So I think it happened a day or two after a hard run. But for over a month and a half now, I have had a pretty sharp pain on the back of my heel that is tender to the touch, and I have to walk gingerly first thing in the morning.

Even at it's worst, the pain usually goes away about 10 min into a run, especially if not on pavement. I took about a month off and it felt like everythig had heeled up. I went for a 25 min light to moderate run yesterday and everything was great. Then I wake up with the heel pain and limp early in the morning again.

I was just curious if anyone has suffered the same injury, and if so, what type of therapy or treatments you recommend. I am trying to avoid seeing an ortho, but afraid I may have to if I want this to go away completely.

Long story short, I can manage, but I just don't want to be doing any permanent damage.

In my amateur medical opinion, it sounds like plantar fasciitis.

TurboVelo said:

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In my amateur medical opinion, it sounds like plantar fasciitis.

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Thanks, that's what first came to mind for me as well but I think that is more on the bottom of the foot. This is really more on the back of my foot, like in between my heel and achilles...about where the "achilles tendon insertion" sport is depicted in the below image...which does not seem good.

I had/have the exact thing and thought I had heel spurs or something. Went to the ortho and it was plantar fasciitis. The best treatment is rest, but if you're like me, you're stubborn.

Treatment prescribed is calf stretches 10-20 times per day 15-20 seconds per stretch. Sounds like a lot, but it's actually pretty easy to sneak it in here and there. I'll try to dig up a copy of the handout he gave me and post in a bit. Also said to walk barefoot as little as possible and recommended a pair of recovery sandals. I bought Hoka Oras and wear them pretty much all the time around the house. I also switched my running/walking shoes to Hoka Bondis with Dr Scholl's plantar fasciitis inserts.

It's been 3 or 4 months since I saw the doc and there's still discomfort, but not searing pain especially when I get out of bed in the morning. Good luck!

https://ibb.co/Kzm9khf5
(Edited to add link to stretches ^)

512Ag said:

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I had/have the exact thing and thought I had heel spurs or something. Went to the ortho and it was plantar fasciitis. The best treatment is rest, but if you're like me, you're stubborn.

Treatment prescribed is calf stretches 10-20 times per day 15-20 seconds per stretch. Sounds like a lot, but it's actually pretty easy to sneak it in here and there. I'll try to dig up a copy of the handout he gave me and post in a bit. Also said to walk barefoot as little as possible and recommended a pair of recovery sandals. I bought Hoka Oras and wear them pretty much all the time around the house. I also switched my running/walking shoes to Hoka Bondis with Dr Scholl's plantar fasciitis inserts.

It's been 3 or 4 months since I saw the doc and there's still discomfort, but not searing pain especially when I get out of bed in the morning. Good luck!

https://ibb.co/Kzm9khf5
(Edited to add link to stretches ^)

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This is great, thanks! So I guess plantar fasciitis can creep up to the back of the foot just above the heel? Or was yours on the bottom of foot?

I had some mild pain in the underside of my foot, but the heel pain is what sent me to the doc.

512Ag said:

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I had some mild pain in the underside of my foot, but the heel pain is what sent me to the doc.

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Cool thanks, and good tip above on avoiding barefoot. I may start sleeping with crocs next to the bed at least. Damn my high arches and stiff calves.

Sounds like insertional Achilles tendinopathy to me.

The tendon needs the right kind of load to actually remodel and repair, and complete rest doesn't provide that.

Start with isometric holds in a heel-raised position and build systematically from there.

No eccentrics (heel drops) and no aggressive calf stretching. Dorsiflexion compresses the tendon against the heel bone and can make things worse.

A heel lift in your everyday shoes will help reduce compression at the insertion while things are still pissed off.

I suggest you stop running until you've built some actual capacity back into that tendon.

aggiederelict will have plenty more to offer.

I'm struggling with a similar pain right now, and I am also confused as to what it is (achilles or something else).

