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Tuesday, September 6, 2011

Severe Heel Pain: Email Advice

 Dr Blake's Note: This nice young lady is a good sport letting me publish this. What we do to our bodies sometimes!!! I can only lie and tell you I would never do a dumb thing like this. We are all capable. I hope my comments to her are helpful.

Dear Dr. Blake:

     I am awake at 5:07 am EST due to severe generalized pain in my right heel, with touch sensitivity on the posterior/lateral aspect and a severe ache in the medial/plantar area. This has been going on for about 5-6 days now, but this is the first time I have been unable to sleep due to pain. I am currently unable to walk to the bathroom, and have had to crawl. Ouch.

     I am pretty sure this was brought on by my own blatant stupidity in pursuing a 2-day bricklaying project, in the course of which I (unbelievably enough) repeatedly rammed bricks level into their bed of stone dust, using only my own dumb foot/heel, protected only by one of a pair of flip-flops. I have never had any significant heel pain before, although my then-50ish sister did have a prolonged bout of plantar faciitis some years ago.

Dr Blake's note: Hope you will send a photo of this project someday.

     Because I had to be brave and bring my last kid to college three days ago (sob!), I looked up on the Web how to do taping for relief of the pain. This allowed me to hobble around Providence for a day, and the subsequent couple of nights (after daytime taping) were tolerable. However, yesterday I did not tape and also did not walk too much (although I did do some yard work). Now I am in agony.

     I am 61, in good general health, no meds except the recent q6h ibuprofen (which has been giving me some relief-- but not tonight). I have used, infrequently over the years, a few quick, tapered courses of oral Prednisone for nasty poison ivy rashes that had persisted for days. I had no problems with this. Tonight, as I lay awake in pain, thinking about inflammation, I decided to research the use of oral steroids for plantar faciitis, and found your site. My question is this: as my fasciitis appears to be due to repeated, but acute, self-induced trauma, do you think I might be in increased danger for rupture were I to take a short Prednisone course? I want this to go away fast, of course, and will do a real period of complete rest/ice/stretching if that's the best idea. I am not prepared for cortisone injections and certainly not surgery,

Thanks for your advice.

Sincerely,
Sheila
Boston, Massachusetts


     Sheila, hope you don't mind me using your email on my blog tonight. All identifying info will be removed. With that history, u have a calcaneal fracture until proven otherwise. Get an MRI to rule out. If negative or positive all of the decision making will change. Do not take NSAIDs or oral cortisone due to the potentially negative impact on bone healing. Rich. Good luck. 


Dear Dr. Blake:

    Thanks so much for your excellent advice. I had already scheduled an MRI for this Thursday to r/o Fx, which, given the pain today, I'm thinking more and more possible (although I know the pain from plantar faciitis alone can be intense).

Feel free to post, but thanks for protecting my anonymity: wouldn't want even more people to know about my unbelievable stupidity! Hope this keeps it from happening to someone else, but really: who else would be so dumb???

Best,
Sheila

Dear Sheila, Thanks again for being a good sport about this. I get alot of emails, and I wanted to post this one to focus you and my readers on what you should expect.

  1. If you have a positive MRI for calcaneal (heel) fracture, the treatment is 3 months in a removable boot. 
  2. If you have a positive MRI for plantar fascial tear, the treatment is 3 months in a removable boot.
  3. If you have a positive MRI for intense inflammation only, the tapered cortisone course, with contrasts and ice, with a short course of removable boot, with some PT or accupuncture are all helpful.
  4. If you have a positive MRI for any of the above, you may still have nerve trauma/sensitivity concurrently. The pain from nerves is difficult to treat, and has been solutions.
  5. If you have a negative MRI, then you have plantar heel bursitis (may not show well on MRI) or nerve trauma, or both. If I think there is bursitis, with a negative MRI, I like ice massage, physical therapy, or cortisone shots (which you correctly are not a fan of, but may be crucial). 
So, where do you go from here? Can the MRI and see what it says. Positive or Negative is helpful to rule things in or out. Try to create a painfree environment. Because there can be an element of nerve trauma with your history, pain begets pain, and the symptoms can spiral out of control. Take the pain seriously, and do all you can to completely eliminate it for the next month. You are bound to heal quicker that way. And if you are in the Back Bay area and see a young lad that looks like the photo below, that is my son Chris.



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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.