Hello Scott,

I have been reading your notes on plantar fasciitis, heel spurs, tarsal tunnel syndrome, and nerve damage with much interest and sympathy because I have been suffering from the same conditions for almost 10 years now. In 1991, I began having pain in my left heel after walking, and I went to see my primary care physician, who simply prescribed me Ibuprofin. For a second opinion, I went to a podiatrist who took x-rays and diagnosed me as having heel spurs. He treated me with cortisone injections, lowe-dye strapping, and orthotics, and in '92, performed an endoscopic surgery to release the plantar fascia. During my recovery from the surgery, my right foot began to ache as well, presumably because I was on it entirely to allow my left time to heal. Soon, the doctor was injecting cortisone in my right foot also, with only temporary relief ( approx. one month). I thought that I could work on my feet if I were to wear "comfortable" shoes with my orthotics, so I became a bartender.

As the years passed, the pain became more severe, and as I tried to walk I distributed my weight to the outside of my feet, causing me to sprain my ankles several times. Without medical insurance, I didn't see how I could afford to see the doctor, so I continued to abuse my feet working on them for 8 - 12 hrs. a day, working two jobs at once.

Eventually, I couldn't stand (pun intended) the pain any longer, so I informed both of my employers in June '96 that I was going to take a few months off for rest, knowing that if I stayed off my feet for a while, the intensity of the pain would subside somewhat. Which it did, until that September, when I took a walk up to a local park to test my limitations. The pain following that short walk was unbearable, and I couldn't walk without crutches. Knowing that I couldn't bartend on crutches, I had someone take me to a hospital, sans insurance.

After running a few tests and x-rays, the hospital put me on disability and recommended heel spur removal surgery. I sought the advice of about 20 doctors before undergoing two separate procedures of sawing off the heel spurs, plantar fasciotomy, and removal of the calcaneal branch nerve in '97. The advised length of recovery was one year, after which I went to another orthopedic surgeon, who sent me to a neurologist for an MRI and NCV tests. They advised me that I had tarsal tunnel, pinched nerves from scar tissue as a result of the repeated cortisone injections, and surgeries. So the orthopedic doctor performed tarsal tunnel release surgery on each foot simultaneously in '98.

Although hope springs eternal, honestly, after each surgical procedure, I've been worse than before. Now, I can't stand for 10 min., in the shower, brushing my teeth, washing the dishes. I have had to learn to change the way I live my life from day to day, with a hand-held shower massage sitting in the tub, and with a foam rubber cushion in front of the kitchen sink to wash dishes on my knees. I often crawl to the bathroom, and I use ice packs at least six times a day to cool the intense burning sensation of my feet. I need to use a wheelchair when I go anywhere, and I've been using electric carts in the grocery stores for years now.

Although I can force myself to walk, it's not worth the consequences of pain that I have to pay for weeks afterwards.

Moral of this story? My advise to you is to avoid having any surgeries on your feet, because you could get crippled like me for life at age 40.

Best of luck,
Janet

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In September of '99 I first felt a little nagging tug in the middle of my heel that completely resolved if I ignored it and kept on walking and standing. Running after two toddlers had me standing most of the time barefoot on tile floor or floor with a worn carpet pad. The pain in my left foot continued to worsen, stretching only made things worse, ibuprofen had stopped working, and I knew I had to get to the doctor. I had minimal morning pain. My pain worsened to more I walked.

The doctor's only sugggestion was cortisone and more powerful NSAIDS, and because I wanted to keep nursing my daughter, I refused. After a load of over-the-counter inserts failed, I knew I had to do something more drastic. I put myself in cast-boot for two weeks, and when I tried to walk a little bit, I felt a searing rip where my heel met my arch, numbness at the tip of my toes, an electric feeling on top of my foot, and heel pain beyond my control. My self-casting was a disaster.