Is your pain worse when you are barefoot? Or when you first wake up in the morning or get up from sitting for a while?

Does the area on your heel feel bruised or tender to the touch?

I'm going on a big hiking trip in August, and I'm worried about it bothering me and possibly getting worse. Not sure if I need inserts or what.

AggieLAX said:

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Sounds like insertional Achilles tendinopathy to me.

The tendon needs the right kind of load to actually remodel and repair, and complete rest doesn't provide that.

Start with isometric holds in a heel-raised position and build systematically from there.

No eccentrics (heel drops) and no aggressive calf stretching. Dorsiflexion compresses the tendon against the heel bone and can make things worse.

A heel lift in your everyday shoes will help reduce compression at the insertion while things are still pissed off.

I suggest you stop running until you've built some actual capacity back into that tendon.

aggiederelict will have plenty more to offer.

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Agree. Except I might do eccentrics. The Alfredson protocol for eccentric loading the achilles tendon was like the original protocol for tendonitis/tendinopathy.

But maybe that doesn't work so well for insertional?

I had something similar last summer, did isometrics, eccentrics, and stiff legged jumps (almost like jump roping without a jump rope), and it eventually went away. But takes forever.

bigtruckguy3500 said:

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The Alfredson protocol for eccentric loading the achilles tendon was like the original protocol for tendonitis/tendinopathy.

But maybe that doesn't work so well for insertional?

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You're right that Alfredson's eccentric protocol was the gold standard for a long time and still has solid evidence behind it; particularly for midportion Achilles tendinopathy.

For insertional, the current thinking has shifted toward starting with isometric holds in a heel-raised position to modulate pain and begin loading without compression, progressing to heavy slow resistance work, and only introducing eccentric work later in rehabilitation.

AggieLAX said:

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No eccentrics (heel drops) and no aggressive calf stretching. Dorsiflexion compresses the tendon against the heel bone and can make things worse.

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Thanks for all of the great info...I think this is what made it worse than any run tbh. I have large/high calves and have always done heel drop stretches before run, but began doing them more aggressively in recent months...and even moreso when the heel pain started, thinking it would help, and I think it made it significantly worse.

TXTransplant said:

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I'm struggling with a similar pain right now, and I am also confused as to what it is (achilles or something else).

Is your pain worse when you are barefoot? Or when you first wake up in the morning or get up from sitting for a while?

Does the area on your heel feel bruised or tender to the touch?

I'm going on a big hiking trip in August, and I'm worried about it bothering me and possibly getting worse. Not sure if I need inserts or what.

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Yes to both questions...I can squeeze the sides of the back of my heel and it feels pretty tender to the touch. And if I have been sitting at my desk for a while, or the dinner table/couch, and get up quickly, I end up limping for a few steps because it's sore again. Definitely most sore in the morning...and worse when barefoot.

I have pretty aggressive high arches and am thinking this may just be part of that curse. Ironically, it does feel better after the run I went on two days ago...and a walk last night, but I may lay off of running for a bit longer, do what AggieLAX above recommended and maybe just stick to nightly walks in addition to those stretches. Walking definitely helps the pain go away at least.

Thanks for the reply. I posted on the ask a PT thread a few days ago, and the guy there said to email him. He just got back to me and he thinks it's insertion Achilles tendopathy, too.

I don't run. Haven't for years. But I lift heavy weights. He asked me if I've injured my ankle, and I've rolled both in the last 2 years. One side is having more pain than the other, but I'm having the same symptoms in both feet.

I only have pain when walking, though. Pain varies depending on what shoes I'm wearing, or if I'm barefoot. No pain at all when lifting weights. I get relief when my heels are slightly elevated.

I also have very high arches.

