Question

I am a 42-year-old male. Over the last few days I have developed an intermittent hot flash in the back of my left calf and upper ankle. The skin feels the same temperature as the surrounding area, but I have a definite sensation of warmth for about 15 - 30 seconds. Is this symptomatic of something?

Answer

The area that is concerning you can be a trouble spot for many types of problems related to the Achilles tendon. This large tendon lies beneath the area that you describe. It sounds as if the bursa of your Achilles tendon may be inflamed, but there can be many reasons that can cause this.

The most common is an Achilles tendon bursitis, which is an irritation of the tendon as a result of different heel positions and functions. I have seen this in overweight patients where the heel tends to function in an inverted position throughout the gait cycle causing excessive pressure on the soft tissue between the posterior outside aspect of the calcaneus (the large bone that forms your heel) and the shoe counter ( the back of your shoe.) In the beginning stages you may feel some tightness and warmth in the area you describe, especially after walking.

Look at the bottom of your shoe and eyeball the bottom of the heel. If it is worn more on the outside compared to the inside this could be causing your problem. The fix is to have your shoes re-heeled. In the meantime you can buy some foam rubber heel inserts that will cushion the heel and elevate it slightly.

Another cause is if you are a "toe walker". This type of walking can put undue stress at the base of your heel and sometimes cause a fracture of the talus, another bone in the ankle joint. This can also happen after an injury such as a sprained ankle.

Another possibility is anterior Achilles tendonitis, which can be caused by any type of strain on the Achilles tendon or arthritic or systemic inflammatory diseases such as rheumatoid arthritis.

In summary, two things can be the cause of your problem. It's either inflammatory (arthritis, tendonitis) or mechanical (ill fitting shoes, walking up and down too many stairs, walking on uneven ground, etc.). Your physician can readily assess your problem with a brief examination.