I bought a night-splint (and a very good and expensive one). No matter how I adjusted it, my toes would be numb in the morning with no relief from the pain. Naprosyn also brought no relief. 400 dollar custom orthotics were impossible to wear because of the pain, even though I tried to break them in slowly. A cortisone shot failed, even though it was skillfully administered through the side of the heel. My only option was to wean the baby and try more drugs. At this point I was crying every day for hours at a time. I was unable to walk more than five steps at a time. My knees were bleeding and my wrists were sore, and frequently my hand would go numb from crawling. I felt atrophy in my calf muscles. Crutches only made my "good foot" worse. I now was in constant pain, even while resting.

I finally weaned the baby after a very traumatic weekend. I then began Daypro and began getting sick enough to vomit at night with no relief from the pain. I then tried Vicodin to sleep, but it only made me groggy. In three months I spent over 600 dollars in chiropractic treatments that helped my flexibility, but drained me. They were painful, and my relief lasted only for two days. Taping did not help. Lengthly ultrasound sessions brought no relief. My nutrition was excellent, and I supplemented regularly with every joint and ligament building thing I could get my hands on. Still, I noticed no improvement.

I finally went into a wheelchair at the end of June. I also began taking Effexor, which is an anti-depressant. This greatly helped the crying jags and helped me to manage life in the wheelchair. I tried a second cortisone shot, which also failed. The podiatrist was amazed to see someone in a wheelchair with PF. He had never seen that before in all his 15 years of practice. Before, I was an active, happy, athletic woman who walked two miles every morning, and now I could barely stand. I have had two home births (and painful ones) and I know how to take pain and grin and bear it. This pain was unreal and woke me constantly. I tried a TENS unit with limited success, and I used it just to get to sleep and wore it all night. I was plagued with fears about how to prepare meals, life the baby out of her crib, and try to dress everybody. I could not stand in the shower and it was hard to lower myself into the bath. Formerly a meticulously neat person, there were stretches of days when I simply couldn't go from room to room to bathe or brush my teeth. The wheelchair made things better, but it was sort of nightmarish to be in it. Everything I'd done had only made me worse. I despaired of getter better - ever. Coupled with this was the disbelief that doctors and other folks had about the degree of my pain - I wished that they could have my pain and see, just for one day, what my life was like. I felt like something freakish had happened to me.

This time the doctor tried prednisone (5 day course) and then followed it up with Celebrex. The pain spread throughout my foot, branching out from my heel, and so he sent me to a neurologist, who did an lengthly exam and EMG. He was puzzled, because I checked out 100% normal. I began having an electric shock feeling in my fascia from heel to great toe that sort of "twanged" when I moved. Then I began swimming more to improve my motion. I then swam daily, despite the great pain I felt walking those 30 steps to the pool.

SLOWLY, I began walking more and more. I stopped stretching, stopped wearing the mightslint, and I felt more improvement. An MRI showed that I had a thickening of the plantar fascia and mild edema. Typical PF MRI. I now was walking from room to room and then dropping to my knees or sitting. I was out of the wheelchair for he most part, with days of setbacks. I now had a little more hope, although not much changed practically - I still ordered all the groceries and home necessities over the internet, and hired a young woman to vacummn, dust, and take the kids for walks. These things helped greatly to normalize my routine and life.

I had always been adverse to the idea of surgery because I feel that this tendon is needed to support my foot. I am only 33 years old and I am wary of the long-term effects. I made the decision to have ESWT (the higher power kind) in my left foot in October with Dr. Zuckerman in NJ. Although I am still recovering from the procedure, I have good hope that this may finally resolve the problem. If not, I intend to try a minimal incision type of sugery.

My advice to sufferers would be to heed your body's warnings very early, and do not be afraid to switch tactics very quickly when something doesn't work. Also, take control of depression immediately. Very bad cases of PF are traumatic and life-changing and they can take a LONG time to recover from. Keep plugging away despite frustrations, and don't be afraid to change doctors to find one who is more sympathetic and helpful. One thing that I do know about PF without a doubt is that different cases respond to dramatically different treatments. You really have to be persistent and find which one is for you.

Barbara TX, 10/23/2000

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Posted by wendyn on 10/23/00 at 22:49
I don't know if this qualifies as "heel hell" or not, but I'll put it all in one place nevertheless.

My foot pain started when I was 11 years old - quite suddenly. It was eventually diagnosed as some type of tendon dysfunction, and my arches began to collapse. I had bunion surgery at 22, but nothing could prepare me for the foot problems that awaited me.

