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Wednesday, October 23, 2019

Pain Level 8 in the Heel without Swelling

     I had a patient recently with left heel pain normally around 8 on a scale to 10 for several months. The examination showed no swelling. She was unsuccessful in PT treatment, so referred by her PT to see me for an opinion. She was diagnosed as plantar fasciitis, with morning pain, but was not responding to plantar fascial treatment. 
     My first thought, which became my tentative diagnosis, was nerve pain. She had morning pain, at 8 level, but it never loosened up better than 5-6. She had orthotic devices, and felt some much better when I removed the heel posts that can focus the pressure on the heel area.
     She had some sciatica on the same side, although negative straight leg test today. What I did find is very tight hamstrings which can be from neural tension. She felt better with support the foot taping for plantar fasciitis and did hurt only at the plantar fascia. 
     So, I was getting mixed signals from her. But over the next month, she will
  1. Wear the orthotic devices with no post
  2. Wear support the foot taping if it continues to work for her
  3. Use warm not ice
  4. Use neural flossing three times a day
  5. Do no prolonged calf or plantar fascial stretches
  6. Avoid positions of maximal ankle flex ion (most stretch on nerves)
  7. Buy Neuro Eze or Neuro One from Amazon and apply three times a day
  8. Refer to Dr. Irene or Robert Minkowsky for peripheral nerve evaluation 

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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.