Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

Plantar Fascia or Achilles ?

Posted by Donna B. on 4/14/01 at 08:15 (044538)

Hi, I have had medial band pf for a while now and I am starting to feel pain on the bottom of my heel ( in the middle and towards the back )is the area still considered part of the fascia or does the achilles attach to the bottom back part of the heel. Doesn't achilles pain hurt on the back of the heel and not the bottom? If I would consider having the ESWT for the plantar fascia would you or have you done the treatment in a few areas not just one? Thanks Donna

Re: Plantar Fascia or Achilles ?

Dr. Zuckerman on 4/14/01 at 08:53 (044547)

Hi,

This could be either the bottom insertional fibers of the achilles tendon or more likely the central band (middle) of the plantar fascia. I have done the treatment in more then one area of the plantar fascia. Dr. Scahden of Austria feels and I agree that the wider the area of ESWT treatment the better the reponse.I hope that this helps you.

Dr. Z

Re: Plantar Fascia or Achilles ?

Donna B. on 4/14/01 at 11:27 (044576)

Dr.Z,Thanks for responding so quickly.So it could be the central band or fibers from the achilles. Where does the achilles attach to the heel bone? I thought it attached just on the back by your ankle? Having pain on the back of the heel, those sharp pains like you have with plantar fascitis is an inflammation of the achilles tendon?

Re: Plantar Fascia or Achilles ? Check for nerve entrapment

Donna SL on 4/15/01 at 01:17 (044649)

Donna,

I had PF (or thought I did), and starting getting pain in the my heel in the same areas that you are decribing. It kept getting worse. It was in the middle, and towards the rims of the heels, especially bad toward the back. All on the bootom of the heel, and as it got worse recently a tiny bit on the sides. My doctor kept telling me that area is from the achilles tendon, but it was no where near the achilles. I also had pain at the insertional point, and in my arches. I had an MRI, that showed a normal plantar fascia, and achilles. Does your pain increase the more time you spend on your feet? Also it can hurt in the morning.

I recently got a second opinion (over a year later). The pod examined me, and in two seconds told me I had nerve entrapment. I then had a nerve conduction test, which confirmed it was entrapment of the inferior calcaneal nerve, and lateral plantar nerve. This won't show on an MRI. This can cause unrelenting heel pain in that area, and is usually mis-diagnosed, as PF. It can also cause pain in the arch area, and insertional point too, and can be confused with PF. You don't even need a nerve conduction test to prove it. Some one has to examine you, and know how to test for this. I'm sure if someone like DR. Z were to examine you in person he would pick this up. Please consider this. I was suffering for over a year with this, and my pod never prescribed PT for this area. and it now looks like there is some nerve damage.

Don't wait as long as I did to get a second opinion. It can be treated conservatively if caugt early, and should be treated before it starts showing positive on nerve conduction test. Also, all the orthotics the pod was making to cure 'my PF' was making this condition worse. Look at the sites below, and srcoll down a bit, and they talk about nerve entrapment in this area.

I am currently having Active release therapy from a chiropractor that seems to be helping. IF this doesn't work I may need surgery. If you are diagnosed with this, try the ART before you get any cortisone shots. I was dissapointed to find out that ESWT will not help this.

You may not have this, and the nerves are just imflamed from the PF, but at least consider it.

http://www.footpain.org/pf.html

Also, look at this article from Podiatry today. It talks about this entrapment, which is sometimes called Baxer's Neuritis.

http://www.podiatrytoday.com/archive/pod_200010/pod_200010f1.html

Donna

Re: Plantar Fascia or Achilles ? Check for nerve entrapment

Dr. Zuckerman on 4/15/01 at 08:06 (044653)

Yes,

Hands on examination is very very important. The article in podiatry today has great pictures and can help anyone to understand nerve entrapement.

Re: DR. Z. Re: Plantar Fascia or Achilles ? Check for nerve entrapment

Donna SL on 4/15/01 at 10:11 (044662)

Hi Dr. Z,

I know you don't have a crystal ball, but do think think that I may need surgery to 'un-entrap' the nerves? I have it in both feet. They also tested for polyneuropathy, and ruled out that out, but I'm still going to see a neurologist. A physiatrist did the testing himself. Also I had normal H-reflexes that rules out S1 radiculopathy. The sural nerves, and the medial plantar nerves were normal on testing.

The results for the lateral plantar nerves were 6.8 for the left, 7.8 for the right, and the norm is less than (6.3).

The results for the Inferior calcaneal nerves were 5.8 for the left, and 7.1 for the right, and the norms are less than (5.1).

The pod didn't try any cortisone shots yet, because he wanted to make sure I wasn't having any more test like an emg, etc, because he said this would affect the results. He still insists on doing a diagnostic shot first. As far as Plantar fasciitis he said he thinks I might have, or had PF, too but wasn't sure, except for a positive bone scan last May.

In the Nerve Conduction test report it says suggestion of nerve demyelination in both feet in the above nerves. (motor conduction studies) Also says some motor axom injury on the left. It also said mixed sensory potentials could not be obtained for either the medial or lateral plantar nerves, on either side, and this could either represent a conduction block, or may be due to technical factors. (I'm not quoting the report exactly as written. There's around 5 pages). Can nerves heal? Do you think there are any chances that with conservative treatment like ART, and any other forms of PT for this area, that this could get better?

Have you treated anyone conservatively with this condition, that resolved without surgery? What treatments have you done? Also,is this the same as tarsal tunnel syndrome? The pod kept talking about tarsal tunnel surgery.

