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plantar fibromatosis

by Margaret
(Palm city florida)

my mother underwent 15 surgeries on her foot. i was the lucky child to get the same condition. had one surgery when i was 16, on crutches etc....well they are back on my left foot like crazy, and on my right now...also a dupytrons on my hand, like my grandfather had. my question is i am a runner 25-30 miles per week they dont hurt, just hard to get shoes!! is there anything that i can do to stop the growing? I am now 53 and they have gotten bigger. do the splints work, i dont want surgery on my feet! thanks Margaret


Hi Margaret,

Surgery on plantar fibromas can be very frustrating particularly in those individuals where they keep popping up in different areas.
A few options are available to you. You could have the existing fibromas injected with cortisone or you might consider the topical medication known as Transdermal Verapamil made by a compounding company in San Antonio, Texas. These two options may be beneficial in shrinking the existing lesions.
Night splints and even prescription orthotics might be of some help in preventing further eruptions.
Unfortunately, there is no easy solution but one of your goals should be to do whatever you can to avoid further eruptions.
I hope this helps.
Marc Mitnick DPM

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plantar fasciitis

by Fay
(Brisbane, Australia)

I have had Plantar Fasciitis since end of March 08. Have had treatment of 2 cortisone injections, icing, stretching hamstrings, and taping, and have had orthotics for 6 wks. Because I have had RSDS previously in hand and arm, I have been told that it is possible that it could occur in my foot. It has been recommended that if foot not much improved within a month to have an injection of local anaesthetic plus glucose - to irritate the torn tendon which hopefully will lead to enforced healing. My question is could this injection by causing further aggravation & injury to the foot possibly bring on RSDS in the foot. Because I lost the use of my arm for 3 yrs am very concerned as to whether this is likely to happen in foot. Thank you in anticipation of your answer.

Hi Fay,
In all honesty I have never heard of injecting glucose to stimulate healing by causing irritation of the plantar fascial ligament.
Because of your RSDS history It is imperative that your doctor always has that in the back of his or her mind. Read my section on CRPS and beware of the intial symptoms.
Before I would have any injection, I would have an MRI to rule out a stress fracture in the heel or perhaps a tear in the plantar fascial ligament, particularly if the heel is not getting better.
Marc Mitnick DPM

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heel pain

I am a 91 year old male with very limited daily activity. My exercise consists of maybe 15 trips to the bathroom using a walker. My heel hurts when I step on it. It shows no discoloration but is slightly indented while the rest of my foot/feet are very swollen and purple. I know my circulation is very poor. I suspect a stasis ulcer but I have no surface irritation and no heel discoloration. Can you offer and suggestions?

Hi,
The smart money would be to have a doctor examine your foot to make sure there is no ulcer or even pre-ulcerative changes in your heel. With your poor circulation this may be a disaster waiting to happen.
If it is found that your heel is clear of any ulceration, then a good heel cushion may make your walking much easier. Do not wait to have the heel examined.
Marc Mitnick DPM

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heel pain

by Robin
(Philadelphia)

hello doctor, I am a medical student and as such I have to be on my feet all day. I have been getting bilateral heel pain for a number of years but never paid enough attn to it till now when I am on my feet 16 hrs/day. The pain progresses during the day, no morning pain as in Plantar Fascitis. It is only located at ball of foot and is very rare in medial fascia. It can be very debilitating at times and emotionally it is very exhausting. I have tried various shoes, heel cushions with little benefit. To my self diagnosis, I don't believe it is Plantar fascitis and I wanted to get your opinion. What else it could be and what is the workup/treatment. Can PCP's help or should I go straight to podiatrist?

