Above the heel pain

by Katherine
(Louisiana)

Hi! Over a year ago I hurt my left foot working out I went to a podiatrist and was diagnosed with planter fasciitis. I was taking anti inflammatories but still having pain. Along with the pain a lump started forming I between the heel and arch. I went to another podiatrist who also said it was planter fasciitis so is started getting physical therapy on my own. They did ultra sound therapy and deep massages. The lump finally went away but the pain didn't. I then went to another doctor who gave me a shot and put me in awaking boot for a month. The pain is gone but another lump formed but it feels like a shoe string going across the top of my heel. I have been stretching, massaging and icing what else can I do?

RESPONSE

Hi Katherine,

In individuals that have repeated plantar fasciitis there are a few things worth mentioning.
You do not mention whether you have orthotics or not, but in my practice, orthotics are the cornerstone of any treatment for plantar fasciitis. The reason is quite simple. All the other treatments you mention are to relieve the pain, but none of them address the underlying problem. If the underlying problem is not addressed properly then you will probably keep having episodes of plantar fasciitis assuming you maintain your current lifestyle and activity level.
The plantar fascial ligament acts as a bow string to support the arch of the foot. If a foot flattens out too much, it puts tremendous pressure on the ligament and the ligament becomes inflamed at its insertion into the heel bone. (this is the most common, but not only cause of heel pain). An orthotic supports the ligament so that it will not over stretch and thus the heel pain will eventually go away if it is not being constantly irritated.
The other point I would like to make is about your type of heel pain complaint. Because you have had repeated heel pain issues and because there has been excessive swelling and prolonged swelling, I am a bit concerned about other potential problems.
The first thing that comes to mind is the possibility of a tear in the plantar fascial ligament. This does not happen regularly, but certainly happens frequently enough that at this point, with your repeated episodes, someone should look into that possibility.
This would require an MRI which is very good at determining whether there is a tear or other pathology in the ligament.
Another, more remote possibility is a fracture in the heel bone. A stress fracture may occur without history of trauma, from nothing more than exercise. An MRI would also point out a fracture if there indeed, is one present.
I know you have been to a few podiatrists, but quite frankly I am very underwhelmed by the quality of care that you have received. Find a doctor who is willing to really investigate the problem and then who is willing to address the underlying cause of your problem.

Marc Mitnick DPM
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