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PF getting worse and worse - lots of burning sensation now

Posted by KellyS on 8/04/01 at 11:21 (055447)

Hi-
I've had PF for about 18 months now, and didn't get treated for about the first 10, thinking it would just go away. I had no idea it could get this bad! I got an xray about 6 months ago, and sure enough there were heel spurs, too.

I've had a fair bit of conservative treatment - several pairs of orthotics, lots of stretching/icing, trying to rest but it's difficult because I have to walk some at work, advil and now vioxx. Have also just had a first treatment by a chiropractor who does Active Release Techniques. But I do not seem to be getting better, only worse. I am concerned that the orthotics have actually caused more pain, my doc has adjusted them multiple times and they still seem to press just at the insertion point and cause more pain. I understand most PF patients need orthotics in the long run to provide support, so I keep trying to wear them, keep trying them in different shoes, etc. For about one blissful month, they worked wonders, but then the improvement stopped abruptly.

Now I have pain almost all the time, even while sitting. And I have an awful lot of burning sensation in the heel areas. Does this indicate nerve trouble and if so, should I talk to my doctor about a specific treatment option? I am concerned about letting any nerve trouble go for a long time since letting the original PF go for too long obviously got me in this bind.

At what point should I consider ESWT or surgery? I am very very hesitant to try surgery of any kind on my feet, but am tempted to look into ESWT.
Does it ever happen that orthotics make PF worse? I used to be very active. Do your severe PF/heel spur patients ever get back to not having constant pain or maybe even getting to run again? My doc here seems to think that even with heel spurs, I should eventually be able to get back to some level of activity.

Suggestions appreciated!

Re: PF getting worse and worse - lots of burning sensation now

Dr. Zuckerman on 8/04/01 at 11:41 (055449)

Hi,

You have suffered for a long time. You need further evaluation which include a nerve work up. Have you found that your orthosis are making the foot hurt more, how about the rest of your lower extremity.

Many posters on this board report pf damage due to improper othosis.

and yes ESWT is something that you need to have if your clinical examination determined the need. We have many patients that get back to normal activity after ESWT.

Re: PF getting worse and worse - lots of burning sensation now

Donna SL on 8/04/01 at 14:30 (055468)

Kelly,

You may have some nerve entrapment from having PF for so long, or from the orthotics. The 1st branch of the lateral plantar nerve, or the lateral plantar nerve itself may be entrapped, and can cause most of this pain, and burning. Orthotics especially if they are not right sometimes can cause this, or make this worse, because they usually press on this area of the nerve, or could be causing a stretching of the nerve, depending on the position they are putting your foot in. Also if you have an ankle equinus a traditional orthotic could cause stress on the tissues, and eventually entrapment of these nerves.

Dr Zuckerman gave you good advice. Get someone to evaluate you for nerve entrapment. Once I was diagnosed, and treated with ART, my symptoms reduced dramatically. Make sure the ART practitioner is certified in lower body ART though. This is critical. You have to give it a chance, and have more than one treatment, and you should see results very soon. Also if you can, stop wearing the orthotics ASAP, and get into a softer padded heel like a spenco cross trainer orthotics to help relieve pressure on the nerve. Just tape the foot for stability though which is very important.

Someone just mentioned in article in JAPMA, that explains about this nerve entrapment, and how to diagnose it. Try to get a nerve conduction test.
This article is in Adobe Acrobat (PDF format) If you have trouble opening up adobe, it was reproduced on the treatment section of the board by someone named footpro on a thread that was started on 7/18/ 01 'reliability of the first few steps in the morning test' then look at 'any way to tell for sure' by footpro. I posted a response below his. But try below site first

http://www.japmaonline.org/cgi/reprint/90/6/281.pdf

This is a good article too.

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

You may have other nerves involved so it's important you go to someone that knows all the proper nerves to test.

If you don't have other complications, and the ART practitioner is certified in lower body, you should start to feel some relief after several sessions, and not wearing the orthotics. Also, have you had an MRI to rule out any serious lesions, etc. pressing on the area? Nerve entrapment does not qualify for ESWT. Some doctors have used cortisone in this area to reduce the inflammation, but I was advised against it by many doctors, and haven't needed it yet.

For now try icing on the side of your heels on the medial (inside) side of your foot. You can extend the ice to the ankle area, behind the bump, and also under the heel. This should give you some relief, because this is the natural course of the nerve, and where is is usually inflammed. Also it can extend to the lateral side of your heel, and foot.

Donna

Re: PF getting worse and worse - lots of burning sensation now

Dr. Zuckerman on 8/04/01 at 11:41 (055449)

Hi,

You have suffered for a long time. You need further evaluation which include a nerve work up. Have you found that your orthosis are making the foot hurt more, how about the rest of your lower extremity.

Many posters on this board report pf damage due to improper othosis.

and yes ESWT is something that you need to have if your clinical examination determined the need. We have many patients that get back to normal activity after ESWT.

Re: PF getting worse and worse - lots of burning sensation now

Donna SL on 8/04/01 at 14:30 (055468)

Kelly,

You may have some nerve entrapment from having PF for so long, or from the orthotics. The 1st branch of the lateral plantar nerve, or the lateral plantar nerve itself may be entrapped, and can cause most of this pain, and burning. Orthotics especially if they are not right sometimes can cause this, or make this worse, because they usually press on this area of the nerve, or could be causing a stretching of the nerve, depending on the position they are putting your foot in. Also if you have an ankle equinus a traditional orthotic could cause stress on the tissues, and eventually entrapment of these nerves.

Dr Zuckerman gave you good advice. Get someone to evaluate you for nerve entrapment. Once I was diagnosed, and treated with ART, my symptoms reduced dramatically. Make sure the ART practitioner is certified in lower body ART though. This is critical. You have to give it a chance, and have more than one treatment, and you should see results very soon. Also if you can, stop wearing the orthotics ASAP, and get into a softer padded heel like a spenco cross trainer orthotics to help relieve pressure on the nerve. Just tape the foot for stability though which is very important.

Someone just mentioned in article in JAPMA, that explains about this nerve entrapment, and how to diagnose it. Try to get a nerve conduction test.
This article is in Adobe Acrobat (PDF format) If you have trouble opening up adobe, it was reproduced on the treatment section of the board by someone named footpro on a thread that was started on 7/18/ 01 'reliability of the first few steps in the morning test' then look at 'any way to tell for sure' by footpro. I posted a response below his. But try below site first

http://www.japmaonline.org/cgi/reprint/90/6/281.pdf

This is a good article too.

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

You may have other nerves involved so it's important you go to someone that knows all the proper nerves to test.

If you don't have other complications, and the ART practitioner is certified in lower body, you should start to feel some relief after several sessions, and not wearing the orthotics. Also, have you had an MRI to rule out any serious lesions, etc. pressing on the area? Nerve entrapment does not qualify for ESWT. Some doctors have used cortisone in this area to reduce the inflammation, but I was advised against it by many doctors, and haven't needed it yet.

For now try icing on the side of your heels on the medial (inside) side of your foot. You can extend the ice to the ankle area, behind the bump, and also under the heel. This should give you some relief, because this is the natural course of the nerve, and where is is usually inflammed. Also it can extend to the lateral side of your heel, and foot.

Donna