Thanks.
Hi Robin,
The title of your post is "heel pain" but the content of your question refers to pain in the ball of the foot, so I am not sure if you have 2 foot problems going on. I will try to answer your question relative to the "ball of the foot".
The two most common foot conditions that I see related to forefoot pain in people who are on their feet all day is capsulitis and Mortons neuroma with metatarsalgia a close third. The higher the heel and narrower the shoe that you wear, the more pain you are going to experience.
Now, if I misunderstood your question and your pain is seems to be related from the heel to the forefoot, then the most likely culprit would be plantar fasciitis. Although not terribly common technically the pain from plantar fasciitis could affect the heel and the ball of your foot; it is usually the central slip of the plantar fascial ligament that is affected.
I would think because of the complexity of your complaint, a podiatrist would be far better suited to diagnose your problem as opposed to your PCP.
You may end up finding that nothing more than a good arch support is needed to take pressure off the painful areas of your feet and re-distribute your body weight more evenly.
Good luck.
Marc Mitnick DPM

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Heel pain

by Nicole Roach
(Winnipeg, Manitoba, Canada)

I jumped off of a high wall and landed on my left heel only, then fell. I walked on it all night, and just ignored the pain. When I woke up the next morning I couldn't even walk on it, but there was no x-ray place open because it was sunday. I looked at it and it didn't look swollen or bruised. I went to the doctors the next day and got x-rays. The doctor said that it was just sprained, but he didn't really look at the x-rays that closely. He told me to take advil and ice it. I have been doing this for the past week and it is just getting worse. I am also walking around a school all day on my foot. Could I have a fracture that the doctor didn't notice?

Hi Nicole,
Find yourself another doctor. If you do have a fracture it needs to be treated immediately. Sometimes a fracture will not show up immediately and either it will have to be re x-rayed or you may possibly need a bone scan or MRI.
Marc Mitnick DPM

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heel pain

by Richard
(Nottingham, UK)

Hello Dr.

I would appreciate your advice- I have a recurring pain on the outside of the right heel, about 1 inch up from the ground running parallel with the ground, from the middle of the foot to the heel. The pain only happens when the foot is in a particular attitude, usually involving some (small) rotation, and feels like a sudden burning sensation, quite acute.

Thank you for your help.

Hi Richard,

Sounds like you either have an irritation of the sural nerve which is the nerve that passes thru the foot at the exact area you describe. Assuming the rotation you mention is inversion (your heel would tilt inward towards your other foot) then basically you are stretching the nerve and burning may occur.
The same rotation may also cause some irritation to the peroneal tendons which may also cause some burning.
If this bothersome to you, see a foot specialist; it is a treatable condition.
Marc Mitnick DPM

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PAIN IN THE HEAL OF MY FOOT

by stormy
(moraine ohio)

My feet are pretty dryed out and I treat this with vasaline almost daily. but I have noticed that on my left heal there is pain and is also red and warm to the touch. I notice this most in the morning and thru out the day the pain level stays about the same.

Hi Stormy,
The first thing that comes to mind is a heel fissure, that has possibly become infected. This condition is very common in the winter months when there is no humidity in the air and skin that tends to be dry becomes even drier.
The crack in the skin may not be visible unless you wet the area first.
If this is the case and the area is infected your first step would be to see a doctor in order to clear up the infection. Once that is done refer to my page on heel fissure for ways to keep the problem from recurring.
Marc Mitnick DPM

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heel pain

by Marsha
(Humble, Texas )

My husband says that the bottom of his foot on the heel is sore all the time and sometimes it feels as though he has stepped down hard on a stone in his heel area. Is there anything he can do at home to help with this pain? He is a plumber and on his feet all the time. He wears work boots and climbs ladders on a frequent basis.

Hi Marsha,
The business of feeling like he stepped on a stone is suggestive of a bone bruise of the heel bone (calcaneus).
Ladder climbing can also aggravate heel pain.
I would think his best bet would be to add a cushioned heel cup to his work boot. Let him look for Silipos heel cushions, a surgical supply store should have them.
If that does not help he should see a podiatrist.
Marc Mitnick DPM

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severe heel and arch pain in both feet

by Edward T Peck
(Riceville, TN, )

50 year old Home builder by trade over last couple weeks pain getting progressiveley worse centered in heels radiating into arch,back of heel and up ankles.
Have tried different boots and inserts but to no relief. On my feet all day long carrying heavy weights, using ladders, on concrete and uneven ground pain so bad at times have twisted ankles causing them to pop. What do you think this might be and is there corrections i can take?

