My poor beloved Red Sox. Don’t tell anyone, but my Boston roots once again betray me and I must confess my true baseball allegiance as a member of the Red Sox nation. By this time, I’m more than accustomed to disappointment, and yes, I will continue to forever live in 2004 and 2007. So while it’s a bit of a drag to hear David Ortiz is out with a heel injury, it’s also an opportunity to talk about the heel a bit more.
This is not a new topic for this blog – we’ve discussed plantar fasciitis and Achilles tendonitis, two common heel conditions that I see daily in my NYC podiatry office. Papi’s injury is a little more unique, and apparently more ambiguous. Plantar fasciitis (heel pain) is almost always painful for the first few steps in the morning and Achilles tendonitis presents a pain in- you guessed it – the Achilles tendon. Both conditions are detectable by MRI, so it can be a bit confounding to sustain a heel injury that is not readily apparent on MRI. This is one of those times when we doctors have to diagnose the old fashioned way – using our brains. And barring a ligament or tendon tear, plantar fasciitis, Achilles tendonitis, or fracture of the heel bone, the most likely diagnosis, by process of elimination, is bursitis.
So what is bursitis?
Let’s start with defining normal anatomy. A bursa is a fluid-filled sac found in many joints in the body, the purpose of which is to cushion the bones and soft tissues. Some areas of the body, such as the bottom and back of the heel, have a few bursae. In cases of trauma, either blunt, or repetitive, the bursa itself becomes irritated and inflamed, and that condition is termed bursitis. The treatment is essentially the same as any other type of inflammation, namely rest, anti-inflammatory medicine, and time. In refractory cases, an injection of cortisone will safely and effectively accelerate the healing process. But as I’ve said before, the body wants to heal; we just have to enable it to do so. If you are having any kind of heel pain, it’s always better to have it evaluated in the office where it can be seen on X-ray, or diagnostic ultrasound.
And to all my fellow Red Sox fans hiding out in Yankee country, don’t worry, Big Papi will be back, and this will heal. There will also be victories in our future, and likely disappointment too. Ah, to be in 2007 again.
See you in the office.
Dr. Ernest Isaacson