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nerve entrap injection-odd result

Posted by chrisb on 7/03/03 at 13:04 (123510)

I posted here last week, saying my doc was planning a marcaine injection around the medial calcaneal nerve area (he suspects nerve entrapment is part (or most) of my problem 3 years after PF onset). The plan was/is to see if the anaesthetic gives pain relief and this may help indicate nerve entrap. Well, a funny thing happened.
I expected the marcaine to wear off after 4-6 hours. 14 hours later it was still giving me pain relief. My night splint felt pain-free. The next day - surprise - there seemed to be marginal recovery. Very marginal, but something. 2 days later my doc had planned a cortisone shot to the same area, but instead decided to try another marcaine shot. Same result - very marginal improvement.
Does anyone have this experience, or any idea what it may indicate?

Now I'm 6 days later and the improvement has not continued. I'm going back to see what he suggests tomorrow.

Re: nerve entrap injection-odd result

Dr. Z on 7/03/03 at 15:43 (123520)

Hi

Marcaine is a Long acting anesthetic. It can last for 12 hours plus.
So what does this mean. It means that the medial calcaneal nerve is numb and part of this nerve gives feeling to the plantar fascia. Is there a direct relationship maybe but I doubt it. Did your doctor really completely just block this nerve or did he place some marcaine into the fascia is one of my guesses . Did you have an ultrasound of the plantar fascia. Do you limp whe you sit for a period of time. These are important questions whether trying to determine if the plantar fascia is the cause of your pain

Re: nerve entrap injection-odd result

chrisb on 7/03/03 at 21:55 (123543)

Thanks Dr Z for your valuable opinion.
Yes I have had an ultrasound which indicates my fascia thickness at 5.8 which could be diagnostic of PF I understand. However I do not limp when I sit for a period of time -- my best time is when I stand after resting, and the pain onset is proportional to the length of time I'm on my feet (not long) -- which I understand could indicate nerve entrap. Hence the unclear diagnosis in my case I suspect. Not knowing how much of my problem is PF or nerve is driving me crazy, but I feel I have to take action. I've had nearly 3 years of this and I refuse to throw away another 3 if there is any possible recourse.
What to do? ESWT is no use for nerve inflam, but I could try it anyway. Alternatively, I could opt for alcohol injection to kill the nerve or surgery. Or? What would you do if you were in my shoes?

Re: nerve entrap injection-odd result

Dr. Z on 7/04/03 at 09:36 (123565)

I would go for the Alchol injections to the medial calcaneal nerve and see what kind of relief you get. If no relief then ESWT

Re: nerve entrap injection-odd result

Ed Davis, DPM on 7/04/03 at 11:07 (123572)

chrisb:
I agree with Dr. Z's idea of trying alcohol sclerosing injections of the medial calcaneal nerve. The area that is still in a grey zone in my opinion, is the meaning of increased thickness of the plantar fascia. I believe that thickness needs to be adjusted for body weight, activity level and occupation. For example, if you are a 250 lb. contruction worker or a runner, I would definitely not conclude that 5.8 is too thick.
On the other hand, if you are a 120 lb. secretary, I would consider 5.8 mm to be within a pathologic range.
Ed