Is ice treatment effective for retrocalcaneal bursitis?

by Beverley
(Sussex UK)

I have suffered for 2 years from retrocalcaneal bursitis in my right foot and, more recently, the left.

I have had this diagnosed by ultrasound scan and the achilles tendon itself is healthy and intact - or it was at the time of the scan.

I have tried resting - but find this psychologically difficult to do and not necessarily effective.

I had 1 x schlerotherapy treatment with Hakan Alfredson about 18 months ago - minimally effective and very expensive (referred to here).

I have tried a small heel lift in my shoe which helps with the pain, but possibly prolongs the problem. I find that eccentric loading of the achilles tendon exaccerbates the problem, but I do benefit from massaging and stretching the calf muscles and the plantar fascia.

I am a distance runner and this problem restricts my training and performance. I can race up to half marathon distance (but will be in a lot of pain for a few days afterwards), but my last 2 marathons have been painful affairs which have left me unable to walk for a couple of days.

I can only manage 40 miles per week, and this involves running with a degree of discomfort every time. Ideally, I would like to be running 60 miles per week and running 1 or 2 marathons a year to my potential - rather than hobbling around the course.

I suppose my question is - will ice treatment be beneficial in any way other than as pain relief.

I have been following your advice for ice dipping, and the feet do seem to be less painful. Initially pain in the right (worse problem) increases! but seems to be less painful after a while.

Any other advice would be gratefully received.

Thanks in advance



Joshua Answers:

Hello Beverly.

It's been a while since you asked this question, so I'll jump right to the answers.

1. Ice Dipping effectively is primarily a pain reducer. In an of itself, it's not a cure (although it can be, depending).

2. Having said that, one of the main problems with Tendonitis, bursitis, and pain, is the pain enhancing chemical that gets released with the Process of Inflammation.

So if you don't deal with the inflammation effectively, the bursitis is likely to stay right on the edge of going bad, especially with as active as you want to be.

Thus, Ice Dipping and Ice Massage.

3. Even if you Achilles tendon is healthy, that doesn't mean everything is great. You say that massaging the calves and plantar fasciitis gives you relief. This points to that your calf muscles and connective tissue structures are TOO TIGHT and TOO SHORT.

If you calf structures are (they are) chronically too tight, then they are putting too much constant tension/pressure on the retrocalcaneal bursa, thus constantly irritating the bursa.

Rest doesn't really help because of the chronic nature of the tightness...even at rest there is too much tension on the tendon/connective tissue.

The heel lift helps because it shortens the structure and takes tension off. But as you suspect, it makes things worse, as it helps your structure get EVEN SHORTER! Which then puts more tension/pressure on the bursa with every step you take.

4. So for you:

A. More Ice Dipping, and lots of it.

B. Ice Massage on the bursa area. Gentle at first, but then push it as much as safely possible. This will take repetition.

C. Massage/Ice Massage your calf structures. Get in there and push/stetch. Make everything longer, looser, stretchier, more open. This will take repetition.

Focus on B and C, but A is just smart to do.

Also, I would get my Vitamin D level tested, and supplement with Magnesium as you are so active (and thus your muscles are tighter than they should be and pulling lots of magnesium, the lack of which helps to keep things tight).

More questions, more answers.

Please reply using the comment link below. Do not submit a new submission to answer/reply, it's too hard for me to find where it's supposed to go.

Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert

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