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back of the heel pain in CA

Posted by John B on 5/20/02 at 12:23 (084676)

Just discovered this list and web site - very informative. I have been experiencing pain at the back of my heel for a year now, and diagnosed with a heel spur (calcium deposit) at the insertion of my Achilles tendon. After various treatments, my doc is suggesting surgery even though he admits there is a chance this will not help. Does anyone know if my condition can be treatable with ESWT? Or any clinics in Southern California with a machine? I am frustrated with the whole process, and can't even remember what it felt like to be without pain. Thanks for any help.

Re: back of the heel pain in CA

Ed Davis, DPM on 5/20/02 at 15:23 (084689)

ESWT can be used for pain in back of the heel. The FDA has approved it only for plantar fasciitis so insurance companies may be hesitant to cover it for the problems you are having. The downside to ESWT is quite small so it may be worth a try if insurance coverage is available. A low cost alternative exists in Canada. Vancouver's Sonorex treatment center would be the closest.

The experience with pain in back of the heel is not as extensive as with plantar fasciitis. I suspect that if there is a lot of bulid up of calcium/bone around the insertion of the achilles, that surgical treatment may be preferred. The surgical technique and experience of the surgeon is a lot more critical in this area than in plantar fascia release surgery, but the outcomes, if well performed, can be superior.
Ed

Re: back of the heel pain in CA

John B on 5/20/02 at 16:58 (084698)

Thank you for the input Dr. Davis. I have spent considerable time misdiagnosed - treated for tendinitis, bursitis etc. Finally, an x-ray revealed a bone spur at my Achilles insertion, and I was shuttled off to physical therapy (iontophoresis of a steroid). This calmed things down, but pain began again, and a subsequent x-ray showed the bone spur had broken off the back of my heel. I was finally allowed an MRI, which revealed a partial tear of my Achilles as well. I am at a loss for what to do next after going to docs for 10 months. If I am a candidate for ESWT, I think I will be vactioning in Vancuver.

Re: back of the heel pain in CA

Ed Davis, DPM on 5/20/02 at 18:53 (084712)

What type of docs have you seen so far? It sounds like a 'garden variety' diagnosis in my practice -- something that should not be misdiagnosed unless you got stuck with a general practitioner who did not want to make a referral.

Southern Cal has a tough managed care system that often discourages referrals and good care--that is why I practice up the coast in WA where one can still try to give patients the best care possible.
Ed

Re: back of the heel pain in CA

Sandy L. on 5/22/02 at 19:36 (084921)

I also have spurs in the back of both heels. Only the right one hurts, although I've had 2 previous surgeries to remove bone near the achilles. I still need another surgery and at he achilles has started thinning. I also have bursitis surrounding the spur. One DPM suggested 'casting.' Another DPM disagreed with that technique. What do you think?

Re: back of the heel pain in CA

Jack W. on 5/27/02 at 13:43 (085357)

John B.: Just happened to be checking the web site and found your post. I want to preface my comments by saying my condition may not be identical to yours but certainly similarities exist. I was a five year sufferer from Achilles Insertional Tendonitis with Calcification when I had my first ESWT treatment on Sept. 8, 2001. Prior to the first treatment my right heel would experience horrendous pain during my daily runs. I resumed running 3 weeks after my first ESWT treatment and slowly built my mileage and speed up. The pain has been greatly diminished 3 treatments and almost 9 months later. The progress has been slow and I am NOT cured. But it is bearable and I am not considering surgery. I believe additional treatments will help and I am scheduled for a fourth in a week or so. I would recommend ESWT for this condition, but don't expect a miracle overnight cure.

Re: back of the heel pain in CA

Ed Davis, DPM on 5/20/02 at 15:23 (084689)

ESWT can be used for pain in back of the heel. The FDA has approved it only for plantar fasciitis so insurance companies may be hesitant to cover it for the problems you are having. The downside to ESWT is quite small so it may be worth a try if insurance coverage is available. A low cost alternative exists in Canada. Vancouver's Sonorex treatment center would be the closest.

The experience with pain in back of the heel is not as extensive as with plantar fasciitis. I suspect that if there is a lot of bulid up of calcium/bone around the insertion of the achilles, that surgical treatment may be preferred. The surgical technique and experience of the surgeon is a lot more critical in this area than in plantar fascia release surgery, but the outcomes, if well performed, can be superior.
Ed

Re: back of the heel pain in CA

John B on 5/20/02 at 16:58 (084698)

Thank you for the input Dr. Davis. I have spent considerable time misdiagnosed - treated for tendinitis, bursitis etc. Finally, an x-ray revealed a bone spur at my Achilles insertion, and I was shuttled off to physical therapy (iontophoresis of a steroid). This calmed things down, but pain began again, and a subsequent x-ray showed the bone spur had broken off the back of my heel. I was finally allowed an MRI, which revealed a partial tear of my Achilles as well. I am at a loss for what to do next after going to docs for 10 months. If I am a candidate for ESWT, I think I will be vactioning in Vancuver.

Re: back of the heel pain in CA

Ed Davis, DPM on 5/20/02 at 18:53 (084712)

What type of docs have you seen so far? It sounds like a 'garden variety' diagnosis in my practice -- something that should not be misdiagnosed unless you got stuck with a general practitioner who did not want to make a referral.

Southern Cal has a tough managed care system that often discourages referrals and good care--that is why I practice up the coast in WA where one can still try to give patients the best care possible.
Ed

Re: back of the heel pain in CA

Sandy L. on 5/22/02 at 19:36 (084921)

I also have spurs in the back of both heels. Only the right one hurts, although I've had 2 previous surgeries to remove bone near the achilles. I still need another surgery and at he achilles has started thinning. I also have bursitis surrounding the spur. One DPM suggested 'casting.' Another DPM disagreed with that technique. What do you think?

Re: back of the heel pain in CA

Jack W. on 5/27/02 at 13:43 (085357)

John B.: Just happened to be checking the web site and found your post. I want to preface my comments by saying my condition may not be identical to yours but certainly similarities exist. I was a five year sufferer from Achilles Insertional Tendonitis with Calcification when I had my first ESWT treatment on Sept. 8, 2001. Prior to the first treatment my right heel would experience horrendous pain during my daily runs. I resumed running 3 weeks after my first ESWT treatment and slowly built my mileage and speed up. The pain has been greatly diminished 3 treatments and almost 9 months later. The progress has been slow and I am NOT cured. But it is bearable and I am not considering surgery. I believe additional treatments will help and I am scheduled for a fourth in a week or so. I would recommend ESWT for this condition, but don't expect a miracle overnight cure.