I just found this article. Don't know how reputable it is, since the site does sell different devices, but the diagrams and descriptions of the problem made sense to me. It offers some alternative exercises that it says are more effective for this specific issue.

https://www.humanlocomotion.com/the-ideal-exercises-for-managing-insertional-achilles-injuries/

TXTransplant said:

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Thanks for the reply. I posted on the ask a PT thread a few days ago, and the guy there said to email him. He just got back to me and he thinks it's insertion Achilles tendopathy, too.

I don't run. Haven't for years. But I lift heavy weights. He asked me if I've injured my ankle, and I've rolled both in the last 2 years. One side is having more pain than the other, but I'm having the same symptoms in both feet.

I only have pain when walking, though. Pain varies depending on what shoes I'm wearing, or if I'm barefoot. No pain at all when lifting weights. I get relief when my heels are slightly elevated.

I also have very high arches.

I just found this article. Don't know how reputable it is, since the site does sell different devices, but the diagrams and descriptions of the problem made sense to me. It offers some alternative exercises that it says are more effective for this specific issue.

https://www.humanlocomotion.com/the-ideal-exercises-for-managing-insertional-achilles-injuries/

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It's pretty frustrating. Looking back, I have definitely had bouts of this in both feet (luckily never at the same time), dating back over a decade. Probably 2-3 times in my life. I never really thought anything of it and just kind of powered through and eventually it just went away.

I'm a little more nervous to take that approach at 45 though. One time I am pretty sure doing squats at the gym cleared it up. I had been suffering with back heel soreness in my left foot and I remember noticing no pain when leaving the gym. And it literally never came back in that foot. Maybe it was the heel raising, or just the general leg movements stretching certain tendons, or maybe I falseley attributed it to squats and it was just coincidence. Tempted to go to the gym and try it again.

Aging sucks

512Ag said:

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I had/have the exact thing and thought I had heel spurs or something. Went to the ortho and it was plantar fasciitis. The best treatment is rest, but if you're like me, you're stubborn.

Treatment prescribed is calf stretches 10-20 times per day 15-20 seconds per stretch. Sounds like a lot, but it's actually pretty easy to sneak it in here and there. I'll try to dig up a copy of the handout he gave me and post in a bit. Also said to walk barefoot as little as possible and recommended a pair of recovery sandals. I bought Hoka Oras and wear them pretty much all the time around the house. I also switched my running/walking shoes to Hoka Bondis with Dr Scholl's plantar fasciitis inserts.

It's been 3 or 4 months since I saw the doc and there's still discomfort, but not searing pain especially when I get out of bed in the morning. Good luck!

https://ibb.co/Kzm9khf5
(Edited to add link to stretches ^)

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I actually had the exact opposite happen to me. I have the pain right where OP described. Thought it was plantar fasciitis but xray revealed a heel spur that looks like it's right under a nerve. I just use NSAID cream about an hour before a run.

If that's what it is, plantar fasciitis comes on quickly and heals slowly. Treat the inflammation with ice, stretching, tennis ball, boot to keep your foot extended while sleeping if you can stand it, and especially a giant needle cortisone shot. That will do the trick…after a month or so.

This is a good video about tendinopathy and tendon rehab. I haven't watched the whole thing yet. But so far seems good.

Also, something to look into is shockwave therapy. I had a PT do it on my shoulder when I was overseas and it was quite painful to endure, but by the next day I felt significantly better. I'm seeing it advertised more frequently locally where I'm at by PT clinics and chiropracters. As long as they know how to use it, I think it's worth trying if symptoms are not getting better.

I've been doing the two exercises in that link I posted for the past 3 days, and there is a marked difference in my pain and stiffness. Pain isn't gone entirely, but it is so much less severe, even when I first wake up and when walking barefoot.

Went on a walk today wearing my hiking shoes, and I had very little pain. Also a huge improvement. It also feels like my heel is elevated in my hiking shoes, so I think that bodes well for being comfortable on my trip.

I will say, the exercises are uncomfortable/fatiguing on my calves, particularly the outer edge running vertically down my calves. But so far they seem to be helping, and I plan on keeping it up.