z.
First let me admit that I haven't been very religious with the exercises.

I am doing the same exercises that I did when I was in PT. Sitting on the floor, using theraband - move foot against resistance of band in sets of 20: pull up and out, pull up and in, push down and out, push down and in, pull straight out. These are the same ones that my PT had me doing a couple of months ago. I have also done some of the towel-scrunching and the picking up marbles, but it's hard for me because my toes are really short... hee hee.

The pain is worst when I roll my my ankle around... It is either right on the back or just inside, starts at the very bottom of my foot and just goes up about 3 inches. (It's not up the back of my leg.) I have the pulling/tearing sensation in my arch almost directly in front of the insertion point, along with very sharp PF heel pain when I step on it.

Thanks for listening.
Val.

Re: Cycling technique

Valerie S on 5/20/01 at hrmin (048350)

Hi Julie.

Please don't anyone tell me that this is from riding my brand new bike! I will be very upset if I have to give this up too (the walking was enough to lose)... hee hee.

But seriously, the pain started long before I got the bike, but definitely don't want the bike to irritate the PF or anything else. While riding the bike, I have NO foot or ankle pain.

I ride with the center/ball of my foot down on the pedal. My leg extends almost fully but not totally as I pedal.

When I got the bike at the local bike shop, they checked the seat height for me and watched me ride. They were very helpful. I wanted to make sure I was doing everything correctly... even though they say you never forget how to ride a bike...heehee. I am riding this bike as a substitute for riding the stationary bike that I rode in PT. It's a lot harder to ride a real bike, moving yourself through space!... My PT told me that increasing the blood flow was supposed to speed healing. I am also riding in order to burn calories, as part of a weight loss plan... hoping that losing weight will make my feet feel better, and that improved muscle tone will take some stress off my ankles and feet.

This pain started several weeks ago, without any specific incident. I had developed severe ankle pain, which my pod told me was compensatory pain.

Sorry to go on and on... thanks so much for caring, and for helping me.
My feet hurt really bad today... I skipped the night splint last night to see if I woke up worse or better without it... I think worse, but can't tell because my heel was very irritated when I went to bed. I am hoping that it is from going out suit shopping with my husband, and not from my bike riding. My legs are tired, but I can't wait to go again today: we're gonna try the 2 miles of hills that lead to the frozen yogurt shop, hoping that I will have the energy to climb the hills and get home... hee hee. Better leave early, since I can't walk my bike home. :)

The only time my feet don't hurt really is when I am riding my bike.
Thanks again, and have a great day!
Val.

Re: Pain up back of heel -- is this just PF?

Dr. Zuckerman on 5/20/01 at 10:33 (048352)

It sounds like a tendonitis of the posterior tibial tendon. How about cutting down on the theraaband resistant workout. Let try only ten times instead of 20. May have to stop this if the pain isn't reduced . So cut back with this one

Re: Pain up back of heel -- is this just PF?

bg cped on 5/20/01 at 10:56 (048357)

What kind of shoes did you wear to the mall? how old are they? did your Doc or Therapist say if you over pronate or have flat feet? If you have not done so go out and buy a good pair of running shoes or cross trainers. Got to a decent store where they will measure your foot and fit you properly. Tell them you are getting orthotics soon and to fit you a little on the bigger side.

You prob have not had your foot measured the correct way in some time you may be bigger size thn you want to think, but get them bigger if they measure that way. If it is achille or post tib tendon as Dr Z said the shoe should help.

If you are wearing flexible walking shoes like rockport, easy spirit, keds, or similar and you have those 2 conditions it will get better sooner by changing shoes. What shoe have you been wearing and if you know what model?

Re: Shoes

Valerie S on 5/20/01 at hrmin (048377)

Thanks for bringing that up.
I have been wearing Birkenstocks exclusively for many years. I let my pair of Londons wear out before I went to the podiatrist in the first place, which might have been a contributor. He tells me that I do overpronate. The pair that I am wearing consistently right now is Boston. I also have a pair of Arizona sandals, but really need a new pair because they flop around a little and I can't get the straps right anymore.

I have very short wide feet, and my toes like to sprawl out... that's why I started wearing Birks in the first place many years ago. All running shoes that I have tried, even wide widths seem to pinch my toes together, and the way that they push my foot forward aggravates my ingrown toenails. I guess I should try another type. I am getting my orthotics back from the shop early next week. This is my 2nd adjustment, and I have little faith that they will fit me this time either. I just don't want to spend the money out of my pocket. I have Aetna PPO, and they told me that they will only pay for one pair of orthotics. Why don't they make running shoes with big square toeboxes?

Thanks again... Val.

P.S: We made it to the yogurt shop! 2 miles up and down long hills... feels so good to ride bike again.

Re: Cycling technique

Julie on 5/20/01 at 14:57 (048381)

Hi Val

I didn't mean to worry you with my question and am sorry if I did. I certainly don't want you to discourage you from bike riding. I was just wondering if there might be a connection, as you didn't mention the new pain before you started riding, but you say it started long before. And it doesn't sound as though the way you pedal could be putting a strain on your achilles. If you were pedalling fully dorsiflexed or fully plantarflexed it might, but you say you're extending almost but not totally fully, so I don't see a problem there.

So it sounds from what you say as though biking has nothing to do with the pain, and it's great that you can do it and enjoy it. It's so important to be able to do something you really love, and that you and your husband can do together. Go for it.

All the best.

Julie

Re: Shoes

Dr. Zuckerman on 5/20/01 at 15:29 (048392)

There is a new balance model that is extra depth for wide feet. Just ask any store that sells the New Balance shoes and they will show them to you.
Maybe even go online and take a look at the New Balance web site

Re: Shoes

bg cped on 5/20/01 at 16:01 (048398)

Try a new bal 810 they make them in x wide for women, if your toe is hitting the end your shoes are too short. Brooks also makes a wide shoe for pronators that is also a straight last and wide. Have your orthotic guy measure both your arch length and heel to toe length. Go to a little bigger shoe and have him thin out the last 2 inchs of your orthotic, it will give you more wiggle room in the toes

Re: Pain up back of heel -- is this just PF?

ellen w on 5/20/01 at 19:55 (048418)

Val --

some of this sounds like symptoms, especially the stiffness in the ankles, I had when I was diagnosed with retrocalcaneal bursitis, and the inflamed sac was pressing against the tendon. There was also a very hard, red area at the back of my heel. The inflammation was visible with an x-ray, but not on MRI. You might ask your doc if this is a possibility.

ellen