Creaky heel: Need to worry?

author : AMSSM

comments : 0

Member Question:

"Not too long ago, I  had a bunion removal on my right foot.The doctor says it's fine to walk on it and stuff now, so here it is July and I'm now working out mildly and stuff (mainly upper body and walking around outside). Recently I'm feeling this pain in my left foot. It feels like a creaking or stretching of (I think) a tendon. I'd say its a few inches above the heel. I'm not sure if it's tendonitis, or something else similar. I think it's mainly from me being on bedrest for months, not excercising one bit until now, but it's really bothering me. Only when I bend or move my ankle, do I feel it. My girlfriend says it's nothing to worry about and laughs but I'd rather hear from others first. Not sure if height or weight may be a factor or not but I'm 6'5" weighing about 190. My weight goal is 210. I'm 23 years old.

Answer from Jeremy Wells, MD
Member AMSSM 

Heel pain can be a nagging and frustrating symptom. There can be many causes. Location and worsening factors are keys to diagnosis. Based on your description, you are correct in attributing symptoms to the tendon.

A large tendon, the Achilles, and a smaller tendon, the plantaris, are located at the posterior heel. There are several other tendons at the ankle but these are directly behind the bony prominences and don’t seem to be the cause of your symptoms. A majority of posterior heel pain involves the Achilles tendon. It is a large, powerful tendon – but can have its weaknesses.

There are two bursa, fluid filled sacs that provide cushion/glide to tendons, at the posterior heel. These can also be inflamed - painful, swollen, and creaking sensation. It may be hard for you to differentiate between the bursa and tendon as a cause for your pain. The good news is that treatment and recovery are very similar.

Your symptoms can be related to the period of immobility following your surgery. When a tendon is kept still or has a dramatic decrease in use, it tends to stiffen up and sometimes shorten. The actual cast, splint, or boot can also directly irritate the tendon or bursa due to constant pressure or traction. Once you return to using the tendon, discomfort and swelling can occur. Sometimes the side opposite of a surgery can become painful due to over use and dependence on that leg to stand or move around. When you walk and the move the ankle, the Achilles is being utilized heavily.

Your symptoms should steadily be improving and it is safe to return to activity. Treatment starts with a gradual return to your prior activity levels – especially running and lower leg weight lifting. You should also be utilizing cold/ice therapy when painful and over-the-counter NSAIDs (ibuprofen and naproxen) to help with inflammation and pain. A simple heel lift shoe insert can improve constant symptoms with walking. It helps to cushion the heel and shortens the distance the Achilles tendon has to move to work. Basic stretches can help improve symptoms and speed recovery.

There are some more advanced therapy movements you can consider. These are eccentric exercises and are commonly called Alfredson Protocol Exercises. More information is readily available from many resources. If you continue to be symptomatic, consider starting these.

Be mindful of warning signs that may represent worsening symptoms or a more significant injury. These include swelling, redness, warmth, weakness, and loss of motion. If symptoms worsen or continue past several weeks, you should seek the assistance of a sports medicine physician or physical therapist.

I wish you well with continued healing and hope you can fully return to pain free activity soon.

Jeremy Wells, MD
AMSSM Member
Hattiesburg Clinic Sports Medicine

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date: October 30, 2016