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Pain on the rim of my heel

Posted by Signe on 4/24/01 at 23:24 (045635)

The best way to describe my pain is that it is all around the rim of my left heel, on the bottom but not centered. It was slight at first but after going on vacation last year, and lots of walking, it became constant and affects my life everyday now.

I've been to the foot doctor twice and he took xrays and gave me a hard heel cup. I've switched to New Balance walking shoes and a Rockport shoe. Both have good support and plenty of room for my toes. I even went to a rheumatologist to see if arthritis is causing the pain. I do have arthritis in most of my joints, and my left knee has also been especially painful since vacation, but because of allergies I can't take most conventional medicine. She gave me pain pills and that's it.

This has aged me quickly and is painful every day. Any thoughts what it might be? The doctors don't have an answer for me. I am a 54 year old female.

Re: Pain on the rim of my heel

Donna SL on 4/24/01 at 23:47 (045636)

Signe,

This is usually a sign of some type of nerve entrapment, or the beginning of it. Usually the inferior calcaneal nerve (Baxter's nerve), and possibly the lateral planter nerve is affected which causes these symptoms. I went undiagnosed for almost two years with this. I had the same symptoms. Get a second, or even third opinion, and find someone familiar with this. Surgical type podiatrist would probably be the best for diagnosing this, or a even a physiatrist.

They should order nerve conduction studies to confirm this. It may not show up on these test, so it's important for someone to know how to diagnose this by exam, and your symptoms. The longer you wait to get this treated the worse it will get.

Until you see someone make sure to ice the heels, and also put an ice pack along the medial(inside) part of your ankle in back of the bump down to the side of your heel too. Do this for 20 minutes a couple times of day.

Donna

Re: Pain on the rim of my heel

Dr. Zuckerman on 4/25/01 at 08:05 (045647)

Good answer. In addition you could have some equinus (short achilles) and some dysfunction within the ankle. Yes nerve problems must be ruled out.

Physical therapy is very important, rest, maybe possible cast. There is an excellent article on Tarsal Tunnel in the last months issue for Podiatry Today , go to their web site and take a look at the article.

Re: Do nerves heal? Re: Pain on the rim of my heel

Donna SL on 4/25/01 at 10:21 (045661)

Dr Z,

I only found a bunch of articles in Podiatry Today in the Oct 2000 issue. I couldn't find anything newer on TTS. Is there newer info that I'm missing?

*** Most importantly do you know if entraped nerves that have been damaged can heal once they become thoroughly 'un-entrapped' via ART, other conservative methods, surgery, etc.

If slowing on NCV test suggest demyelination of the nerves involved does that mean permanant damage? One of the four nerves (ICN) I mentioned in the above post also showed possible motor axon injury. Do injured nerves repair themselves?

I have an appointment with a neurologist next week, but I'm just curious to know now. I haven't been able to find much info on the web yet. The pod doesn't want to do any cortizone shots until I've completed any additional neurological testing. If nerves do heal would cortisone increase the recovery time of the damaged nerves?

Donna

Re: Do nerves heal? Re: Pain on the rim of my heel

Dr. David S. Wander on 4/25/01 at 14:46 (045685)

Donna,

While you are searching the web, look for articles written by Dr. Dellon. He is a plastic surgeon that specializes in nerve entrapment problems and has written extensively on this subject. He has pioneered some interesting procedures and theories and a new method of testing for neuropathy. I believe he practices in the Baltimore area.

Re: Do nerves heal? Re: Pain on the rim of my heel

Dr. David S. Wander on 4/25/01 at 14:55 (045689)

Dr. Dellon's website is simply: http://www.dellon.com
His name is A. Lee Dellon, MD

Re: Do nerves heal? Re: Pain on the rim of my heel

Dr. Zuckerman on 4/25/01 at 17:25 (045709)

He has a diabetic neuropathy clinic at John Hopkin in Baltimore Maryland.
He really knows alot about TTS.

