Heel pain underneath heel and back of heel
by Elizabeth
I read your article on bursitis, and your description of discomfort when sleeping on my back with the back of heel on the mattress, as well as the edema of my heel on the bottom seems very much like your description of bursal sacs filled with fluid. My question is: What tests do you use to determine the placement of the filled sac (X-ray, MRI?)so that when you want to drain it, you know; first of all if there is a sac that is filled or 2) exactly where it is located so you know where to find it in order to drain it. Background: Because of a shot of cortisone for a morton's neuroma my foot reacted very negatively and I began walking on my heel, waiting for the ball of my foot to recover. The heel became so swollen and tender that I couldn't touch it. I was on a crutch for a long time. I have now had an orthotic, which enabled me to get off the crutch. But the bottom of my heel remains edemitous and tender if I walk without the orthotic that has a large indentation where my heel sits, so pressure is taken off of it. I think the bursal sac is filled with fluid and want my podiatrist to check further into what exactly is going on in the area. That's why I'm wondering what methods you use to identify the sac...if it is filled, and the method you use to drain it.....laser? Please tell me what you can about all of this. Thank you very much Elizabeth Hi Elizabeth, An MRI may show a bursal sac or bursitis. I am a little concerned about the amount of edema you are having in the heel as a bursal sac will cause a distinct isolated area of swelling. Having said that, you generally do not see that kind of swelling on the bottom of the heel as that area has a lot of fat and thick skin. If you are having a lot of pain in the heel your doctor needs to evaluate the amount of edema present and determine if it is not coming from another source, as perhaps a fracture of the heel bone (as an example). Most of the patients I see where I determine may have a heel bursitis generally do not show swelling or redness; the diagnosis is usually made on clinical grounds, eg: the heel hurts more, the patient walks. Marc Mitnick DPM
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