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I am a runner -- I put in 60 to 80 miles a week and run two to three marathons each year. Lately, I've started to have some heel pain on both sides. I've tried everything I know how to get rid of this. I bought new shoes, I tried heel cups and shoe inserts. I did take two weeks off. The pain never really went away and then it got worse when I added running back in. What's the next step?
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You really need to see a physician to make the diagnosis. Any time symptoms are present bilaterally (both sides), there could be a systemic problem unrelated to your running schedule. For example, rheumatoid arthritis (which is a systemic problem affecting more than just the joints) can be the underlying problem.
In particular, Reiter's syndrome, a sexually transmitted disease can cause bilateral symptoms. Usually, with Reiter's syndrome, there is a triad of other symptoms including skin rash, kidney infection, and conjunctivitis (painful, inflammation of the eye).
There are other causes of heel pain to be investigated. Soft tissue structures such as the Achilles tendon, plantar fascia along the bottom of the foot, and even the bursa (round fluid-filled cushions between the muscles/tendons and bones) can cause heel pain when inflamed. Usually, the person experiences any one of these problems just on one side of the body, but bilateral symptoms are possible.
How can the orthopedic surgeon tell what's causing the heel pain? Location of symptoms is the first place to start. The examiner will also ask the patient what makes it better or worse, and what structures hurt when pressed or palpated. The presence of any visible changes (e.g., skin thickening, bony bump, swelling around the Achilles) will be noted. X-rays can help show areas of calcification (bone build-up from a pump bump) or bone breakdown around the area of a bone bump from chronic inflammation (bursitis).
Treatment always depends on the underlying cause of heel pain. That's why a careful diagnostic sorting process is important and an understanding of what each condition is and how it presents clinically. Imaging tests start with X-rays. MRIs may be ordered when there is suspicion of plantar fascia rupture or calcaneal fracture.
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