Hi Edward,
People in your line of work are notorious for having foot problems, as you state, the daily grind you put your feet through makes it highly probable that at some point in time you will have pain in your feet.
The heel pain is more than likely due to plantar fasciitis or perhaps a heel spur.
The fact that you get radiating pain is highly suggestive of an associated bursitis or perhaps a heel neuroma.
The feet have to be x-rayed to rule out stress fracture of the heel. You do not mention how big you are but generally any kind of arch support that you purchased in a store will not adequately support you particularly if you are carrying heavy weights and climbing ladders.
Since you need your feet in order to make a living I would suggest you see a podiatrist as soon as possible, because I find the longer heel pain persists, the harder it is to clear up.
Good Luck
Marc Mitnick DPM

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endless heel pain with a new lump

by Jennifer
(Iowa)

After exercising regularly on a cross trainer machine, my left heel started with sharp pains to where I had to stop exercising for a short while. I started to exercise any ways with pain not decreasing. Two months later I now have a small (1/4") and painful lump one inch from the back of my heel on the inner side of my left heel. I have trouble walking and exercising daily. Is it possible to heal on its own, or should I see someone? Thanks...

Hi Jennifer,
Foot pain generally takes longer to heal than pain elsewhere because every time you walk on the foot you are basically re-injurying it. Since it has been going on for two months I think it is time to see a podiatrist.
Marc Mitnick DPM

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Pulsating pain/ache near arch on bottom of foot, swelling

I have periodic pain in my right foot that started about 5 days ago, after returning from a vacation where were did a lot of walking, especially stairs. I wore comfortable low heeled wedge-type sandals (similar to nursing shoes as far as padding/comfort). I wear only those kinds of sandals, occasionally sneakers (good ones), and go barefoot in the house. Before this, the only other problems I've had with my feet are occasional cramps eg night cramps, and spraining my right ankle 4 yrs ago.

Symptoms are mildly painful, pulsating/throbbing sensations, not alleviated by rest or by putting my foot up. It's usually mild enough I hardly notice when walking, though I have to step softly when going down stairs (it hurts to step normally - load bearing). I have a little swelling on the padded area on the inside of the foot between the arch and heel, but it's not painful even when I press on it. It is painful to flex my foot (ie kneeling on floor & leaning forward w/ heel up). Sometimes the pulsating pain keeps me from sleeping. The ache is deep, doesn't feel like it's near the surface, but pressing on the area I can't pinpoint exactly where.

Don't know if it's related, but I had body aches (first both legs, then upper body) for the first couple of days also, like when I have the flu, but those aches are gone.

Thanks so much for taking the time to respond! S

Hi,
There are a few things it might be but the first thing I would look into is capsulitis; I say this because you state it hurts more when bending and kneeling. Walking up and down a lot of steps could have set this off. You also need to be concerned about the possibility of a stress fracture.
Try some of my suggestions on my capsulitis page, if you get no relief you will have to see a podiatrist.
Marc Mitnick DPM

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Plantar Fasciitis

by Shawna Gillcash
(Prince Edward Island, Canada)

I have very sore feet in the morning and after excercise. I have gone to Physiotheraphy clinic and they suggested Orthodics. I am waiting to order them. I had to go to my family doctor to get a referal for the insurance company to cover the orthodics, and the doctor told me not to waste my money and to get a cortizone shot. I am not to sure which one to go to or what to do. Do you have any advises?? I know that Cortizone does not cure the problem it just soothes it and needs to be repeated, but do the orthodics cure the problem and will I have to give up wearing the shoes that I love?? I appreciate any advise you can give me on this. Thank You for your time.

Hi Shawna,

Most cases of plantar fasciitis that I see are due to life style situations. The pain is in response to the abnormal tension of the plantar fascial ligament either as a result of excess weight, standing on your feet for long periods of time or from some athletic endeavor. This is compared to situational plantar fasciitis which may be the result of wearing a lousy pair of shoes or stumbling, or some other one of a kind activity.
Your family doctor's advice about a cortisone injection would make sense if you had situational plantar fasciitis (a cortisone shot and eliminating the situation that caused the plantar fasciitis could remedy the problem).

