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PF with no heel pain

Posted by Judith G. on 4/16/01 at 16:51 (044750)

About two years ago I was taking a ballet class and had to stop because the ball of my foot hurt. It hurt when I rolled thru the ball of the foot when walking. I stopped dancing for a while and it went away. I am a 47 years old professional dance teacher. Some months later I began teaching tap dancing on a daily basis and the pain returned. I saw a podiatrist right away. X-rays revealed a small bunion. Within one or two weeks of this visit I began to feel a burning in the arch of my foot, mostly in the area directly behind the ball, but at times not not excluding the entire arch. I stopped dancing immediately, saw my Dr., and began instructing my classes while sitting in a chair which I have done now for the past eight month.

My podiatrist diagnosed me with PF, but seemed baffled that I had no heel pain. He showed me stretching exercised, put me on celebrex, and told me to use ice. I did all that he said. No relief came and I returned. He suggested Aasics running shoes and we put custom made orthodics in them.

On the third visit he gave me a cortisone shot in the heel even though I had no heel pain. It set me back real bad and I could barely walk for one full week. That week was the only time I had any heel pain. We tried a walking cast and later a night splint ...none of which worked. He did'nt know what else to do to help me and suggested I see another Dr. I went to an orthopedic surgeon who ordered an MRI. The MRI report is as follows:
fluid within the tendon sleeve of the flexor hallucis longus tendon consistant with tenosynovitis, increased signal intensity along the most medial aspect of the insertion of the plantar fascia adjacent to the calcaneus, compatible with medial plantar fasciaitis; although, other inflammatory conditions in this region cannot be excluded with certainty, no obvious sign of edema of the fat within the heel pad to suggest infectious etiology, examination otherwise negative. (I've now had this condition for seven months.) The latest development now, was that my foot was becoming puffy on and off and slighty discolored (pinkish purple). It was hard to curl my toes because of the puffiness.

Somewhere in between all the Dr. visits I also tried massage therapy ... a huge mistake and another lenghty set back it seems.

On my next visit the Dr. sent me to physical therapy and put me on 800mg motrin per day and asked me to return in one week. The therapy was a cortisone medicine driven into the area via ultra sound. About two days after completing the suggessted four treatments I noticed I was alot worse off than before. This has been about a week and a half ago. In the morning when I wake up my foot feels okay and the colr is normal, but as soon as get up it becomes immediately purple/pink. It feels very tight even across the top of my foot at times. I am no longer walking. Sometimes I walk just a few steps here and there, but mostly I either crawl or use crutches. I am discouraged and feel I've had yet another huge set back. If I lay around all day with my foot up I'm fine and the foot colr is normal and the real puffy feeling mostly goes away.

I was sent for a nerve conduction study last week. All three major nerve branches were funtioning completely normal. The smaller nerve branches to the muscle tested simewhat weeker. The neurologist mentioned that it was possibele that I had some RSD, (reflex sympathetic dystrophy) I am really concerned about that possibility because about eight years ago I had RSD in my other foot. I stepped on a small piece of glass and when it was removed the nerve was apparently upset. I was treated for several months and got rid of it. If the discoloration I have now is due to RSD I could be in real trouble because I would have had it for a month and a half already and from what I understand if you don't get rid of it within the first few months you can have it for life.

The Doctors are trying their best, but don't seem to know what is really wrong with my foot for sure.

I think I have plantar fasciaitis, but it sure is not a classic case.

I have so many questions and don't know where to turn. Do you have any insight as to what my problem could be?

I wish to express my deepest appreciation in advance for your time and generous support.

Sincerely, Judith G.

Re: PF with no heel pain

Dr. Zuckerman on 4/16/01 at 17:12 (044757)

If you have RSD you must be treated now . Get a consult with a pain management specialist who has experience with RSD. As you know early treatment is the cure. So get moving and get treated.

Re: PF with no heel pain

Dr. Zuckerman on 4/16/01 at 17:12 (044757)

If you have RSD you must be treated now . Get a consult with a pain management specialist who has experience with RSD. As you know early treatment is the cure. So get moving and get treated.