Continued pain and nerve issues after surgery for plantar fasciitis

Last year I started walking for exercise. I walked 4-5 hours a week. I had heel pain but just powered through it. I finally went to the doctor 6 months later as it continued to get worse. He gave me orthotics, took an X-ray which showed a heel spur, and told me to always wear my shoes. He also gave me a cortisone injection. I ended up having three or four injections within a couple of months or so. The pain lessened near the the time of the shots but still continued. It eventually hurt 24/7! It became hard to drive, and I would often be crawling by nighttime. So four months ago, I had surgery for the plantar fasciitis and heel spur removal. He also did a topaz debridement. After the surgery, my pinky toe was no longer able to move out to the side. The incision became infected about a month later to which I was given a cream which did fix the problem. Two and a half months after the surgery, my foot was hurting more. I was given anti inflammatorys. The area where the topaz debridement was done was very swollen. After taking a bath (I don't even stand up to take a shower since I wear my shoes all the time), that area, the end of the arch near my heel, was touching the ground because it was swollen. A few weeks later another doctor at the office happened to see me. He said that I have tarsal tunnel syndrome. He gave me a steroid shot in my hip area and a steroid pack. I was back 5 days later with my son. My original doctor looked at my foot after I told him about being put on the steroids. He then did the deep tissue laser therapy. I had that done three times in one week. It made my foot more uncomfortable. A week later I explained that I was more uncomfortable and that I realized at times I do not have feeling in a portion of my foot. The doctor then gave me a cortisone shot which was unlike any I had before. I was screaming in pain! He said he went through adhesions which was why it was so painful. Then they did the laser therapy. I had the laser done again today. I'm scheduled to have another cortisone shot later this week but am going to cancel it and go get a second opinion. Right now my foot is either in pain or is feeling weird or uncomfortable 24/7. You name it, I feel it! I have shooting pains which sometimes wake me at night, it burns,

it tingles, it aches, it spasms, it loses feeling at times, and the pain can be in the heel all the way up to through the arch and up to the inside of the ankle bone. I'm wondering if I had something else going on before the surgery or if this is a complication from the surgery since tapping on or near the incision gives me that tingling feeling. Also, at this point I am unsure of the best course of action. I am a 43 year old mother of 4 children. I am getting more and more concerned about my future.


RESPONSE

Hi,

The best piece of advise I could give you would be to get a second opinion immediately. Based on your narrative it sounds like the doctors in this group are just "guessing" at this point.

You do not mention it, but I am wondering if you had an MRI prior to surgery. There are just too many conditions that cause heel pain and when it gets to the point of considering surgery, as far as I am concerned an MRI is mandatory to rule out things like a plantarfascial tear, heel fracture, or even a tumor in the heel bone (a remote possibility).

Additionally tarsal tunnel syndrome can cause heel pain as well as a heel neuroma, neither of which would have been resolved with the type of surgery you had. I am assuming you had the Topaz coblation on the bottom of the heel and so the small scar on the inside of your heel would suggest to me that you had an endoscopic plantarfasciotomy.

Now the fact that you cannot move your pinky toe outward, lack of feeling in part of the foot, the burning, tingling sensation you are getting is all nerve type problems. It could be a worsening of a tarsal tunnel, if that is what you actually have, or it could be nerve damage from the surgery.

Since you state when you tap on the incision and get a tingling sensation, that is very suggestive of a heel neuroma.

Complicating all the possibilities is the fact that you had surgery on the heel. Four months post op, I would not expect you to be doing cartwheels but I would have expected you to be getting better and better on a weekly basis; clearly you are not.

You need someone to isolate exactly what your problem is possibly through nerve conduction studies and an MRI and then it will be easier to proceed in a manner that will improve your situation. You cannot continue to have people keep guessing what is going on.

Marc Mitnick DPM
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