An earlier version was Published in the Fortress Alpine Ski Team newsletter
An earlier version was Published in the Fortress Alpine Ski Team newsletter
Our adventure into heel spur growth began last year when our son was 12, and skiing every moment he could. There was a two week period where they were racing 3 days each week and adding training on top. Everyone was exhausted—too much tuning, being cold, sore muscles and general fatigue. At the end of this, “Manchild” pulled his socks off to show his coach his sore heels and, “ voila”, he had large growths on the back of both heels, just outside of the centre line. They were over a cm deep, large enough to name, angry red and very sore.
So what happened, what is it, how can you prevent it and what can you do about it? Depending on the location on your foot, these bumps can mean different things. The ones at the back of the heel, like my son Robert’s little friends, are at the insertion of the Achilles tendon and the bone.
Here is the sum of my meager knowledge. The boot fitting community is, to a large extent, sure that the growth is due to poor boot fit. This is usually because they are too tight, but they also might be too loose. The latter can cause your foot to bang against the back of the boot. Good fitters can find the sensitive site and grind a pocket or blow the boot out to relieve the pressure. But hold on—is this all there is?
I dug more into the literature and pestered my colleagues at the University of Calgary. Their input is unofficial—in that I nabbed them by email or in the halls, and launched into my characteristic gambit “This is really interesting what do you think?” You see, I don’t totally agree with the bootfitters. If it was just mechanical, why was there no other bruising? If something is growing, the body has to also grow new blood vessels to feed the bump, and that usually involves inflammation. If the tendon is inflamed, can the bump also be caused by Achilles tendon injury?
Dr. Benno Nigg is the Director of the Human Performance Laboratory at the University of Calgary. He is also a good neighbor, although he feeds the deer– much to the consternation of the gardeners in the neighborhood. He has worked with Nike and Adidas on high performance shoe design, and has had contracts with the national ski team concerning boot fitting. Benno thought the tendon injury theory had some merit, and thought that pre-exercise active stretching of the tendon may help a lot to prevent further injury. What the heck, good stretching won’t usually hurt so it’s worth a try.
Dr. Preston Wiley is a sports medicine physician in interested in “overuse injuries” in the Roger Jackson Sports Medicine centre at the UofC. He had a PhD student working on reducing pain associated with the bone spur. When I told him Robert was 12 when it happened he exclaimed—“Sever’s disease, it’s relatively common when boys are 12 and girls are 11”. http://kidshealth.org/parent/medical/bones/severs_disease.html# .
Sever’s disease is an acute injury to the growth plate at the site of insertion of the Achilles tendon. It comes on quickly, it will generate a bump, and the pain will go away in 1-2 years as the site heals up. Older athletes get bumps in the same area, but these are called “pump bumps” which alludes to the fact that ladies in high heels get them too. This is more what the boot fitters are thinking of, in that it’s caused by a combination of tension on the tendon and rubbing of the insertion. So the bump might be from rubbing, but keep in mind it may be a growth plate injury, and in part it relates to tendon injury. Also, it isn’t usually bone. It’s usually scarring of the tendon.
So, the bump can be caused by more than one thing. I suggest that f there is acute pain when you are young, try to see a sports medicine physician. The standard pump bump is only alleviated by VERY active icing after your sport and reducing the rubbing. Get on the problem early and fast. Working through the pain in this case will only cause you more problems. Work on the boot fitting. Once the bump hardens and calcifies, there may not be much you can do about it. From our experience, naming them at least makes it more fun to have them.
