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Thursday, November 21, 2013

Heel Pain: Email Advice

Dear Dr. Blake,

I am so grateful to your writing this wonderful blog. Thank you!

For about 12 month I have severe, debilitating heel pain, very similar to plantar fasciitis. I do not have any first step pain and my pain gets progressively worse over the course of the day. 
Dr Blake's comment: Without the am soreness, we are probably not dealing with plantar fasciitis. 

In addition, I experience a burning pain that feels like nerve pain.
Dr Blake's comment: Here is my original video on the differential of heel pain. See if it makes sense that you have plantar fasciitis or another problem. The hardest to diagnosis is nerve entrapment. 

 I am able to only stand or walk for about 3-5 minutes. The inside of my heel is tender if pressed and my heel is painful upon percussion.
Dr Blake's comment: This sounds like possible calcaneal (heel) stress fracture/bone reaction. This diagnosis is only made by MRI or bone scan. 

 Over the past few months, we have ruled out plantar fasciitis, as well as nerve root compression originating from L5/ S1. As a treatment I had received a steroid injection into the plantar fascia, as well as an epidural steroid injection. These treatments have not produced any results. I try to stay very active: I do yoga, Pilates, I walk on a de-weighed treadmill, and I work out on a stationary bike in a tireless attempt to get better. I so hope to be able to take a walk with my children again.
Dr Blake's comment: Even though your workup sounds good, why has there not been an MRI or bone scan? You can have nerve pain from the swelling produced from a calcaneal fracture. So get one of those 2 scans. 

Recently, someone suggested to me that I had Baxter’s neuritis. From the literature that I was able to find, this diagnosis seems to fit my symptoms exactly. I do feel a lot of sensation and pain along the course of the first branch of the lateral plantar nerve. What would be the treatment for this?
I am wondering if I should immobilize my foot instead of stretching it and mobilizing it.
I would be most grateful for a reply.
Kind regards,
Dr Blake's comment: Baxter's neuritis can be a cause, but impossible to diagnosis. It is always a possibility in recalcitrant heel pain. You need to rule out bone issues and then inject the lateral plantar nerve with long acting local anesthetic to see if that helps. If it does, try several cortisone shots into the same area, and consider surgery only if the shots give you temporary but great responses. I hope this helps. Rich

1 comment:

  1. Thank you very much for your kind response, Dr. Blake. All the imaging came back negative (MRI of spine, hip, foot, bone scan, xrays). I will make an appointment with your office in SF.


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.