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The response to the question below was authored by Marc Mitnick DPM

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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ADDITIONAL REFERENCES

Mayo Clinic

Johns Hopkins Medicine

MedlinePlus

Arthritis Foundation

University of Rochester Medical Center

Harvard Health

Drugs.com

American Academy of Pediatrics

Penn State Medical Center

National Institutes of Health

Columbia University Department of Rehabilitation

ScienceDirect

Stanford Health Care

Illinois Bone and Joint Institute

Mount Sinai Hospital

Institute for Chronic Pain

University of Florida Health

American Family Physician

Cedars-Sinai

University of Maryland Medical Center





MY PRODUCT RECOMMENDATIONS
(items I prescribe in the office)


Orthotics for multiple types of foot pain
best buy in a pre-made orthotic
click link below


SuperStepOrthotics


Orthotics for heel and arch pain for those who must wear dress shoes
click link below


redithotics


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(location unknown)
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(location unknown)
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LH

(location unknown)
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(location unknown)
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UK


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Unknown

Unknown location


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Unknown location


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Anonymous




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Arizona
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Poland
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South Carolina
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San Clemente, CA


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location unknown


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location unknown


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Bre

location unknown


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anonymous




Dr. Mitnick, Thank you, you were 100% correct. The pain finally brought me to the ER. I spent 8 days in the hospital. The Doppler you spoke of was able to show that there was no pulse in that foot. This was an arterial clot that split and traveled throughout my leg. My leg was almost amputated. I am in rough shape but have all my parts intact!! You certainly know what you are talking about. Thank you for taking the time to answer. Yours Truly!

anonymous




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Poland




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Seattle, WA


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Bonnie

location unknown




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New Jersey




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Debbie

location unknown




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Chrissy

location unknown




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Evansville, IA




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location unknown




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San Diego, CA




Dr. Mitnick, Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better. So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!

Rivi,

Albany, NY




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Jill S.

location unknown




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Jackie

Whichita, KS




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mark

Boston, MA




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Colorado




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annielou

Colorado


Wonderful advice

by: Anonymous

This is the best site for foot problem info.


Thank you for this information. This description fits my pain and inflammation behind my 2nd toe perfectly.

by: Max

location unknown
Again, I really appreciate that you responded to my inquiry, and that your mention of Parkinson's helped me to find my way to a diagnosis of this difficult to diagnose disease. Most patients see on average 16 doctors before they are diagnosed. I hope that you can help other people that ask for your expertise in the future.

Barb D.

Canada
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Bonnie

location unknown
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Nancie

Wisconsin
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Julie

location unknown
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Renae

North Carolina
Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...

KG

location unknown


Thanks again doc for having this website and we STILL need qualified Podiatrists in beautiful sunny Tampa Bay (Bradenton) Florida.

Bessie Mae

Florida
Dear Dr. Mitnick, Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,

Lynne T.

location unknown
Your webpage is excellent, I commend you on sharing your knowledge to the public.

Robert

New Jersey


Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.

a mom

location unknown


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Melody

Lenoir, NC


Thank you so much Doc for a quick and thorough response!

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Bellevue, WA


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Jodi

location unknown

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