Q & A From Dr. P

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Ask Dr. Pribut

Q. I'm running about 5 days a week - 5-7 miles. I also do 3 hours per week of step aerobics. When I stand up or get out of bed  I have some pain in the back of my heel. Is this plantar fasciitis? What should I do about it?

Jim / Georgia

A. Many problems cause pain upon arising after being seated. The term for this is post-static dyskinesia which means pain upon moving after being still for a while. Many exercise related problems follow degrees of severity which seem to be: 1) pain after exercise, perhaps even a day or so later, 2) Pain towards the end of exercise 3) Pain before you start to exercise. In this specific case the pain at the back of the heel is not plantar fasciitis. Although the Achilles Tendon and the calf muscle tie in to the heel and can aggravate plantar fasciitis, since the plantar fascia is not located in that area the pain is not due to plantar fasciitis. Pain at this area could be insertional Achilles Tendonitis. Other problems that can occur here are a partial tear of the Achilles tendon or avulsion of some Achilles Tendon fibers from the bone, or  a Haglund's deformity, which is a bump on the back of the heel bone, usually on the lateral (outer) side. Insertional Achilles Tendonitis is sometimes worse on the medial aspect of the Achilles Tendon, when the foot over pronates.

I recommend temporarily decreasing your calf stretching exercises, wearing shoes with a small heel lift around the house rather than going barefoot, and avoiding shoes with air soles that might cause your heel to sink into it while running or exercising. I would decrease the amount of stair step exercises and running that you are doing right now also. In the long run you may need a heel lift in your exercise shoe and shoes with no air soles (heels) that might have too much shock absorption allowing your heel to sink into them excessively. Occasionally an orthotic with a heel lift is necessary to decrease rotary stresses that occur within the Achilles tendon itself or decrease some of the stress on the medial side that may occur with excess pronation as the calcaneus everts.

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© 1998 Stephen M. Pribut, D.P.M. All rights reserved. Materials copyrighted by Stephen M. Pribut may be reprinted for personal use only. Permission to reprint or electronically reproduce any document in part or in its entirety for any other reason is expressly prohibited, unless prior written consent is obtained from Dr. Pribut.