Re: QST for nerve testing Re: Do nerves heal? Re: Pain on the rim of my heel

Donna SL on 4/25/01 at 17:25 (045710)

Hi Dr Wander, (anyone needing nerve testing please read)

Thanks for responding, and providing some info. The pod who diagnosed me mentioned Dellon, and the QST testing. (I had forgotten all about the QST testing, until you mentioned it again). When I looked at his site a while back it wasn't clear if the damaged nerves healed. I'm sort of assuming they do, or it would be pointless for someone to go through surgery. I still can't seem to find much info yet. Just by having the Active Release therapy I'm seeing a considerable improvement. I'm just curious if you know if the nerves will totally heal?

The company that manufactures the Quantitative Sensory Equipment (QST) has a web-site. Someone is calling me back tomorrow to give me a name of a doctor who uses the QST equipment in my area. It suppossed to be more sensitive in picking up entrapments then NCV testing, and also is suppossed to me pain less. I would prefer to have that done than another NCV test if needed, which I found a little uncomfortable, and irriated my nerves for a week or so.

Here's the site if anyone needs to get tested for any nerve problems, and wants the QST testing instead of the traditional Nerve conduction test. They list centers that use QST on the web, but will give you someone specific in your area, if you call them.

http://www.medoc-web.com/

Donna

Re: QST for nerve testing Re: Do nerves heal? Re: Pain on the rim of my heel

Dr. Zuckerman on 4/25/01 at 17:38 (045715)

Thanks. We are near Philadelphia . Just learned something. Thanks. I have had a very hard timing finding this testing

Re: QST for nerve testing Re: Do nerves heal? Re: Pain on the rim of my heel

Donna SL on 4/25/01 at 17:59 (045719)

Dr Z,

Glad I could help. Boo hoo hoo, I'm gonna cry though. I wish someone could answer my question about healing nerves.

Donna

Re: Do nerves heal? Re: Pain on the rim of my heel

Dr. Zuckerman on 4/25/01 at 18:37 (045723)

Hi,

I can have you crying. So here goes. The cause of the nerve injury is what will determine the ability to heal If the nerve is entraped yes taking the pressure off of that herve can reduce its ability to cause pain.

Le't see what the neurologist has to say. Another thing to keep in mind is that if the pf is pressing on the nerves then treating the pf can help. Local steriod injections can help. So keep me updated with your appointment

Re: Pain on the rim of my heel

Donna SL on 4/24/01 at 23:47 (045636)

Signe,

This is usually a sign of some type of nerve entrapment, or the beginning of it. Usually the inferior calcaneal nerve (Baxter's nerve), and possibly the lateral planter nerve is affected which causes these symptoms. I went undiagnosed for almost two years with this. I had the same symptoms. Get a second, or even third opinion, and find someone familiar with this. Surgical type podiatrist would probably be the best for diagnosing this, or a even a physiatrist.

They should order nerve conduction studies to confirm this. It may not show up on these test, so it's important for someone to know how to diagnose this by exam, and your symptoms. The longer you wait to get this treated the worse it will get.

Until you see someone make sure to ice the heels, and also put an ice pack along the medial(inside) part of your ankle in back of the bump down to the side of your heel too. Do this for 20 minutes a couple times of day.

Donna

Re: Pain on the rim of my heel

Dr. Zuckerman on 4/25/01 at 08:05 (045647)

Good answer. In addition you could have some equinus (short achilles) and some dysfunction within the ankle. Yes nerve problems must be ruled out.

Physical therapy is very important, rest, maybe possible cast. There is an excellent article on Tarsal Tunnel in the last months issue for Podiatry Today , go to their web site and take a look at the article.

Re: Do nerves heal? Re: Pain on the rim of my heel

Donna SL on 4/25/01 at 10:21 (045661)

Dr Z,

I only found a bunch of articles in Podiatry Today in the Oct 2000 issue. I couldn't find anything newer on TTS. Is there newer info that I'm missing?

