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

heel pain

Posted by Barb Carmichael on 9/06/01 at 13:06 (059231)

Can anyone help? Had EPF almost 10 months ago and still have terrible pain in rim of heel. Podiatrist says there's no more he can offer me. Have had MRI and there is no problem with scar tissue, which is what the dr. was looking for. Here's my question: do they have to be looking specificially for a stress fracture in the rim of the heel in order to know that is the problem? I am wondering if I have a stress fracture. Thank you very much.

Re: heel pain

Donna SL on 9/06/01 at 13:41 (059239)

Barb,

Have you had any nerve conduction studies done? An injured, or entrapped nerve like the lateral plantar nerve, or one of it's branches could cause these symptoms, but wouldn't show up on an MRI.

Donna

Re: heel pain

Barb to Donna on 9/06/01 at 15:36 (059260)

Thank you for answering Donna. May I ask another question? Do you know how nerve entrapment is taken care of?

Re: heel pain

Donna SL on 9/06/01 at 16:10 (059268)

Hi Barb,

I can give you many suggestions of what is helping me, but I'm on my way out the door to receive one of the treatments now. I will try to give you some info later. I can tell you that I had terrible rim heel pain, and once a doctor finally diagnosed nerve entrapment, I started getting treatment for it, and gained much relief. You should try to find someone who knows how to diagnose this either through exam or nerve conduction studies to confirm this.

More later.

Donna

Re: heel pain

Barb to Donna on 9/07/01 at 06:54 (059342)

Alright, it's 'later'.....how about 'more'????? lol I eagerly await any more information you care to share Donna!

Re: heel pain

Donna SL on 9/07/01 at 12:43 (059387)

Barb,

First of all you need to get a second opinion on what's going on. It may take several doctors who know how to pick this up. It needs to be determined if the pain you are having is independent of the surgery you had. Rim heel pain is usually caused my either injury, or inflammation to the inferior calcaneal nerve, also known as the baxter nerve which is a branch off the lateral plantar nerve. This may have gotten injured during surgery, or may just be compressed from adheshions, or scar tissue that can form from having chronic pain conditions like PF for so long. This would not show on an MRI.

If there are nerve problems the only way they can be indentified is through a nerve conduction study test, and possibly an EMG. You need to go to a physiatrist (physical rehab md), or neurologist that is also familiar with feet, and knows what to look for. All the major nerves in the foot should be tested. A good podiatrist would be able to tell them what nerves to test also.

Sometimes this doesn't show up on a nerve conduction test, and someone who knows what they are doing should be able to determine this through an certain exams.

It's critical to get a diagnosis on this, because the longer it goes on the more difficult it is to treat.

It took such a long time for me to get a diagnosis that the nerves in my feet started to get damaged, and I'm hoping they heal, even though a lot of pressue has been taken off them. It can take up to a year.

My situation is not as complicated as yours. I didn't have surgery, so what is working for me may, or may not work for you. Basically if there is pressure on the nerves some method needs to be used to get the inflammation off the nerves.

Some doctors use cortisone in that area to reduce inflammmtion. I decided to try Active release therapy (ART), and acupunture first, which has reduced my symptoms greatly. If I don't get the last few bits out I would consider cortisone treatment in the future. ART is usually performed by a chiropractor. If you absolutely cannot find an ART practitioner, then try myofascial release. Regular PT did nothing. Active release therapy (ART) is a non-invasive way of removing adhesions, and scar tissue off the nerves that form from chronic inflammation. I posted extensively on the subject in the spring on this board, and don't have the time to repost all the info. The best thing I can suggest to do is a search on this board under 'Active Release Therapy' or 'Active release technique' (technique is really the proper name) with my name. I did most of my posing in April 01, and beyond.

Don't let anyone do regular deep tissue massage on you. If it is nerve entrapment this will make it worse.

If this doesn't work for you, you need to find other ways to address this with other forms of injection therapies, medications, etc. If it is nerve entrapment, it won't get better on it's own. Don't consider any type of surgery for this until you have exhausted all conservative methods.

What ever you do once it's determined it's a nerve problem treat it as soon as possible. Otherwise it can develop into what's called a chronic pain syndrome, and is much more difficult to get rid of.

