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cortisone diagnostic question

Posted by chrisb on 7/10/03 at 10:37 (123946)

Dear Dr's -
2 weeks ago I posted that I was having a marcaine shot to narrow diagnosis of possible medial nerve inflammation. (I'm atypical PF 3 years, nowadays no first step pain, not overweight, ultrasound shows fascia 5.8 thickness, MRI shows nothing, nerve conduction test shows small latency but no tts, tried orthotics, pt etc) Since my calf & fascia are now supple but I can't walk 5 yards my doc suspects my original PF is now complicated by nerve involvement.
The marcaine shot was to where I understand the nerves sweep under the heel, i.e. slightly above and to the side of fascia insertion point. The shot eliminated the pain but as you pointed out, some of this effect could have been due to the marcaine dulling the area of fascia insertion as well as the nerve itself. You suggested mixing cortisone with the marcaine to see if the relief continued after marcaine wore off.
Exactly the protocol my doc followed. 6 days ago I had another shot to the same area - cortisone with a small amount of maracaine. After the marcaine wore off there doesn't seem to have been any diminution of pain. I imagined there was very slight improvement on day 2 but now its clear there's been no change.
Does this conclusively rule out nerve involvement?
Would this suggest I consider alcohol injection to the nerve, or ESWT, or a different treatment option?

Re: cortisone diagnostic question

Ed Davis, DPM on 7/10/03 at 16:55 (123968)


Keep in mind that the course of examination you are undergoing is not the only way to distinguish between PF and medial calcaneal nerve entrapment. The alcohol injection is worth a try.

If there is direct tenderness to palpation (pressure) on the origin of the plantar fascia, then the origin of pain is more likely to be the fascia as opposed to the medial calcaneal nerve. Pain upon arising (post-static dyskinesia) is more common with PF. If pain is worse, the day after increased activity, that points toward PF.