Heel tendinitis

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Heel tendinitis

Postby Melodycl » Tue Jan 26, 2010 10:46 am

Hi Lani - I am on my feet at work for sometimes up to 12 hours (teacher) without a break. At the end of last semester - I developed a tendinitis in one of my heels. I wear MBT shoes - and it feels fine (great) when I am wearing my shoes. It hurts when I first wake up - and I have real difficulty walking - once it is stretched out a bit - it no longer hurts and I can walk fine. After 2 weeks of motrin - and starting T-Tapp it has improved by about 60%.

I was wondering - what is your experience with this type of injury? I have to start lecturing again (winter break is over) - and have the same issues with being on my feet all day long with no breaks. Is this something I can keep rehabing myself - or is it time to go in to the ortho doc?

Thanks for your insight. I know you can't give medical advice - or treatment advice - I am asking about your general experiences with heel tendinitis and what generally to expect - and generally when it is time to seek medical care (what are the danger signs).

Thanks so much!
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Re: Heel tendinitis

Postby SactoBob » Tue Jan 26, 2010 11:13 am

Hi Melody,
What you are describing is almost certainly plantar fasciitis. Those are exactly the symptoms I had, and I struggled with it for many years. If you press deeply into the heel on the inner side, you will find the tender spot. It is where the plantar fascia attaches to the heel.

There are a number of ways to treat it, and I have had nearly all I think. You might want to be examined by a podiatrist who specializes in mechanical problems. The last time I was involved in this problem, the scale of treatment was something like this - first a heel cup, then a strapping of the arch to support it, then a trial of a cortisone injection, then custom orthotics. You could try some of the one-size-fits-all orthotics, but they are unlikely to work. In all cases you want to stretch the achilles area. You could try some NSAIDS, but not my choice.

This problem is almost always quickly solved. Maybe our resident trainer knows of something newer or better, but that is almost surely what you are dealing with.
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Re: Heel tendinitis

Postby Lani Muelrath » Tue Jan 26, 2010 12:38 pm

Melody,

My first thought with reading your symptoms is achilles tendonitis, which you would feel through the achilles area and down to the heel. Sacto Bob mentions plantar fasciitis, and thanks Bob for sharing from your personal experience. However, plantar fasciitis is usually experienced more on the bottom of the foot so maybe you can clarify location Melody.

Like SactoBob, I can speak from experience on this one, but for me it was achilles tendonitis. And the thing about tendons is they take a LONG time to heal. And they need rest to do it. Not a pretty prognosis for a busy aerobics teacher, which I was teaching a lot of at the time. Actually led to the problem.

It make be that the MBTs are placing too much of a consisten stretch on the achilles for recovery. Are they not an elevated forefoot? What shoes feel most comfortable? Would you be able to do part of your lecture time sitting? What does doc say about physical therapy? PT could be an enourmous help to you.

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Re: Heel tendinitis

Postby SactoBob » Tue Jan 26, 2010 1:13 pm

I agree, Lani, that it could be Achilles tendinitis too. I also agree that the pain in Achilles is more in the back of the foot, above the heel. I should have asked for a bit more description of the location of the pain.

Plantar fasciitis is felt more in the bottom of the heel, sort of like you are walking with a stone inside your heel. I have had both (for years). If it is Achilles, a shoe with an elevated heel can alleviate the problem. Ice can work for Achilles tendinitis too - freeze a Dixie cup with water, and massage it into the back of your heel. But this advice would come better from a licensed podiatrist or PT. Either way, some treatment is indicated if it does not resolve promptly. Otherwise, it can last for years.

To me, the history of the first few step in the morning being painful, and then feeling somewhat better, is more suggestive of plantar fasciitis. That is a very common history for plantar fasciitis, as I experienced it too. If you press your thumb, or something stiff, into the interior of the bottom of the forward part (towards the big toe) of your heel, you will feel it if it is plantar fasciitis.

My experience was that traditional physical therapy did nothing for my problem, but I am glad if others have achieved success. A lot depends on skill of who treats you. The diagnosis is not usually hard. IMO, the best person to treat this wold be a podiatrist with special training in mechanics. The serious runners and running clubs (or the stores where they shop) would know who the local docs are who are good with this sort of injury.
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Re: Heel tendinitis

Postby Lani Muelrath » Tue Jan 26, 2010 1:22 pm

Great advice SactoBob and thanks for the additional insights. Nothing like the wisdom of experience!

