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Dr.'s What kind of heel pain do I have??

Posted by Todd W. on 5/12/04 at 17:58 (150482)

Hello, I am still having unexplained forefoot pain, and the dr. are having a hard time figuring it out...anyway, my question is I have been diagnosed with PF in both feet. I've had it in my right for 1 yr. left for 3 or 4 months. I had ESWT March 24th on both heels. No conservative treatment ever helped. I have first step pain and heel pain thruout the day. The only thing that really kind of helps is Vioxx, but I haven't taken that since 5 days before ESWT. My question is... I have heel pain thruout the day without it getting better...is this just Chronic PF or is it some kind of nerve problem or something else. My whole heel hurts on both feet not in the arch or no where else. I know it has only been 6 or 7wks for ESWT, but as the day goes by shouldn't my PF go away atleast a little???? I'm starting to think maybe I have Reiter's or something else??? Any opinions dr's???? I do have the HLA/B27 gene. Any help is VERY appreciated... Thanks Todd

Re: Dr.'s What kind of heel pain do I have??

BrianJ on 5/12/04 at 19:04 (150486)

Todd --

I'm not a doctor, but if you are HLA/B27 positive, it seems reasonable to do a more thorough work-up with your rheumatologist. He can try you on sulfasalazine or Humira (Humira does have serious potential side-effects, so ask questions). If you respond to these treatments, it would tend to indicate a systemic problem such as Reiter's, rheumatoid arthritis, etc. If you don't respond, it might help convince you that the problem is PF or nerve entrapment.

Re: Dr.'s What kind of heel pain do I have??

Todd W. on 5/13/04 at 16:13 (150523)

ok I am seeing the Rheumy Monday. Btw, how is nerve entrapment treated? Thanks

Re: Dr.'s What kind of heel pain do I have??

BrianJ on 5/13/04 at 20:31 (150549)

There are several kinds of nerve entrapment that cause foot pain. Most common is probably tarsal tunnel syndrome (TTS), which typically though not always causes burning, 'electrical shock' or pain down the inside of the ankle and through the bottom of the foot. Try tapping on the inside of your ankle below/behind the ankle bump. Does it hurt or buzz?

A neurologist can give you a nerve conduction velocity (NCV) test, which will help determine if you have nerve entrapment. Treatment for nerve entrapments is initially the same as PF (rest, ice, orthotics, etc.). If that doesn't work, surgery can sometimes help, but ONLY if you're sure nerve entrapment is actually the problem and ONLY if you have a good, experienced doctor.

Most importantly, remember that heel pain is usually caused by PF. I've had PF for 7 years now, and I spent a long time (and a lot of money) believing I must have something OTHER than PF. Turns out my problem is caused by degenerative changes in my plantar fascia. These changes occurred because I kept playing sports and jogging long distances even though it was painful. Finally, the pain got too great and I had to stop. Check out tendinosis.org if you want to learn more about the degenerative changes I'm talking about.

Good luck to you.