*** Most importantly do you know if entraped nerves that have been damaged can heal once they become thoroughly 'un-entrapped' via ART, other conservative methods, surgery, etc.

If slowing on NCV test suggest demyelination of the nerves involved does that mean permanant damage? One of the four nerves (ICN) I mentioned in the above post also showed possible motor axon injury. Do injured nerves repair themselves?

I have an appointment with a neurologist next week, but I'm just curious to know now. I haven't been able to find much info on the web yet. The pod doesn't want to do any cortizone shots until I've completed any additional neurological testing. If nerves do heal would cortisone increase the recovery time of the damaged nerves?

Donna

Re: Do nerves heal? Re: Pain on the rim of my heel

Dr. David S. Wander on 4/25/01 at 14:46 (045685)

Donna,

While you are searching the web, look for articles written by Dr. Dellon. He is a plastic surgeon that specializes in nerve entrapment problems and has written extensively on this subject. He has pioneered some interesting procedures and theories and a new method of testing for neuropathy. I believe he practices in the Baltimore area.

Re: Do nerves heal? Re: Pain on the rim of my heel

Dr. David S. Wander on 4/25/01 at 14:55 (045689)

Dr. Dellon's website is simply: http://www.dellon.com
His name is A. Lee Dellon, MD

Re: Do nerves heal? Re: Pain on the rim of my heel

Dr. Zuckerman on 4/25/01 at 17:25 (045709)

He has a diabetic neuropathy clinic at John Hopkin in Baltimore Maryland.
He really knows alot about TTS.

Re: QST for nerve testing Re: Do nerves heal? Re: Pain on the rim of my heel

Donna SL on 4/25/01 at 17:25 (045710)

Hi Dr Wander, (anyone needing nerve testing please read)

Thanks for responding, and providing some info. The pod who diagnosed me mentioned Dellon, and the QST testing. (I had forgotten all about the QST testing, until you mentioned it again). When I looked at his site a while back it wasn't clear if the damaged nerves healed. I'm sort of assuming they do, or it would be pointless for someone to go through surgery. I still can't seem to find much info yet. Just by having the Active Release therapy I'm seeing a considerable improvement. I'm just curious if you know if the nerves will totally heal?

The company that manufactures the Quantitative Sensory Equipment (QST) has a web-site. Someone is calling me back tomorrow to give me a name of a doctor who uses the QST equipment in my area. It suppossed to be more sensitive in picking up entrapments then NCV testing, and also is suppossed to me pain less. I would prefer to have that done than another NCV test if needed, which I found a little uncomfortable, and irriated my nerves for a week or so.

Here's the site if anyone needs to get tested for any nerve problems, and wants the QST testing instead of the traditional Nerve conduction test. They list centers that use QST on the web, but will give you someone specific in your area, if you call them.

http://www.medoc-web.com/

Donna

Re: QST for nerve testing Re: Do nerves heal? Re: Pain on the rim of my heel

Dr. Zuckerman on 4/25/01 at 17:38 (045715)

Thanks. We are near Philadelphia . Just learned something. Thanks. I have had a very hard timing finding this testing

Re: QST for nerve testing Re: Do nerves heal? Re: Pain on the rim of my heel

Donna SL on 4/25/01 at 17:59 (045719)

Dr Z,

Glad I could help. Boo hoo hoo, I'm gonna cry though. I wish someone could answer my question about healing nerves.

Donna

Re: Do nerves heal? Re: Pain on the rim of my heel

Dr. Zuckerman on 4/25/01 at 18:37 (045723)

Hi,

I can have you crying. So here goes. The cause of the nerve injury is what will determine the ability to heal If the nerve is entraped yes taking the pressure off of that herve can reduce its ability to cause pain.

Le't see what the neurologist has to say. Another thing to keep in mind is that if the pf is pressing on the nerves then treating the pf can help. Local steriod injections can help. So keep me updated with your appointment