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Re: Heel tendinitis

Postby seestorcoo » Tue Jan 26, 2010 1:28 pm

I mostly eliminated my plantar fasciitis by making sure I sleep with my feet not in the toe down/extended position. I do this by sleeping on my side or if on my stomach, with my feet hanging over the end of the bed (not great for your back though). I would think that wearing high tops would also help if you are a back sleeper - they used to do that in the hospital to prevent foot drop. Now, if I get a flair, I can eliminate it by just sleeping appropriately for a few days.

Also - my ex-brother in law was a foot surgeon dude (a podiatrist? a surgical podiatrist? what?) and also owns a shoe store. He won't sell those MBT shoes because he says they are so bad for the feet. Don't know anything else about them.

Hope you feel better soon.
If you are going to doubt something, doubt your limits.
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Re: Heel tendinitis

Postby Melodycl » Wed Jan 27, 2010 2:46 pm

Thanks for the responses and great conversation. It is achilles tendinitis - it is clearly the tendon going up the back of my heel . Actually the MBTs are the most comfortable shoe for me as I can wear them all day without issues. The second most comfortable is bare feet. I have the issues when I wear other shoes. I do have a fitted orthotic for my shoes - it helps a little but not much.

I made an MD appoint for next week - as I have to start standing again tomorrow :-(

I tried the NSAIDS for two weeks and I am thinking cortisone will do the trick - I hesitate to take steroids as I have auto immune and I don't want to upset what little balance I have. I am planning to discuss this with the doc.

My teaching style to is talk from the back of the room (on my feet) and to walk around and between the rows - it helps prevent students from using their computers for non-class work in class and helps the back row feel like they are as important as the front row. Sitting will be very hard for me - and will disrupt my flow. Hopefully it won't come to that. :?

It sounds like I might have to make some changes though in order to heal my heel {sigh} I'll let you know how it goes after I visit the MD.

Thanks again for the discussion - great information!
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Re: Heel tendinitis

Postby momof4 » Wed Jan 27, 2010 4:28 pm

Make sure you're well-informed of the side effects of cortisone injections. I had several on my foot where I have a small broken bone, and later read that they can weaken the area (I'm not sure if I'm saying that correctly--something to do with making the area more brittle, maybe?). Also, my understanding is that it's not a cure--in my situation, once the shots wore off, the pain returned.

By chance have you looked into ChiRunning/Walking? This emphasizes taking smaller steps when you walk, and not landing hard on your heel. The two times I experienced achilles tendonitis were: at an ROTC summer camp, where we (females) had to take huge steps (thus, landing hard on our heels) to "stay in step" with the guys, and many of us got injured; and when I decided one day that I needed to land on my heels more when I ran, like other runners I saw--the next day my achilles tendon was extremely sore!

Here's a short clip from youtube about it: http://www.youtube.com/watch?v=w8egf6aXgH0
Around 4 min is where he discusses walking, but the whole video is good.
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Re: Heel tendinitis

Postby Lani Muelrath » Wed Jan 27, 2010 9:50 pm

Momof4,

As a teacher since forever believe me I know all about the need to move around during presentation! Not only due to the "power of circulation", but because it is just more fun and helps you communicate better. Not to mention those errant laptops!

Glad the MBTs feel good. They will probably heal fine over time, it will just take much more time with being continually active on them. As long as you are not giving new injury. Was there a trauma that caused this in the first place of which you are aware?

Lani
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Re: Heel tendinitis

Postby JayGrains » Wed Feb 03, 2010 11:38 pm

Wow I have had this and I didnt know there was a name for it or even that it was a major problem. I work long hours at times (12-15 hours some days) and am on my feet on concrete floors. I used to find it hard to walk in the mornings but it gets better after a few hours. My problem is the tendon in the bottom of my foot. I dont have much trouble with it lately though. I have found arch support and soft shoe inserts help as well as exercise. I have cured this at times by using a stairmaster machine at the gym I used to go to. I do not exercise any more but Ive been on the McD diet for about 2 years and I cant prove it but I think it has helped. I am also flat footed which doesnt help. I dont know if this helps you at all but reading this post has actually helped me. Now my problem is my back and or neck will cramp and be very painful when I work these kinds of hours. Yoga helps but I almost never do it. When you work the kinds of hours we do its hard to fit in exercise. I know lame excuse. Im trying to change.
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Re: Heel tendinitis

Postby Melodycl » Wed Feb 10, 2010 11:43 am

Thanks again for the great discussion and suggestions.