In the interim if you are not on some powerful anti-inflammatory like Vioxx, I would suggest you get on that right away to reduce the inflammation. In addition, also request a drug call neurontin to help calm the nerve pain down. If this doesn't work try Nortriptyline. This will also help the nerve pain from getting out of control. Also try to ice the inner part of your ankle behind the bone, and also the medial part of your heel, and also underneath the heel where the arch meets the heel, because that is the course the nerve follows. It may feel like you should ice at the rim of the heel, but that won't really help because that's just the area the nerve supplies feeling to, but not where it really is located at.

Good luck, and keep me posted if you get a diagnosis on this.

Donna

Re: heel pain

Barb to Donna on 9/07/01 at 15:41 (059405)

WHEW!!!! And THANK YOU. You are wonderful to take so much time to explain things. Thank you thank you. I WILL be getting a second opinion but not until early october. am using vocodin for pain and using celebrex and icing and already deal with chronic pain in other parts of my body. i try to stay off my feet as much as possible because this is the only thing that really helps. i AM thinking that maybe this situation existed before the pf surgery too; interesting too that i have had deep tissue massage on OTHER parts of my body for the chronic pain! did some physical therapy about 3 months after surgery cause the pain just wouldn't cease. cortisone injections have helped but i've had so many and have read all the negatives about having TOO many. but you have offered me so much to think about and, again, THANK YOU.

Re: heel pain good pain management site

Donna SL on 9/08/01 at 01:23 (059448)

Hi Barb,

You're very welcome. I was wondering about cortisone shots myself. Is the relief only temporary? What area did you have them done at? Try to find out if they were done near any of the nerves I mentioned in the other post. My pod, and everyone else that's been treating me kept talking me out of them, but I was thinking maybe they were wrong. The podiatrist that I got the second opinion from who diagnosed me wanted to do cortisone in the areas he thought the nerves were entrapped. He used to be the head of the surgical section at the Podiatry School here. I told him if nothing else works I'll be back. A physiatrist is doing the acupuncture in my feet, lower legs, and lower back.

This a wonderful website on chronic pain.

http://www.bayareapainmedical.com

It explains how it manifest itself. Maybe after reading this you'll understand why it is important to try drugs like neurontin, etc. to break this cycle they call wind-up pain. Look at both the patient, and doctor area. Also chronic pain can sometimes be resistant to drugs like vicoden. Neurontin, nortriptyline, etc., may help you more, and they are non-addictive. You can continue with the anti-inflammatory, but these drugs may give you much relief. Start with just neurontin. It's so mild, it won't hurt you. Try to see a pain management specialist.

I'm just learning now that the sooner you treat pain the better, and the longer it remains chronic the more difficult it is to get rid off. The nervous system become overly sensitive to pain.

The ART is a godsend though. It seems like your whole body gets screwed up when your feet are in pain, especially the lower extremities. A good chiropractor will give you relief in all these areas. Art can be performed almost anywhere on the body.

Also ask whomever you see to test for Tarsal Tunnel syndrome, which might be the case if one of the major nerves off the posterior tibial nerve is entrapped. I didn't have the traditional symptoms initially. (No positive tinnels sign) Mostly just heel pain, (the worst at the rims), plus all kinds of other foot pains that was initially only diagnosed as PF. I later had positive nerve conduction studies confirming tarsal tunnel syndrome.

Donna

Re: heel pain good pain management site

Donna on 9/08/01 at 14:52 (059511)

the site you recommended is AWESOME, to quote my daughter! i just had to take a minute to let you know, now back again for more info! thank you.

Re: heel pain good pain management site

Barb TO Donna! on 9/08/01 at 19:18 (059530)

How embarrassing! In my excitement to tell you I liked the pain management site I used YOUR name!

Re: heel pain good pain management site

Donna SL on 9/08/01 at 19:42 (059538)

And I thought we had new Donna on the Board. Ha Ha.

Glad you are enjoying the site. My physiatrist told me about it. He's a pain managment specialist too. I think he knows the doctors at Bay area pain medical. I've never been there. That office is around 14 miles from where I live. He said they have more experience them him in that area, but I think he's doing a good job so far. If I ever talk to any of the doctors there, I'll let you know what they have to say.

