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What Next? This is horrible.

Posted by CHRIS M on 3/13/03 at 19:05 (112836)

I have had PF And heels spurs for a little over 3 years. I've tried everything: (or what i believe is everything) Custom made orthodics,cortizone shots,physical therapy, stretching,and ESWT 4 weeks ago. The ESWT has provided no relief at all. Actually, my feet are worse.
The pain has 'seeped' up to my lower back. Every step i take creates pain in my lower back. My back is now sore when sitting or laying down. I can't even think about wearing dress shoes. Standing for 45 minutes at my brother's wedding was a nightmare. I try to remain positve, but I don't see this going away. The pain is so chronic and pronounced i can't see it ceasing. I'm going to look in to surgery (the cutting kind.) This seems like my only hope! Can anyone give me some thoughts or suggestions on this? I'm 33 years old. I exercise daily, (no running, of course) I have very flat feet and a pronation in my right foot. Sorry about the whining and length of post. Thanks.

Re: What Next? This is horrible.

Dr. Z on 3/13/03 at 19:39 (112845)

I would give the ESWT alittle time. I would make sure I have plantar fasciitis/heel spur syndrome. If you do have it then plantar fascia release with heel spur removal would be you best choice. If you like to have information on Minimial incision plantar fasciotomy there is a video on this site and my web site is http://www.thefootspecialist.com . I have used this procedure for over twenty years. Feel free to ask for any advice

Re: What Next? This is horrible.

Pauline on 3/14/03 at 10:23 (112941)

Which machine was used for your ESWT and how soon after your treatment did you begin to notice the back pain?

It's possible your pain isn't related to your ESWT treatment or P.F. at all.

Can you tell if your pain runs from your back downward or from your foot up toward your back or neither just pain in your back along with your foot.

Have you seen an Internist or Neurologist since getting the additional back pain?

I'm not a doctor, but I wouldn't think about surgery until you definately identify the source of your back pain. Surgery on your plantar fascia
may not cure your pain at all and could leave you with TTS or RSD when is all is said and done. Look at the surgical postings on this site.

A few more tests from an Internist or Neurologist might not be a good investment before you consider surgery.

Re: What Next? This is horrible.

CHRIS M on 3/14/03 at 11:59 (112962)

Thanks for the response. I will give the ESWT a little more time. I believe it has helped my heel spurs a little, but certainly not the plantar fasciitis. I have been diagnosed with PF and have seen X Rays of my heel spurs. My left and right heel alternate on which one hurts worse.

I have been told and read that people with flat feet should not have minimal incision plantar fasciotomy. Is this true? Do you know if anyone in the Twin Cities would perform this surgery?

I believe my back problems have been caused somewhat by my orthotics. I'm not exactly sure what kind they are. They are a hard orthotic that is about 2/3 the length of my shoe. I think they were about $300.00.(Covered by my insurance.) Any advice on a possible change in orthotics would be appreciated.

I was unable to access the foot taping video. Could you briefly tell me what that is. Thank you very much.

Re: What Next? This is horrible.

CHRIS M on 3/14/03 at 12:14 (112965)

You're right, my back pain isn't related to my ESWT treatment. I've had the pain for a while. It has gotten worse lately. I don't know which machine was used for my procedure. I should have asked, but i didn't. (the kind that doesn't work. :)

I guess the pain really doesn't run, it just pretty much is my feet and back. I think i need to try different orthotics. I've been biking nearly every day and i believe this has probably led to my back ache as well.

I have never seen an Internest or Neurologist. I will read up on the surgical postings.

thanks for the reply.

Re: What Next? This is horrible.

Pauline on 3/14/03 at 14:37 (112984)

Did you ever consider that your orthotics could be causing part of your back pain? Since they change your gait, they can cause problems anywhere on the leg and even in the back. Remember everything is connected. Many people here cannot wear their custom orthotics and indicated that their foot pain got worse or they developed other pain. Have you tried just taping your feet and not using the orthotics to see if your back pain decreased? If not you might want to give it a try. Scott has a section on the site that describes taping.

Don't think your alone not knowing which way to turn next. We've all been there, but you'll find that those people that rushed into surgery thinking it was their cure all didn't always get the results they expected.

I think most of us have expermented with a large variety of items to see if we could get some relief. We have bags of 'stuff' in our closet hoping that the next item purchased would cure our P.F.

Your back pain deserves to be evaluated before you run for P.F.surgery and you might just try taping and going without your orthotics for a couple of days to see if you notice any improvement in your back pain.

Become your own detective. Trial and error on your own is sometime the P.F. patients best source of help. You might also lighten up on the cycling to see if that makes a difference. Some people have posted that it has agravited their condition.

Do yourself a favor and take your time, do all your homework, then make your decision on whether you should have surgery.

Re: What Next? This is horrible.

Dr. David S. Wander on 3/14/03 at 16:15 (112991)

I would also consider having some tests performed to rule out arthritic disorders. You can speak with your doctor regarding these tests or you can obtain an opinion from a rheumatologist. I get concerned when patients have failed conservative care and ESWT, have bilateral pain (left and right) and also complain of back pain. I really believe a rheumatology work-up is in order.

Re: What Next? This is horrible.

Rosemary on 3/16/03 at 14:22 (113135)

Dr. Wander, you mentioned that you have concern when people have bilateral pain, failed conservative care and ESWT and also have back pain. Do those who present with PF on both feet generally do not have other pains, such as back pain? What would you be thinking if someone does have the above symptoms. Thanks.

Re: What Next? This is horrible.

Dr. David S. Wander on 3/16/03 at 17:52 (113152)


In my practice, I see many more patients with pain on one side vs. bilateral heel pain. I certainly do see patients with bilateral heel pain, but in my practice the majority present to my office with pain in one heel. If a patient has heel pain (especially bilateral), has failed conservative care AND complains of back pain, I do begin to strongly consider other causes of the pain. Often, radiculopathy/radiculitis (a fancy name for nerve pain radiating from the back) can be the culprit or a host of rheumatological conditions such as rheumatoid arthritis, Reiter's Syndrome, Anklylosing Spondylitis, Lupus and many other disorders that can present with symptoms in the heel. Some of these disorders are more common in men, some more common in women. Most often, heel pain is caused by plantar fasciitis, but when conservative therapy has failed, I recommend having the indicated blood tests or a consult with a rheumatologist to rule out any of these conditions.

Re: What Next? This is horrible.

Mar on 3/17/03 at 07:00 (113186)

Dr Wander -

I'm glad to read this post, as I have an appointment with a rheumatologist tomorrow to evaluate all my tests and perhaps do other tests. I don;t have back pain but have had many tendonitises and bursitises over the years as well as IBS and just keep wondering. My GP and other docs seem to think it is only PF, but I need to set my mind at ease. I was glad to read your post and confirm for me that I am not just being paranoid! Mar