If your problem is due to a life style situation than orthotics are the only thing that makes any real sense over the long term. You need to control the plantar fascial ligament on a daily basis so that it does not continually over stretch. By not allowing the ligament to over stretch, the pain will eventually subside plus you stand a good chance of it not returning (unlike a cortisone shot).

Since you exercise I am assuming you do it on a regular basis and this would be one example of a life style situation plantar fasciitis.

I hope this information helps.

Marc Mitnick DPM

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arch pain

I believe that I have Plantar faciitis. I have pain where my heel meets the arch, and to a lesser extent, along the arch. It is not painful to the touch, but standing or walking for a few minutes makes my feet feel like I've been on them for hours. Its not a sharp pain, but more like an ache. My lower legs and knees also feel like I've been walking all day. In addition to the pain, shoes that I've worn for several years suddenly seem too small, and for a period of time, the balls of my feet hurt and were painful to the touch, but that has passed.

Is this typical of Plantar Faciitis, or does it seem like something else ?

Thanks very much.

Hi,
Sounds very much like plantar fasciitis. I would recommend trying an orthotic. Give it a couple of weeks, if the pain does not subside, then I would suggest you see a podiatrist.
Marc Mitnick DPM

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pain in the heel and ball area over 10 years. is getting worse. should the foot be removed?

I have had foot problems for over 10 years. Nothing seems to work. I have been getting shots, but that does not work. the pain is worse and I can not walk. My ankle, knee, hip, and back are now in pain. would it not be better to cut it off and use a plastic foot? Who should I get to do the removal?

I am 62 years old and need to be able to walk. I care for my grand children and work on a mining claim. Being able to walk is a must. If surgery is not the answer, what about cutting the nerves so I don't feel the pain?

Thank you,

skip

Hi Skip,
Wow, in my 29 years of practice, no one has ever posed that question to me.
I suppose theoretically that might be an option, but I would suggest that you would have to be in excruciating pain on daily basis to even consider it.
I would hope at this point you would have seen every conceivable doctor that might be able to help you including a podiatrist, orthopedist, neurologist, physiatrist, pain management specialist and vascular specialist.
If your pain is neurological in origin than a sympathectomy might help, but of course I do not know the source of your pain.
If your pain is of musculo-skeletal origin and again you are in excruciating pain, you could consider a fusion of the major joints of the foot and ankle which could be beneficial.
Have you tried walking in a walking cast? It might be a bit clumsy but certainly no less so than with a prosthesis.
I do not know where you live but if it is in a rural area, your best best would be to make an appointment at a large medical center, preferably a university medical center, in a nearby city and let a couple of the specialists there evaluate your problem.
I hope this has helped.
Marc Mitnick DPM

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heel pain after jumping of chair

by gavin
(derry ireland)

write about a year half ago i was painting and jumped of a chair and landing sideways on my ankle i thought it was a bad sprain and would go away and heal after about 7 months i finally went to the ae department they xrayed my foot and could not see anything wrong with my foot i told them i had constant heel pain the pain was on side ankle and went done to the heal and stayed there i still have a cracking noise in my ankle that only came about when i fell when i turn my ankle the bone that runs down the side of ankle pops in and out pinchs in out i got a referral to go back to ae and they still could not do anything then about 4 months ago i got referred to foot clinic and two months ago i got referred to podiast hew asked me alot questions about pain first thing in the morning when i first get out of bed and geting up after sitting i said yes to the pain in my heel part he did not give me time to talk about my symtoms and said i had plantar fasciilas and made and sent me out insoles that are making pain worse my heel pain is worse when sitting not when getting up after sitting down are first thing in the morning tingling and burning pain and sometimes it gos numb i hav been looking at different and i think it sounds more like a pinched nerve because thats what its like a constant toothach in my heel help please i am unable to work because of this because after an 15 minute walking the pain back like a knife up into the heal really bad.

Gavin,
With a history of trauma, no real relief in such a long period of time, no findings on x-ray, my best piece of advice would be to have an MRI so that the whole affected area could be adequately assessed.
Your complaints never sounded like plantar fasciitis to me.
There is a possibility that it is nerve damage, but because there was an incident of traums, I am thinking there is more to the pain than that.
Marc Mitnick DPM

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