Donna

Re: heel pain

JeanB on 9/10/01 at 19:24 (059792)

I have tried both Celebrex and Vioxx. There is no comparison--Vioxx works the best for me. Celebrex is more specific to osteoarthritis pain. Vioxx covers a broader spectrum of pain.

Re: heel pain

Donna SL on 9/06/01 at 13:41 (059239)

Barb,

Have you had any nerve conduction studies done? An injured, or entrapped nerve like the lateral plantar nerve, or one of it's branches could cause these symptoms, but wouldn't show up on an MRI.

Donna

Re: heel pain

Barb to Donna on 9/06/01 at 15:36 (059260)

Thank you for answering Donna. May I ask another question? Do you know how nerve entrapment is taken care of?

Re: heel pain

Donna SL on 9/06/01 at 16:10 (059268)

Hi Barb,

I can give you many suggestions of what is helping me, but I'm on my way out the door to receive one of the treatments now. I will try to give you some info later. I can tell you that I had terrible rim heel pain, and once a doctor finally diagnosed nerve entrapment, I started getting treatment for it, and gained much relief. You should try to find someone who knows how to diagnose this either through exam or nerve conduction studies to confirm this.

More later.

Donna

Re: heel pain

Barb to Donna on 9/07/01 at 06:54 (059342)

Alright, it's 'later'.....how about 'more'????? lol I eagerly await any more information you care to share Donna!

Re: heel pain

Donna SL on 9/07/01 at 12:43 (059387)

Barb,

First of all you need to get a second opinion on what's going on. It may take several doctors who know how to pick this up. It needs to be determined if the pain you are having is independent of the surgery you had. Rim heel pain is usually caused my either injury, or inflammation to the inferior calcaneal nerve, also known as the baxter nerve which is a branch off the lateral plantar nerve. This may have gotten injured during surgery, or may just be compressed from adheshions, or scar tissue that can form from having chronic pain conditions like PF for so long. This would not show on an MRI.

If there are nerve problems the only way they can be indentified is through a nerve conduction study test, and possibly an EMG. You need to go to a physiatrist (physical rehab md), or neurologist that is also familiar with feet, and knows what to look for. All the major nerves in the foot should be tested. A good podiatrist would be able to tell them what nerves to test also.

Sometimes this doesn't show up on a nerve conduction test, and someone who knows what they are doing should be able to determine this through an certain exams.

It's critical to get a diagnosis on this, because the longer it goes on the more difficult it is to treat.

It took such a long time for me to get a diagnosis that the nerves in my feet started to get damaged, and I'm hoping they heal, even though a lot of pressue has been taken off them. It can take up to a year.

My situation is not as complicated as yours. I didn't have surgery, so what is working for me may, or may not work for you. Basically if there is pressure on the nerves some method needs to be used to get the inflammation off the nerves.

Some doctors use cortisone in that area to reduce inflammmtion. I decided to try Active release therapy (ART), and acupunture first, which has reduced my symptoms greatly. If I don't get the last few bits out I would consider cortisone treatment in the future. ART is usually performed by a chiropractor. If you absolutely cannot find an ART practitioner, then try myofascial release. Regular PT did nothing. Active release therapy (ART) is a non-invasive way of removing adhesions, and scar tissue off the nerves that form from chronic inflammation. I posted extensively on the subject in the spring on this board, and don't have the time to repost all the info. The best thing I can suggest to do is a search on this board under 'Active Release Therapy' or 'Active release technique' (technique is really the proper name) with my name. I did most of my posing in April 01, and beyond.

Don't let anyone do regular deep tissue massage on you. If it is nerve entrapment this will make it worse.

If this doesn't work for you, you need to find other ways to address this with other forms of injection therapies, medications, etc. If it is nerve entrapment, it won't get better on it's own. Don't consider any type of surgery for this until you have exhausted all conservative methods.

What ever you do once it's determined it's a nerve problem treat it as soon as possible. Otherwise it can develop into what's called a chronic pain syndrome, and is much more difficult to get rid of.

