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heel pain not responding to treatment

Last year i went to my foot doctor in pain, he said i had planter fasciitis,had 4 cortisone shots, wore a night splint, had PRP injection, and now having burning pain in my entire heel. Taking Lyrica and nerve vitamins and going to Physical Therapy and still no better. Help completely lost.


RESPONSE

Hi Amy,

Press on the medial side of your heel. That would be the inside portion of the heel. Then compare what you feel to the other heel. If the heel you have been having problems with hurts more than the other heel, there is a very good chance you have what is known as a heel neuroma.
Most people and unfortunately, even doctors all think all heel pain is the same, eg: plantarfasciitis. Even though plantarfasciitis is probably the most common cause of heel pain it is not the only cause.
Aside from the fact that your heel did not respond to the previous treatments, it is probably safe to say that most cases of simple plantarfasciitis will resolve in a period of a year.
The fact that yours has not is obviously cause for concern.
Getting back to heel neuromas, there is a nerve that comes down the inside of the heel and works it way to the bottom of the heel. It is this nerve, known as Baxter's nerve that gives people sensation on the bottom of the heel.
Sometimes however, the end of the nerve will become irritated from the constant pounding of every day walking.
Typically, the symptoms are such: the foot will get worse as the day progresses. In other words, the more you walk on it, the more it hurts. Symptoms will include, overt pain, possibly burning, possibly tingling and in most cases the pain will travel around the heel; it is not limited to just one spot on the bottom of the heel (unlike plantarfasciitis).
So, in theory, all though the cortisone injections might have helped, the night splint and the PRP injections would have been of no value. I do not know what kind of physical therapy you are having, but since they are probably treating you for plantarfasciitis, chances are slim that PT will help that much as well.
There are some other conditions that come to mind that may also give you similar symptoms. One is a heel bursitis, which basically is a sac filled with fluid that is initially formed by the body to "cushion" an area, but the cushion then becomes inflamed and it begins to hurt. A bursitis as well, will cause traveling, burning pain in the heel. Probably not numbness or tingling.
Another consideration would be the possibility of a tarsal tunnel, which is the equivalent of carpal tunnel that occurs in the hand. This too is damage to a nerve. I do not see this often, but it has to be ruled out when a patient has your type of symptoms.
Lastly, you have to rule out a tear in the plantarfascial ligament. Any time I have a patient with heel pain that does not seem to be responding to treatment in the expected manner, I send them for an MRI to rule out a tear and any other esoteric problems that may be causing pain.
My suggestion here would be to go back to your podiatrist, if you think he or she knows what they are doing, or perhaps consult a different podiatrist and let the doctor investigate the potential causes that I have mentioned.
One question. Are you wearing orthotics? I ask because in my practice and I think most practices, orthotics are the central core of treatment as they are the one device that will adequately support the plantarfascial ligament so it can heal.
I would first rule out all the conditions I have mentioned, but if it comes down to just plain plantarfasciitis, my opinion is, without a good supportive orthotic, you will have your heel pain for a long time.

see related
article....heel neuroma

see related
article....heel pain

see related
article....tarsal tunnel

Marc Mitnick DPM

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