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B27 antigen and plantar fasciitis/heel spurs

Posted by theresa g on 5/20/04 at 16:58 (150919)

I am female and 47, have had one foot operated on for pf 18 months ago. The heel pain is gone (thankfully), but I have some mild swelling and pain in the metatarsals of the 3 smallest toes. I wonder if this is related to the limp and exquisite pain I have from the heel spur in my other foot. I wear orthotics from the Good Feet store, which worked great for the first 2 months I wore them (long break-in period increasing 30 minutes of wear each day). Prior to the surgery, I had a cortisone injection in the right foot because of the pain and got relief for exactly 6 weeks, at which time the fascia ruptured. I heard the snap and immediately was unable to bear weight on it. 5 months later, I had the surgery after having no relief from exercises, icing, medications or 4 months in the cam-boot.

I know that I have the B27 antigen due to tissue typing for my youngest son's bone marrow transplant. I never had any back pain, though my dad was disabled from back pain. My brother, age 43, also has B27 and heel spurs.

What is the general consensus of people with B27 and heel spurs? It seems that it is rather common for we 'lucky' bearers of the B27. I don't know for a fact, but I imagine that I have arthritis in my feet also, weather changes are brutal. I'm sucking down ibuprofen like crazy (1600 mg on good days, 3200 mg on bad days) and Vioxx doesn't do anything. Can't take naproxen since it messes up my kidneys and Tylenol does no good.

My insurance has disallowed coverage for the second heel surgery (long story omitted), so I'm either going to have to tough it out till I finish my MLT course and get a job in about 4 months (hopefully that has insurance that will cover this without a wait period) or get out the cam-boot again and hope that I can function for a few more months. I will probably get the injection, though I'm leary of doing this again. I'm having difficulty getting through the day in the lab, when I spend a lot of time on my feet. I sit down when I can, but as you know, the pain is always worst when you first get up. Any suggestions?

Sorry this is so long. Thanks for any answers, suggestions or commiserations.

Re: B27 antigen and plantar fasciitis/heel spurs

Ed Davis, DPM on 5/21/04 at 15:10 (150974)

theresa:
Having the HLA-B27 allele predisposes one to heel pain of an inflammatory origin. It is often a reason not to do surgery because it calls the diagnosis of true plantar fasciitis into question.
Ed

Re: B27 antigen and plantar fasciitis/heel spurs

theresa g on 5/21/04 at 15:46 (150980)

What would be done, other than surgery? I don't desire surgery, but I don't desire the pain, either. I'm already at the max for my pain meds, as mentioned in the original post. What would be a way of determining true PF? The podiatrist that did the surgery was convinced that it was PF. Prior to the surgery on the right foot, I hadn't mentioned the B27 to him because I wasn't aware of the implications. It wasn't till I was doing some research for my Serology/Blood Bank/HLA class that I happened upon this link between heel pain and B27 (not homozygous in my case).

Re: B27 antigen and plantar fasciitis/heel spurs

ann m on 5/21/04 at 23:03 (151008)

Suggest you visit a rheumatologist. I'm B27+ and have been dealing w/severe foot pain for >20yrs along with other aspects of spondyloarthropathy. Anti-inflammatory meds can be very effective for some--they've helped my other symptoms but limited effect on feet. Good luck.

Re: B27 antigen and plantar fasciitis/heel spurs

theresa g on 5/22/04 at 07:10 (151017)

Thanks for the info. What other sorts of problems (which joints) are you having problems with? So far, all I have to deal with is heel, foot, some knee pain and occasional wrist and hand pain (which I used to attribute to mild carpal tunnel syndrome and clarinet playing-now I'm not so sure). How did you find out you were positive? Which anti-inflamatories have you used?

Re: B27 antigen and plantar fasciitis/heel spurs

Ed Davis, DPM on 5/23/04 at 13:40 (151078)

theresa:
It is definitely possible to have PF plus chronic inflammation of the fascia secondary to an HLA-B27 related type of arthritis. They are not mutually exclusive. Although I would keep a close watch to see if your symptoms wax and wane with inflammation as measured by a ESR (erythrocyte sedicmentation rate).

HLA-B27 aside, one must still consider the entire gamut of non-surgical treatment before surgery. Scott's Heel Pain Book is an excellent place to start in order to understand the nature of conservative treatment. ESWT is the latest conservative treatment with a very high success rate for PF.
Ed

Re: B27 antigen and plantar fasciitis/heel spurs

theresa g on 5/23/04 at 19:38 (151088)

According to the website, there is not a place in Oklahoma to have ESWT done. Closest is Houston, 10 hours away. My last ESR was normal, approximately 5 months ago, which would lead me to believe that more trouble is coming from PF.

Also, my insurance has disallowed treatment on my left foot because I was just recovering from surgery on the right foot when we got the policy (for self-employed people). Once I finish my coursework and get licensed, I hope to get a permanent job with benefits. Group insurances are less likely to disallow pre-existing conditions, especially if I don't mention it.

I'm considering getting a night splint, too. Hubby isn't too enthusiastic about it, but it's not his feet that hurt!! What is the most popular brand? I'm considering the HealWell, because it leaves more air to circulate. I have a problem with hot flashes/power surges at night and don't really want to have my foot baking in a foam casing.

Thanks,
theresa

Re: B27 antigen and plantar fasciitis/heel spurs

Ed Davis, DPM on 5/25/04 at 14:27 (151218)

theresa:
Choice of night splints are often based on the comfort factor if it is not comfortable it won't be used). The N'Ice and Stretch which was available on this site got high marks for comfort. We use that and one called the 'Cub.'
Ed