Pain after tarsal tunnel and plantar fascia release

by Andrea
(Charleston, SC, USA)

I had tarsal tunnel and plantar fascia release, and heel spur removal on both feet. Left foot was done 8 months ago and right foot was done 6 months ago. I did 6 weeks of physical therapy and was out of work for 5 months total. My job requires me to stand all day. I haven't had 1 day pain free yet. I get weird shocks, shooting pain in a variety of places, and constant soreness. I can't walk fast and I can't walk far. Stairs are challenging also. I've inquired about a follow-up MRI or x-ray to see if everything looks good. My doctor just keeps telling me to be patient and that everyone heals at different rates. (So basically his answer is no.) With my job it's hard to be that patient. I'm curious if I truly need to wait out the pain? Have I gone back to work too soon? Or at my time frame should I be feeling more relief? I will say that the pain I was having before surgery was just in the middle bottom of my heel and in my Achilles. That pain is gone and it is now a new pain mostly all over my feet (but more on the sides.) Thank you for any feedback!

RESPONSE

Hi Andrea,

Although you might not be completely healed at eight months, the best way to gage your progress is to decide if you are improving. In general, if your feet are less painful then they were last month, and next month they are less painful then they are today, then you can assume you are improving, albeit at a slower rate then most people.

With that in mind, if your progress has stagnated and you do not seem to be making progress, then there may be a problem.

The fact that you work on your feet all day may be a factor in slowing down your progress and that has to be taken into account.

There are a couple of issues here and it is difficult for me to be more specific simply because I cannot examine you and do not have access to your medical records.

The fact that your feet seem to hurt all over as opposed to just the bottom of the heel where the original heel spur was present leads me to believe there may be a couple of issues going on here.

If there is pain all over the heel and perhaps the rest of the foot, I would look at the tarsal tunnel procedures as a potential problem. Since the purpose was to release the pressure on the nerve (which can cause heel pain), there may be issues with the nerve actually being "free". An entrapped nerve could cause diffuse pain, or numbness or tingling. An MRI might be helpful to look at the surgical result, but nerve conduction studies might also be beneficial, particularly if you had that test prior to the tarsal tunnel release, which I assume you had.

The other potential problem may be the result of the plantar fascial release. If the release was too aggressive, this can cause what is known as destabilization of the lateral column which are the bone structures including the fifth metatarsal bone and the bones behind them. You mention pain on the side of the foot. If this is the outside of the foot, then one has to suspect a destabilization of the fifth ray or lateral column.

Those are the areas I would look into. Again, if you have reached a point where you are not improving in a somewhat regular progression, then perhaps testing would be indicated.

If your surgeon is not interested in exploring this further, then why not see another specialist in your area?

Marc Mitnick DPM
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