DEAR DR. DONOHUE: I have Achilles tendonitis. I also have a bump on my heel. Both hurt. I have had many kinds of therapy, including ultrasound, but nothing has worked.

Any recommendations you have would be greatly appreciated. I am not interested in surgery. – V.K.

ANSWER: Although the Achilles tendon (heel cord) is the body’s strongest and thickest tendon, it gives grief to many people, athletes and nonathletes alike. Tendons attach muscles to bone. When the muscles contract, the bones move.

The Achilles tendon connects the calf muscles to the heel. When the calf muscles contract, the foot bends downward to lift the body and push it forward. It’s involved with every step we take. Overuse inflames the tendon and causes pain, swelling and warmth. The pain worsens with activity. Rest eases the pain but leaves the tendon stiff so that the first step taken is quite painful.

Tight calf muscles, shoes with little cushioning, a misaligned foot and too little rest with too much use contribute to inflammation of this tendon. In addition, the tendon doesn’t have a great blood supply, so healing takes a long time. The part of the tendon that receives the least amount of blood is 1 to 2 inches above the heel, and that’s the area that’s usually involved and usually most painful.

Rest is the most important aspect of treatment. Rest doesn’t mean complete inactivity. It means cutting back on walking and eliminating running if you’re a runner. Two weeks of anti-inflammatory medicines – Aleve, Motrin, Advil — can help. A heel lift inserted in the shoe also rests the tendon. You can find such lifts at all drugstores.

How long has this been going on? If it’s been longer than three months, you need to see an orthopedic surgeon. You might need a cast, and you shouldn’t dismiss surgical correction as a possibility.

The bump could be something else. It could be an overgrowth of bone, which comes from shoes with a very stiff heel counter (the back of the shoe). A change of shoes, padded heels and a heel lift often can take care of this problem. Or it could be bursitis. There are two heel bursa that reduce tendon friction. They, too, can become inflamed. A cortisone injection often relieves this trouble.

DEAR DR. DONOHUE: My teen wears flip-flops all day, every day. We live in a fairly warm climate, and he wears them even during the winter months. I don’t think this is good for his feet. Do you have any information on this? – W.M.

ANSWER: I don’t think flip-flop manufacturers intended them to be substitutes for shoes. They’re for the shower room, beach and a couple of other similar places.

Researchers at Auburn University have examined flip-flop use and have found that constant wearing of them can present potential problems. The foot instinctively adapts to flip-flops to keep them on the feet. Users unconsciously take shorter steps, and their feet strike the ground at a slightly different angle than shoe wearers. When flip-flop users go back to wearing shoes, these foot mechanics persist and cause foot discomfort. Flip-flops provide no arch support and very little cushioning.

DEAR DR. DONOHUE: I started bodybuilding at the age of 18, and it was my passion. In 2005, I had to stop because of pain in my hands and wrists while performing the bench press. I tried holding the bar with the heel of my hand, but it didn’t do much for the pain. Wraps don’t work.

If I use a weight that I can lift 12 times, but lift only six times, rest 20 seconds and then do another six, would that fix the problem? – M.R.

ANSWER: You need to have a hands-on exam by a doctor to find out what the exact problem is.

You can do any exercise that doesn’t hurt. If it hurts, stop. Your six lifts with a 20-second rest and then another six lifts is OK if you have no pain. I’d increase the rest period to a full one minute or two minutes.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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