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The response to the question below was authored by Marc Mitnick DPM

Heel pain underneath heel and back of heel

by Elizabeth
(Colorado Springs, CO)

Dr.

I read your article on bursitis, and your description of discomfort when sleeping on my back with the back of heel on the mattress, as well as the edema of my heel on the bottom seems very much like your description of bursal sacs filled with fluid. My question is: What tests do you use to determine the placement of the filled sac (X-ray, MRI?)so that when you want to drain it, you know; first of all if there is a sac that is filled or 2) exactly where it is located so you know where to find it in order to drain it.

Background: Because of a shot of cortisone for a morton's neuroma my foot reacted very negatively and I began walking on my heel, waiting for the ball of my foot to recover. The heel became so swollen and tender that I couldn't touch it. I was on a crutch for a long time. I have now had an orthotic, which enabled me to get off the crutch. But the bottom of my heel remains edemitous and tender if I walk without the orthotic that has a large indentation where my heel sits, so pressure is taken off of it. I think the bursal sac is filled with fluid and want my podiatrist to check further into what exactly is going on in the area. That's why I'm wondering what methods you use to identify the sac...if it is filled, and the method you use to drain it.....laser? Please tell me what you can about all of this.

Thank you very much
Elizabeth

Hi Elizabeth,
An MRI may show a bursal sac or bursitis. I am a little concerned about the amount of edema you are having in the heel as a bursal sac will cause a distinct isolated area of swelling. Having said that, you generally do not see that kind of swelling on the bottom of the heel as that area has a lot of fat and thick skin.
If you are having a lot of pain in the heel your doctor needs to evaluate the amount of edema present and determine if it is not coming from another source, as perhaps a fracture of the heel bone (as an example).
Most of the patients I see where I determine may have a heel bursitis generally do not show swelling or redness; the diagnosis is usually made on clinical grounds, eg: the heel hurts more, the patient walks.
Marc Mitnick DPM

Comments for Heel pain underneath heel and back of heel

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Feb 05, 2011
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Laser check
by: Anonymous

Elizabeth--
You totally rock. I will certainly check into the laser option. After all, they (lasers) can be used for some fantastic things on the medical front these days.
Best to you, to.
----Fiona

Feb 05, 2011
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Laser
by: Anonymous

Fiona: I have also read that some "pain" lasers can help. Something else to check into.

Best to you
Elizabeth

Feb 05, 2011
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Thank you Elizabeth!
by: Anonymous

Hi Elizabeth (and the good doctor who has been in on this, too) ... Deeply appreciate your words. I will take your encouragement to heart. Knowing that you are managing somehow does help, so thank you again. I'll continue with the protective horseshoe and sensible foot-wear until I can get a physician to try to figure it out. I"m afraid they'll just say -- oh, you've been running too much, and you'll "just" have to cut back. That is my worry. I can't cut back that much; I depend on running. If there's structural damage, then hopefully it can be pinpointed and my doc and I can actually get rid of the cause of pain. It's such an awful problem, foot pain! Any pain is, of course. :)
Thx for the recommendations about dress shoes.
Best, Fiona

Feb 03, 2011
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MRI results
by: Elizabeth

Fiona:

Sorry to hear about your foot problem as well. I don't feel any crackling as you describe. I did have an MRI. It showed some edema in the problem heel, but was not diagnosed as bursitis (as my doctor had done). I continue to wear orthotics and may I suggest SAS shoes for more dressy wear. I can wear them without an orthotic because of their comfortable design. I have just tried to make the best of this because there seems to be no answer. I hope you are able to find more answers for your particular case.

All the best to you in your healing process.

Feb 03, 2011
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I have EXACT same heel pains as Elizabeth
by: Fiona

I was reading Elizabeth's descriptions and practically weeping with sympathy, as I have been battling those two heel-pain location for months. Mostly underneath the heel, but also just above the heel at the back. The entire rear heel-area gets swollen, warm and red. If I try to land normally on the heel, I can actually hear stuff inthere crackling. It's upsetting and painful. I, too, have to wear little horseshoes under the heels (only one heel is painful, but I place one under the other heel for balance), but even then the heel hurts. Bursitis? Fracture? I'm at my wits end on this. I can't get an MRI for three months (that's when health insurance finally kicks in). Can ANYONE help me in the meantime?

Aug 02, 2010
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Response to dr. answer--more info
by: Elizabeth

Thank you for your response. I would like to give you further information.

My doctor said that I basically have very little fat pad on my heels (on both of them..although only the injured one is causing pain. The injured foot has been xrayed--there is not other problem observed to be the cause of the edema. My doctor has diagnosed calcaneal bursitis. It is absolutely the case that the more I walk on my foot (heel) the more sore it becomes. Currently, I have been given orthotics designed so there is very little pressure on the injured heel. That has enabled me to stay off of the crutch that was necessary before the orthotics.

Isn't it possible that two bursal sacs are filled with fluid....one on the bottom and one on the back of my heel and that both would need to be drained? I will be having an MRI to, hopefully, tell the condition of the sacs. Also, please tell me the process you use to drain them....if this turns out to be the case...laser or what method?

Thank you so much for your patience in answering a second time.

Elizabeth

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ADDITIONAL REFERENCES

Mayo Clinic

Johns Hopkins Medicine

MedlinePlus

Arthritis Foundation

University of Rochester Medical Center

Harvard Health

Drugs.com

American Academy of Pediatrics

Penn State Medical Center

National Institutes of Health

Columbia University Department of Rehabilitation

ScienceDirect

Stanford Health Care

Illinois Bone and Joint Institute

Mount Sinai Hospital

Institute for Chronic Pain

University of Florida Health

American Family Physician

Cedars-Sinai

University of Maryland Medical Center

MY PRODUCT RECOMMENDATIONS(items I prescribe in the office)

Orthotics for multiple types of foot pain best buy in a pre-made orthotic click link below

Orthotics for heel and arch pain for those who must wear dress shoes click link below

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Unknown location

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Arizona

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San Clemente, CA

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location unknown

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Dr. Mitnick, Thank you, you were 100% correct. The pain finally brought me to the ER. I spent 8 days in the hospital. The Doppler you spoke of was able to show that there was no pulse in that foot. This was an arterial clot that split and traveled throughout my leg. My leg was almost amputated. I am in rough shape but have all my parts intact!! You certainly know what you are talking about. Thank you for taking the time to answer. Yours Truly!

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location unknown

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New Jersey

Thanks so much for answering my question. You've been more help to me than my own Dr. has been lately. Thanks again....I hope to be able to walk without pain someday.

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location unknown

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Evansville, IA

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San Diego, CA

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Whichita, KS

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Boston, MA

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Colorado

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Colorado

Wonderful advice

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This is the best site for foot problem info.

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location unknown

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Canada

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Wisconsin

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North Carolina

Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...

KG

location unknown

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Bessie Mae

Florida

Dear Dr. Mitnick, Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,

Lynne T.

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New Jersey

Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.

a mom

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Lenoir, NC

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Bellevue, WA

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Jodi

location unknown

Heel pain underneath heel and back of heel

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