For the record, I have never been overweight - the most I've ever weighed is 117 lbs (other than pregnancy). I state this for the benefit of those who believe that only overweight people get PF.

Three years ago, after starting a "get in to shape" program - I developed painful shinsplints and then suddenly intense pain in my feet. I had been jogging and doing aerobics a lot. The pain in my feet was diagnosed as PF, and a local podiatrist taped my feet (this provided great relief) and custom made a pair of hard plastic orthotics. My feet healed over a period of about 6 weeks.

The following summer (just over two years ago) I foolishly ran about in flat sandals on cement for several days. This triggered a recurrance of PF that kept me out of the gym for the better part of 6 weeks. I saw my podiatrist, he taped my feet again and patted me on the head. He suggested I stretch a lot, but he never told me how. He gave me a prescription for NSaids that I never filled. He never told me not to go barefoot. It was around this time that I remember telling him that my feet were starting to just ache all the time.

In October or November two years ago, I developed a sudden intense pain in my right foot while walking. My foot swelled slightly and started going numb. I ignored it and continued to exercise. Eventually the pain became significant and I went back to the Pod. He suspected I had a "global strain", he prescribed ice, Naproxen and rest. I followed the suggestions for the most part (I don't think I rested as much as I should have) but the pain continued. I returned in agony a few weeks later. He refilled my Naproxen, did an xray (normal except for bone spur) and ordered blood tests for Diabetes/Lupus/Rheumatoid arthritis and Sed rate. When all returned okay, he suspected TTS but he wasn't sure. I rested lots and it seemed to help.

The pain came and went and I headed off to a sports medicine specilist after developing sciatica. He belived I had Posterior Tibial Tendonitis, and he had concerns about my lower back. He prescribed physio and possibly new orthotics. I saw the physiotherapist regularly over the next six months. He was baffled by my up and down progress and the sudden severe recurrances of my pain. He and the Sports Med doctor discussed the possiblity I may have MS (they later dropped this theory but it was scarey just the same).

Following a significant increase in pain my pain (again it started during a mild walk), sports med doctor ordered a bone scan. This was relatively normal. He prescribed Elavil and Voltaren for my pain. At this point, I had developed pain in both feet and could barely walk at all. I couldn't eat or sleep and I started losing weight. I never took the drugs because I was afraid they would only mask the pain, and I wanted to know what was really wrong with me. In retrospect, I should have taken something - but I put up with the pain for weeks on end.

In desperation, I returned to Pod #1. He said I definately had TTS, he raised my orthotics even higher (this made me much worse) and told me that his partner could give me a coritsone should and make me all better. I met with the partner, when I tried to discuss possible side effects or complications from the shot (so I could at least make an informed decision)- he laughed and told me that he wouldn't poke an artery and have me bleed to death on the floor. Honest to God that is what this man said. I left, and never went back.

I had new orthotics made by the physio place, I could tolerate these slightly more than the others - but I still couldn't walk more than a block or so slowly at a time. Phsio place suspected I may have RSD - at this point my one foot was rather odd colored and hypersensitve to even the slightest touch.

The sports med referred me to another sports med who specialized in compartment syndromes, and he also requested nerve conduction tests. The wait was about three months for the doctor, and close the five months for the tests.

The nerve conduction tests showed a latency in both medial and lateral plantar nerves (slight) but due to a mix up during the exam - the tester "forgot" that I had pain in both feet and not just one. Therefore, he concluded that this could not be causing my problem. He recommended "conservative" measures for six more months.

The new sports med doctor did six xrays on my hips and pelvis etc and decided that I probably had Ankylosing Spondylitis. He sent me for another bone scan on both feet, legs, hips, pelvis and lower back. The bone scan was negative, he decided that I probably had TTS. He recommended several months on celebrex and phsyio/acupuncture. He also suggested maybe a cortisone shot, but warned that it could cause rupture of the Post Tib tendon. I received a referral to a foot and ankle surgeon and I was advised that the wait would be six months.