I was starting to see some improvement with the ART, but the test seemed to inflame the nerves again this week, but they are calming down some what. The physiatrist said I should give the ART a chance, before I get a cortizone shot. Do you think I should get a shot sooner?

Sorry about all these questions at once, but I am so surprised, and concerned about this diagnosis.

Donna

Re: Plantar Fascia or Achilles ?

Dr. Zuckerman on 4/14/01 at 08:53 (044547)

Hi,

This could be either the bottom insertional fibers of the achilles tendon or more likely the central band (middle) of the plantar fascia. I have done the treatment in more then one area of the plantar fascia. Dr. Scahden of Austria feels and I agree that the wider the area of ESWT treatment the better the reponse.I hope that this helps you.

Dr. Z

Re: Plantar Fascia or Achilles ?

Donna B. on 4/14/01 at 11:27 (044576)

Dr.Z,Thanks for responding so quickly.So it could be the central band or fibers from the achilles. Where does the achilles attach to the heel bone? I thought it attached just on the back by your ankle? Having pain on the back of the heel, those sharp pains like you have with plantar fascitis is an inflammation of the achilles tendon?

Re: Plantar Fascia or Achilles ? Check for nerve entrapment

Donna SL on 4/15/01 at 01:17 (044649)

Donna,

I had PF (or thought I did), and starting getting pain in the my heel in the same areas that you are decribing. It kept getting worse. It was in the middle, and towards the rims of the heels, especially bad toward the back. All on the bootom of the heel, and as it got worse recently a tiny bit on the sides. My doctor kept telling me that area is from the achilles tendon, but it was no where near the achilles. I also had pain at the insertional point, and in my arches. I had an MRI, that showed a normal plantar fascia, and achilles. Does your pain increase the more time you spend on your feet? Also it can hurt in the morning.

I recently got a second opinion (over a year later). The pod examined me, and in two seconds told me I had nerve entrapment. I then had a nerve conduction test, which confirmed it was entrapment of the inferior calcaneal nerve, and lateral plantar nerve. This won't show on an MRI. This can cause unrelenting heel pain in that area, and is usually mis-diagnosed, as PF. It can also cause pain in the arch area, and insertional point too, and can be confused with PF. You don't even need a nerve conduction test to prove it. Some one has to examine you, and know how to test for this. I'm sure if someone like DR. Z were to examine you in person he would pick this up. Please consider this. I was suffering for over a year with this, and my pod never prescribed PT for this area. and it now looks like there is some nerve damage.

Don't wait as long as I did to get a second opinion. It can be treated conservatively if caugt early, and should be treated before it starts showing positive on nerve conduction test. Also, all the orthotics the pod was making to cure 'my PF' was making this condition worse. Look at the sites below, and srcoll down a bit, and they talk about nerve entrapment in this area.

I am currently having Active release therapy from a chiropractor that seems to be helping. IF this doesn't work I may need surgery. If you are diagnosed with this, try the ART before you get any cortisone shots. I was dissapointed to find out that ESWT will not help this.

You may not have this, and the nerves are just imflamed from the PF, but at least consider it.

http://www.footpain.org/pf.html

Also, look at this article from Podiatry today. It talks about this entrapment, which is sometimes called Baxer's Neuritis.

http://www.podiatrytoday.com/archive/pod_200010/pod_200010f1.html

Donna

Re: Plantar Fascia or Achilles ? Check for nerve entrapment

Dr. Zuckerman on 4/15/01 at 08:06 (044653)

Yes,

Hands on examination is very very important. The article in podiatry today has great pictures and can help anyone to understand nerve entrapement.

Re: DR. Z. Re: Plantar Fascia or Achilles ? Check for nerve entrapment

Donna SL on 4/15/01 at 10:11 (044662)

Hi Dr. Z,

I know you don't have a crystal ball, but do think think that I may need surgery to 'un-entrap' the nerves? I have it in both feet. They also tested for polyneuropathy, and ruled out that out, but I'm still going to see a neurologist. A physiatrist did the testing himself. Also I had normal H-reflexes that rules out S1 radiculopathy. The sural nerves, and the medial plantar nerves were normal on testing.

The results for the lateral plantar nerves were 6.8 for the left, 7.8 for the right, and the norm is less than (6.3).

The results for the Inferior calcaneal nerves were 5.8 for the left, and 7.1 for the right, and the norms are less than (5.1).

The pod didn't try any cortisone shots yet, because he wanted to make sure I wasn't having any more test like an emg, etc, because he said this would affect the results. He still insists on doing a diagnostic shot first. As far as Plantar fasciitis he said he thinks I might have, or had PF, too but wasn't sure, except for a positive bone scan last May.

In the Nerve Conduction test report it says suggestion of nerve demyelination in both feet in the above nerves. (motor conduction studies) Also says some motor axom injury on the left. It also said mixed sensory potentials could not be obtained for either the medial or lateral plantar nerves, on either side, and this could either represent a conduction block, or may be due to technical factors. (I'm not quoting the report exactly as written. There's around 5 pages). Can nerves heal? Do you think there are any chances that with conservative treatment like ART, and any other forms of PT for this area, that this could get better?

Have you treated anyone conservatively with this condition, that resolved without surgery? What treatments have you done? Also,is this the same as tarsal tunnel syndrome? The pod kept talking about tarsal tunnel surgery.

I was starting to see some improvement with the ART, but the test seemed to inflame the nerves again this week, but they are calming down some what. The physiatrist said I should give the ART a chance, before I get a cortizone shot. Do you think I should get a shot sooner?

Sorry about all these questions at once, but I am so surprised, and concerned about this diagnosis.

Donna