I just returned from my first visit to the Sports Medicine Clinic in Seattle. While more info will be forthcoming, I do have some preliminary info to share.
We discussed my recent running history. I told him how I trained for and ran my marathon back in May, then had my first run-in with the heel pain a couple of weeks later. Then came the 3 week layoff, then back into training (for Ragnar, primarily), then a six week layoff, then very minimal running the last 4-5 weeks.
He then observed my feet as I was standing (barefoot) and noticed that my offending foot pronates quite a bit. He then remarked at how tight my right calf and achilles are, and how that is likely affecting my foot movement during foot strike.
He then took xrays of my foot (unlike the PT I saw earlier this year). I don't have them to post here, unfortunately, but upon his diagnosis, he explained—and showed me— that I have a condition called Haglund's Deformity. There's a prominent growth on the top of my right heel that's causing irritation of my achilles tendon and, possibly, the bursa. While this may not be directly related to the pain I'm also feeling in other areas of my foot, it's certainly the genesis of this injury. The excessive pronation is likely the cause of at least the other pain, if not also this deformity issue. He also said something about a possible cyst there, although I wasn't totally clear about that. He said that surgery probably won't be needed. Oh — he also said that my six week layoff would have been enough time off if it was just tendonitis (not totally sure I agree), and that the recurring nature of the injury points to a structural problem (as the x-ray showed, and to which I do agree).
I asked him if he thought tinkering with my running form could have contributed to this and he confirmed that he has seen many runners who have been injured during that process. While agreeing that working to improving one's form isn't a bad thing, he said that our bodies do settle on a natural running form based on our biomechanics and structural issues (but again, no, he doesn't think over-striding and heel-striking are good). He did comment that I'm probably not a good candidate for Vibram Five Fingers, though.
He agreed that other contributing factors could be overuse and increased hill training (which really pushed it over the top back in August).
As you might suspect, he does recommend custom orthotics. While I've been averse to this idea before, now I say bring 'em on. Fortunately, he's not a fan of what he calls "bricks" (i.e. heavy, motion-control shoes, which I used to wear) and that I should be fine continuing to wear my neutral running shoes. I'll just have a bit more support to correct my overpronation in that foot.
The next step in the process will be an MRI to take a look at the soft tissues & tendons surrounding the heel (and ankle area) to see how inflamed they are. I'm awaiting a call from their office to schedule an appointment.
Thankfully (and as I suspected) there's no sign of any stress fractures. I just have a freakish heel bone and a wonky foot movement.
So that's all I know at this point. As you'd guess, I'm done running for the time being. After the MRI, we'll discuss cross-training options, and how long it might be until I start running again.
Not running is a major bummer, but I'm happy to be working with someone who (so far) I trust.