Here's my update:
I went to the MD and the MD I got (mine had left the practice) is very wholistic and doesn't like to give meds if he can impact the cause doing secondary prevention so to speak. Ordinarily I like that - but that day I was in a lot of pain and just wanted steroids. He told me that my core was weak (I knew that) - and aging causes a decreased in collagen and that can impact the fluidity and function of our tendons (I knew that) - and that being overweight puts a strain on the feet (I knew that too). I knew all of this - but didn't want to hear it. All I heard was "your old and fat." He suggested I join a gym and walk with full body movements in 4 ft deep water and do abd crunches in bed before I get up - and by putting a towel under my knees - stretch my foot up to 90 degrees when I crunch to stretch the tendon.

Here's my response: There is no way I can do abd crunches before getting up to pee in the AM. :oops: But I can stretch out my tendon and message my heel to aid in the warm up and stretching. I can do T-tapp exercises to improve abs and overall muscle tone and lose inches (ultimately wt). I am not joining a gym to walk in water - at this time I cannot add anything to my life - especially adding in travel time. I am walking with T-tapp on the video a couple times of week and when the weather gets better may try walking in my own pool (but it is cold and raining in SoCal so that will have to wait). I can change shoes during the day to alter the way my foot and tendon respond. I alternate with my MBTs and my cross trainers INew Balance) with an orthotic that has a good arch support (from the walking store).

Here's what I think: I think he's right. I am aging, I do have underdeveloped muscle tone (core and elsewhere), and I do carry extra pounds. I can alter this with a plan that works with my lifestyle and body. I have felt an improvement in my AT since doing T-tapp (getting my arch up and putting weight on the outside of my foot) - and doing the tendon stretches in the AM. And I am improving my core strength with this same exercise regime. So . . . I think I am recovering and I didn't need steroids - and I am glad that I was able to put my bad attitude in check and see what I could do that essentially accomplished the same thing.

Thanks again everyone!
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Re: Heel tendinitis

Postby SactoBob » Wed Feb 10, 2010 12:19 pm

I get really irked when I hear of this type of medical "advice." I got the same advice from an orthopedic surgeon - that my heel pain was from getting old and out of shape, so get used to it - when I was in my TWENTIES. That is rubbish, but I didn't know any better and suffered for years.

The lifestyle recommended here will take care of the weight and overall health, and you will no longer feel old - you will have lots of energy and feel incredibly great.

In my case, a friend finally prevailed upon me to see a podiatrist who treated runners and specialized in foot mechanics. I couldn't believe it. After years of misery, he put a bit of felt in my shoe and I was totally cured in about 3 days. I couldn't believe that I suffered so needlessly for years, and still don't believe it. The MD was a board certified orthopedic surgeon, and I figured that he must know about this sort of injury. How wrong I was.

Well, sorry for the rant (I still think of those years I "lost" to heel pain), but if the heel pain persists, and you decide to see a podiatrist who treats such problems, the running clubs or elite shoe stores will know the podiatrists who specialize in this sort of thing.

And of course, give the McDougall program an honest try and you will find your health taking off through the roof. You don't have to accept that aging necessarily involves pain and loss of function (e.g. see my story below). Dr. McDougall tells us that we should be able to enjoy our bodies almost until the end of life, and that is my goal, which I believe is achievable.
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Re: Heel tendinitis

Postby Lani Muelrath » Wed Feb 10, 2010 4:54 pm

Melody,

Oh! You are doing T-Tapp! What did you end up getting and how is it going?

Lani
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Re: Heel tendinitis

Postby Jan Tz » Sun Feb 14, 2010 7:18 am

I have plantar faciitis, too, from spending a lot of time over the years both walking on cement and standing on cement floors, usually in cheap over-worked sneakers.

To ease the pain, I have switched to New Balance shoes and also do a stretch program. Full body stretch, plus extra emphasis on legs and feet. Anything that stretches the bottom of your foot will give relief.

I like the book, "Stretching" by Bob Anderson.
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Re: Heel tendinitis

Postby Lani Muelrath » Wed Feb 17, 2010 10:34 am

Jantz,

Sounds like success! It may help others to know why you switched to New Balance - when you get a chance to share!

Lani
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