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.
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