Big Papi Grounded With Heel Pain

David Ortiz, also known asBig Papi, the designated hitter of the Boston Red Sox, is presently sidelined with heel pain.  Heel pain should not be taken lightly.  In matter of fact, JoeDimaggio, the great centerfielder of the New York Yankees, was on the disabledlist for three months with heel pain.  The difference is that Joe D suffered from a condition called plantar fasciitis, where Ortiz has Achilles tendinitis.

Plantar fasciitis is the mostcommon cause of heel pain, but if your pain is at the back of the heel, then the usual culprit is the Achilles tendon.  The Achilles tendon is that thick tendon at the back of the ankle and attaches to the heel bone.  This tendon becomes the calf muscle.

Achilles tendinitis is verycommon especially in athletes or in people over the age of 40.  Athletes tend to torque their bodies in such a way that it puts excessive strain on the tendon.  Achilles tendinitis will also occur in people who have very high arches.  In this case, the tendon becomes shorter and tighter.  So, any strenuous activities can lead to an inflammation of this tendon.  People with very flat feet also can get Achilles tendinitis because the heel is over-pronating, meaning it is turning outward excessively, causing the arch to collapse.  This leads to the torque of the tendon, which causes the pain.

Activities that make you runon the balls of your feet are also the culprit, such as runners who run on their toes, basketball and volleyball players who are constantly jumping, and sports that require ballistic movements such as baseball and football.  The key to prevention is to make sure one always stretches before and after the activity.  Caution: Never stretch a cold muscle or joint, so always warm up first.

Another cause of heel pain at the back of the heel is a condition called retrocalcaneal bursitis.  There is a bursa (sac of fluid) between the bone and the tendon.  This structure prevents excessive friction of the tendon from the bone when it moves.  In a lot of these cases, the heel bone will be thickened in this area with a prominent “bump.”  This irritates the bursa and now you have bursitis.  The bump is also called a pump bump, because it rubs against the back of pump style shoe. 

The main treatments for these conditions are rest, ice, and a compression sleeve.  A lot of times a heel lift will be applied into both shoes to allow for the Achilles tendon to rest.  This should only be used for a very short time, because the bottom line is that you want to stretch out the tendon, and not shorten it.  Physical therapy is an extreme necessity in most cases.

If the cause of the tendinitis is biomechanical, meaning the way the foot functions during gait,then a custom orthotic is very beneficial.  If the above treatments do not help, then there are many newer treatments and technologies out there that can help.  At Family Foot & Ankle Specialists inPiscataway/Hillsborough NJ, we employ most of these treatments.

The first one is extracorporeal shock wave therapy, also known as ESWT.  This is a non-invasive procedure that is done in the office.  After the area is numbed, the ESWT machinewill send deep, penetrating sound waves into the heel.  This will break down any scar tissue that might be present as well as to increase blood flow to the area.  The patient can walk immediately and will find relieve within the next couple of months.

In addition, the K-Laser is an FDA-approved laser for the use of pain resulting from all types of tendonopathies.  The procedure is also totally non-invasive and does not require any anesthetic.  The laser is painless and takes about five minutes.  Usually 10-12 treatments are required.  At Family Foot & Ankle Specialists, we have had wonderful results using this laser for these problems. 

The key is that if Achilles tendonitis is not treated quickly, scar tissue can result, making the treatments more difficult and increasing the liklihood of a less than optimum result.  So, you should not let the problem linger for too long.  Call your local podiatrist and get back into the game.