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Persistent pain in the back of the heel

Posted by David C. on 4/08/04 at 14:04 (148594)

I have had increasing pain in the back of my right heel for many months; eventually it became bad enough that I sought out a podiatrist. Because the right foot pronates badly, he prescribed custom-made orthotics. The orthotics do hold my feet (especially the right one) in what seems a better position, but still I cannot get beyond the pain. Every pair of shoes hurts me--either by rubbing against the back of the heel if the shoes are too loose, or by pressing against it if they are too tight. Wearing rubber heel cups on top of the orthotics helps some, but the heel cups won't stay in place and do not seem to me to be a long-term solution. I have curtailed my walking drastically, have used anti-inflammatories, and ice the heel at least once a day. Still no improvement. Is this plantar fasciitis, or something else? (Only rarely is the pain on the bottom of the foot.) What do you suggest I do? I am still under care of the podiatrist, but I am thinking of seeking a second opinion. Many thanks.

Re: Persistent pain in the back of the heel

Dr. Z on 4/08/04 at 18:59 (148600)


This sounds like achilles tendonitis.. Do you have pain going up and down stairs. Do you have pain when first walking after sitting for any period of time.? Did you podiatrist say you have a pump bump or a haglunds deformity. What did he say was causing your heel pain?

Re: Persistent pain in the back of the heel

David C. on 4/12/04 at 12:35 (148762)

I suggested to the doctor when I first went to see him that it was Achilles tendonitis, but I don't think he ever confirmed that. He simply said that my lower leg and foot are bowed inward enough that when I walk, my foot pronates badly. This causes my foot to roll in my shoes, which in turn produces friction between my shoe and my heel--particularly the bone to which the tendon is attached. This is the chief cause of my pain. However, I have since noticed that I can aggravate the problem even by walking barefooted or in sandals, which suggests to me that external friction is not the sole cause. I suspect that the internal mechanics of the foot are thrown off by the pronation.

The orthotic the doctor made for me does reduce the rolling of my foot. But it doesn't stop other sources of friction between my heel and my shoe. At the same time, it tilts my foot in such a way that my weight now comes down on the outside of my foot, causing pain in the outside of my heel, the outside of my instep, and my two smaller toes. My impression is that it may be impossible simultaneously to solve the problem of the heel pain and avoid pain in the rest of my foot. I am still under care of my podiatrist and will see him again this week. I am just interested in any other suggestions you may be able to give me. Thank you very much.