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The Running Doc on Achilles bursitis

Dr Lewis Maharam


Monday, December 14, 2015, 6:00 AM

Our Running Doc explains how bursitis can commonly be misdiagnosed as Achilles tendinitis.Debbie Egan-Chin/New York Daily News

Dear Running Doc:

I just returned from the Rock ‘n’ Roll San Antonio Marathon event. We had thousands of participants and just perfect weather. I had a great time. I have been treated for Achilles tendinitis by my sports medicine physician with full-length orthotics, calf stretching, and physical therapy, none of which have helped. Is my physician missing something?

Jesse R, Prescott, AZ

I get a lot of questions about problems in the Achilles area that don’t respond to traditional treatment. What Jesse had was something called retrocalcaneal bursitis — a commonly missed diagnosis that mimics Achilles tendinitis.

Immediately in front of the Achilles tendon’s insertion into the heel bone is a bursa, or fluid-filled sac, whose primary purpose is to permit smooth gliding of the tendon over the bone. This bursa can become inflamed due to either excessive pronation (inward roll of the foot) that is not properly controlled by an orthotic, or to friction caused by the heel of a constrictive running shoe. The resulting pain is very similar to that of Achilles tendinitis. This condition tends to fool physicians unfamiliar with treating runners, but the diagnosis is simple for those who know what to look for, and requires no expensive testing.

Treatment for this condition is fairly straightforward: Proper-fitting shoes and full-length, flexible orthotics are essential as a first step. Next, physicians often recommend physical therapy, stretching, and anti-inflammatories. Tough cases that go on for six months or longer usually need stronger anti-inflammatories, longer therapy and sometimes an injection of PRP. Not cortisone because it would then make the tendon weaker and more likely to rupture in the future. I have seen one case that did not respond to the above treatments and required surgery to cut away the inflamed bursa.

Jesse flew to see me in NYC. Luckily, such measures are rarely necessary and Jesse just had hard orthotics that ended midfoot. I injected Jesse with PRP since she came on Friday, and suggested she wear a pair of custom full length orthotics. One week later she was pain free.

If you have this problem and it’s taken care of early, you should soon be running pain free.

Enjoy the ride!

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Lewis G. Maharam, MD, FACSM is one of the world’s most extensively credentialed and well-known sports health experts. Better known as Running Doc™, Maharam is author of Running Doc’s Guide to Healthy Running and past medical director of the NYC Marathon and Rock ‘n’ Roll Marathon series. He is Medical Director of the Leukemia & Lymphoma Society’s Team in Training program. He is also past president of the New York Chapter of the American College of Sports Medicine. Learn more at runningdoc.com.

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