In the interim if you are not on some powerful anti-inflammatory like Vioxx, I would suggest you get on that right away to reduce the inflammation. In addition, also request a drug call neurontin to help calm the nerve pain down. If this doesn't work try Nortriptyline. This will also help the nerve pain from getting out of control. Also try to ice the inner part of your ankle behind the bone, and also the medial part of your heel, and also underneath the heel where the arch meets the heel, because that is the course the nerve follows. It may feel like you should ice at the rim of the heel, but that won't really help because that's just the area the nerve supplies feeling to, but not where it really is located at.

Good luck, and keep me posted if you get a diagnosis on this.

Donna

Re: heel pain

Barb to Donna on 9/07/01 at 15:41 (059405)

WHEW!!!! And THANK YOU. You are wonderful to take so much time to explain things. Thank you thank you. I WILL be getting a second opinion but not until early october. am using vocodin for pain and using celebrex and icing and already deal with chronic pain in other parts of my body. i try to stay off my feet as much as possible because this is the only thing that really helps. i AM thinking that maybe this situation existed before the pf surgery too; interesting too that i have had deep tissue massage on OTHER parts of my body for the chronic pain! did some physical therapy about 3 months after surgery cause the pain just wouldn't cease. cortisone injections have helped but i've had so many and have read all the negatives about having TOO many. but you have offered me so much to think about and, again, THANK YOU.

Re: heel pain good pain management site

Donna SL on 9/08/01 at 01:23 (059448)

Hi Barb,

You're very welcome. I was wondering about cortisone shots myself. Is the relief only temporary? What area did you have them done at? Try to find out if they were done near any of the nerves I mentioned in the other post. My pod, and everyone else that's been treating me kept talking me out of them, but I was thinking maybe they were wrong. The podiatrist that I got the second opinion from who diagnosed me wanted to do cortisone in the areas he thought the nerves were entrapped. He used to be the head of the surgical section at the Podiatry School here. I told him if nothing else works I'll be back. A physiatrist is doing the acupuncture in my feet, lower legs, and lower back.

This a wonderful website on chronic pain.

http://www.bayareapainmedical.com

It explains how it manifest itself. Maybe after reading this you'll understand why it is important to try drugs like neurontin, etc. to break this cycle they call wind-up pain. Look at both the patient, and doctor area. Also chronic pain can sometimes be resistant to drugs like vicoden. Neurontin, nortriptyline, etc., may help you more, and they are non-addictive. You can continue with the anti-inflammatory, but these drugs may give you much relief. Start with just neurontin. It's so mild, it won't hurt you. Try to see a pain management specialist.

I'm just learning now that the sooner you treat pain the better, and the longer it remains chronic the more difficult it is to get rid off. The nervous system become overly sensitive to pain.

The ART is a godsend though. It seems like your whole body gets screwed up when your feet are in pain, especially the lower extremities. A good chiropractor will give you relief in all these areas. Art can be performed almost anywhere on the body.

Also ask whomever you see to test for Tarsal Tunnel syndrome, which might be the case if one of the major nerves off the posterior tibial nerve is entrapped. I didn't have the traditional symptoms initially. (No positive tinnels sign) Mostly just heel pain, (the worst at the rims), plus all kinds of other foot pains that was initially only diagnosed as PF. I later had positive nerve conduction studies confirming tarsal tunnel syndrome.

Donna

Re: heel pain good pain management site

Donna on 9/08/01 at 14:52 (059511)

the site you recommended is AWESOME, to quote my daughter! i just had to take a minute to let you know, now back again for more info! thank you.

Re: heel pain good pain management site

Barb TO Donna! on 9/08/01 at 19:18 (059530)

How embarrassing! In my excitement to tell you I liked the pain management site I used YOUR name!

Re: heel pain good pain management site

Donna SL on 9/08/01 at 19:42 (059538)

And I thought we had new Donna on the Board. Ha Ha.

Glad you are enjoying the site. My physiatrist told me about it. He's a pain managment specialist too. I think he knows the doctors at Bay area pain medical. I've never been there. That office is around 14 miles from where I live. He said they have more experience them him in that area, but I think he's doing a good job so far. If I ever talk to any of the doctors there, I'll let you know what they have to say.

Donna

Re: heel pain

JeanB on 9/10/01 at 19:24 (059792)

I have tried both Celebrex and Vioxx. There is no comparison--Vioxx works the best for me. Celebrex is more specific to osteoarthritis pain. Vioxx covers a broader spectrum of pain.