I started wearing Birks and they were the first thing that made any difference. I also started acupuncture and yoga and the combination seemed to help too. My blood test for B12 came back borderline low, and following supplementation - my pain level also continued to drop.

In an effort to find a pair of orthotics that I can actually wear, I bit the bullet and tried pod #3. He was very nice. He suspected that I did in fact have TTS, and suggested I wait to see the surgeon. He did not feel that I would be able to tolerate the orhotics and suggested I wear Birk inserts in my sneakers - he was right, I find them much more comfortable.

At this point my GP felt that I was sufferinf from some type of systemic neuropathy. I was sent to a neurologist for follow up nerve conduction tests - the wait was five months.

Nerve conduction tests were redone a few months ago - 100% normal.

Saw the foot and ankle surgeon, he suspects my pain is from my arches collapsing and causing tension on the nerves. The only surgical option is Pes Planus reconstruction. He ordered an MRI - the wait for the MRI was 5 months, I will have my results this week.

Phew, I think that covers the highlights.

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From CindyP:
Oh my where to begin. 7 years ago (how depressing) I went to a doctor for heel pain. The 3200 mg. of ibuprofen route didn't work. He sent me on to a decent orthopedist. After x-rays and looking at feet he said pf. Sent me to physical therapy for 90 days and it almost worked except for one sore spot. But the ortho guy said if this doesn't work come back for the cortizone injections. At that time I said to self "Dr. been smoking weed if he thinks he sticking me in my foot with needle." Over the years I ate boxes of ibuprofen and the like and thought maybe it would go away or I could learn to ignore it. But the pain level has made a slow progression into burning torture. About almost 1 year ago I found v.a. medical benefits were available to me so I went to the emergency room thinking I can hurry this up because I was tired of the life changing devestation of this pain. I was thinking oh it may have turned into tarsal tunnel. After waiting a month and a half ( they work slow) I saw a pod. He took a look see ( you cannot touch my foot with out really pain) and sent me to an mri which took a month to get in and then two weeks to get back to him. That one didn't work( I moved it is painful to be still for that long).So another month and a half passes to get from mri back to see him. This one was all of two hours but learned the trick. The mri tech came in and told me "now taking picture lay still" So when I see the pod he said a neuroma in your heel I dont do this will get you to the neurologist. So I said I just wait for them to call me. He said yes. Two weeks went by then no phone call. So I call them and after much run around and me yelling they said " YOu no candidate for neurosurgery." So where do I go I said. We will get you appt. for ortho. Did I mention pod gave me script for indocin and elavil. Just makes me tired didn't take away pain. So when I went to see ortho he looked at my mri and he said we cannot remove this too much possible scaring could end up worse than before blah blah blah. Silly me I thought my goal was to get my life back. You just told me so sad to bad. But he told me he would consult with foot surgeon in Louisville and call me back in two weeks seeing what they said. Also scheduled me for nerve conduction test. Well two weeks pass and no call. So mad i am now. Go to see my local state representative and said help . After he makes phone calls I get call from hospital.Cancelling nerve conduction test because they didn't feel it would serve any purpose? Have never understood that. Well I guess that ortho had gotten yelled at . They rescheduled my appt to see him. Then when I get there they told me they had tried to call and cancel that. By this time I am ready to scream .So after those many months I had received no actual treatment. Just a different script for neurontin which doesn't work and vitamin b6? This idiot ortho referred me to pain management. So I go there, after he said don't take neurontin. They shoot me with cortizone, put me back on 1800 mg of neurontin and 100 mg of elavil. I am sorry I refuse to take all these drugs when I think all they have to do is remove it. If they can take an organ out of one and put in another they can do this. So now I am having to pay out of own pocket to go to foot surgeon in Louisville. $350. Did I also mention when the ortho said he would talk to surgeon he didn't even talk to the guy he said he would? These people have driven me insane. All the while the foot pain is increasing in intensity. One more thing. A week before I found out the mri results, the dog (127lbs) stepped on my foot and dug his claws into it. Cut the foot about 1/4" on top. The foot turned red and hot and I thought infected. After that pain just has been slowly turning up in volume like radio. That is my wonderful horror show. Sorry so long.

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