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

Heel pain

by Karen
(Neenah)

I have been experiencing burning and stabbing pain in my right heel which had initially surfaced 10 years ago and has gotten progressively worse over time. There have been periods when it mitigated slightly due to greatly decreased activity, but then re-emerges worse than ever when normal activity is resumed. While my foot does hurt right out of bed in the morning, I do not believe I have "first step" pain. The pain decidely worsens as the day progresses. It is always worst immediately after I have been off my feet for any period of time and then I stand up again. I have been treated with taping, anti-inflammatory meds, stretching exercises (which greatly exacerbates the pain) and icing, passive night splinting, multiple rounds of cortico-steroid injections (which relieved the pain temporarily, but then it returned with a vengence after several weeks time), and finally physical therapy (which entailed iontophoresis and ultrasound with deep tissue massage). I have been "diagnosed" with plantar fasciitis and, more recently, tendonitis of the abductor hallucis. (Although the pain in my heel is most intense where the abductor hallucis attaches, it also exists in the middle of the heel and the outside.) Within the last year, I developed similar pain but with less intensity in my left foot. Physical therapy (ultrasound with deep tissue massage and stretching) and rest resolved that pain within six treatments, but so far nothing has touched the pain in my right foot. I have most recently been diagnosed with Baxter's Nerve Entrapment and

my new podiatrist recommends surgical release. (My x-rays are normal and I am scheduled for an MRI. I do not experience tingling or numbness and do not react to Phalen's maneuver.) I have read in other articles that there is a possibility of developing further nerve entrapment from the medial incision and that surgery should really only be considered when one can no longer walk. I would really appreciate any thoughts/recommendations that you could offer. I am completely exhausted, confused, and demoralized at this point. The only thing I am certain about is that this is no way to live.

Hi Karen,
Well you certainly have run the gamut of treatments. As soon as you mentioned burning and stabbing pain, I knew you had more than plantar fasciitis. That is why your pain is not at its worse first thing in the morning.
Since you have been diagnosed with a heel neuroma, Baxter's nerve, instead of surgery you might want to first consider cryosurgery where the nerve is frozen in an effort to reduce the sensitivity. Additionally you may also want to try denatured alcohol injections of the nerve, which I do and have had a great deal of success.

Yes, you do run the risk of further nerve entrapment when the nerve is excised due to scarring of the incision.

I am glad you are having an MRI done because many times the tendonitis of the abductor hallucis muscle is actually a rupture which will require surgical repair.
Marc Mitnick DPM

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May 14, 2009
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Should have added...
by: Karen

Sorry Doctor-
I should have been more complete in my follow up note. In addition to the tarsal tunnel surgery, I also had a Topaz (laser ablation) fasciotomy. I was told that this should hopefully improve the long term stability in my foot over a total release. (It is a long story, but I had to cancel my first surgical appt to care for a family member for a few months, and being off my feet much of the time alleviated most of the pain in my heel. The pain returned quickly if I'd go for a run however. I did notice, though, that when my heel wasn't hurting, the middle of the ball of my foot and my middle three toes were numb. When I was able to reschedule my surgery and saw the podiatrist again pre-op, he did some additional tests and tarsal tunnel was diagnosed in addition to the plantar fascia tear.)One week post surgery I am weight bearing with the boot and crutches. No problems from the incision, and the entire procedure was virtually pain free. The bottom of my foot has a weird, kind of numb feeling which I know is due to the nerve decompression and it could take a while to feel "normal" again. I know it sounds like an extreme move, but something had to be done. I have lived with this for ten years and had tried everything else I have ever heard about. Enough is enough! Thanks for your advice! Your site is awesome.

May 07, 2009
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Follow up to follow up
by: Karen

Well, my heel pain saga continued as I was furthered diagnosed by my podiatrist as having tarsal tunnel syndrome. I had surgery this past Monday to release the nerve compression, which I learned post-surgically was most likely caused by internal vericose veins that were taken care of at the same time. I am currently in a compression bandage and walking boot, but non-weight bearing for the week. We'll see what happens. I have been told that the recovery period is lengthy given the nerve involvement.

Hi Karen,
I am a little concerned. You state you had an MRI which revealed a partial tear of the plantar fascial ligament and degeneration of the fat pad, both of which would account for heel pain.
Even though a tarsal tunnel can cause heel pain, the above two findings are more consistent with heel pain.
So...this begs the question of why did the doctor operate on your tarsal tunnel without at least addressing the two more probable causes of heel pain? You should discuss this with your doctor.
Marc Mitnick DPM

Jan 26, 2009
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Follow up
by: Karen

I received the results of my MRI and it shows a degeneration of the fatty pad in the heel as well as a partial tear in the plantar fascia. My podiatrist doesn't do cryotherapy/cryosurgery and isn't aware of anyone locally who does, but I guess since the ligament is actually torn, it would require surgery anyway? Sound appropriate? I am kind of freaked out at the idea of three weeks on crutches but if it presents a chance for relief, I am all in.

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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

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(location unknown)

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(location unknown)

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(location unknown)

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Unknown location

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location unknown

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location unknown

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New Jersey

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San Diego, CA

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Colorado

Wonderful advice

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location unknown

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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

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Florida

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New Jersey

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a mom

location unknown

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Lenoir, NC

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Bellevue, WA

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Jodi

location unknown

Heel pain

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