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Message
Paging GEAUXT help needed heel pain possibly non PF
Posted on 7/31/23 at 7:56 pm
Posted on 7/31/23 at 7:56 pm
Paging geauxt. Getting desperate for relief from (possibly) non PF related heel pain. Looking for advice on where to go from here.
Dealing with heel pain for 1 year now. The pain is in the dead center of my heel directly under the calcaneus, as well as on the “inside brim” of my heel under my ankle bone not plantar surface. It gets worse as the day goes on.
Originally tried the inserts from new balance, helped minimally, around October of 22, I had a steroid shot from an orthopedic surgeon, as well as began using powerstep pulse inserts, and wearing mizuno running shoes. At this time I also began getting treatment for PF including dry needling, scraping, the usual PF exercises and stretches. During this time I never truly felt like the arch supports made me better, and at times felt worse with them in my shoes.
Fast forward to November of 22 and was still looking for relief so I saw a podiatrist who thought I was dealing with a sub-calcaneal bursitis and got a 2nd shot a little further back in the heel and was given heel cups to wear. This was helpful for about a month before the pain came back. At this time it was around Christmas and I decided to just go barefoot while I was at home for the long weekend, as the full support method just wasn’t working and while I wasn’t pain free I was 1-2/10 until late February 23, when my pain shot up to a constant 6-7/10.
At this time I went back to treatment and exercises etc and saw a now 3rd dr (second podiatrist) who was adamant it was PF and I was given a now 3rd shot and forced into powerstep inserts that just had me constantly lit up. I did the back and forth with him a while til I ultimately ordered custom inserts from him, and the day I got them got a 4th shot and ultimately was good from mid May 23 to mid June 23 no pain in hokas and custom inserts until one day the pain came back and it’s where I’ve been stuck since mid June. I can’t wear any structured shoe or any insert custom or off the shelf without instantly triggering a higher Level of pain.
Now at this point I’ve had X-rays, an MRI, and a nerve conduction study (haven’t had these results yet).
I’ve done everything I can for treatment and exercise, have spent thousands on shoes (every brand) inserts drs visits etc and I’m still in pain.
The ortho who did the MRI says my only options are PRP or a cast for 6 weeks.
And I’m still yet to get the nerve test back but that ortho (different from
The mri ortho) thinks it might be baxters nerve or tarsal tunnel.
I know this is a very long post but I’m miserable and I’m absolutely desperate for advice here. I’m on my feet a lot and nothing I do gives relief, and lately all stretching/rolling does is flare up some Achilles tendinitis. If anyone reads this and has advice I’d love to hear it.
I’m sorry for the tl;dr
Dealing with heel pain for 1 year now. The pain is in the dead center of my heel directly under the calcaneus, as well as on the “inside brim” of my heel under my ankle bone not plantar surface. It gets worse as the day goes on.
Originally tried the inserts from new balance, helped minimally, around October of 22, I had a steroid shot from an orthopedic surgeon, as well as began using powerstep pulse inserts, and wearing mizuno running shoes. At this time I also began getting treatment for PF including dry needling, scraping, the usual PF exercises and stretches. During this time I never truly felt like the arch supports made me better, and at times felt worse with them in my shoes.
Fast forward to November of 22 and was still looking for relief so I saw a podiatrist who thought I was dealing with a sub-calcaneal bursitis and got a 2nd shot a little further back in the heel and was given heel cups to wear. This was helpful for about a month before the pain came back. At this time it was around Christmas and I decided to just go barefoot while I was at home for the long weekend, as the full support method just wasn’t working and while I wasn’t pain free I was 1-2/10 until late February 23, when my pain shot up to a constant 6-7/10.
At this time I went back to treatment and exercises etc and saw a now 3rd dr (second podiatrist) who was adamant it was PF and I was given a now 3rd shot and forced into powerstep inserts that just had me constantly lit up. I did the back and forth with him a while til I ultimately ordered custom inserts from him, and the day I got them got a 4th shot and ultimately was good from mid May 23 to mid June 23 no pain in hokas and custom inserts until one day the pain came back and it’s where I’ve been stuck since mid June. I can’t wear any structured shoe or any insert custom or off the shelf without instantly triggering a higher Level of pain.
Now at this point I’ve had X-rays, an MRI, and a nerve conduction study (haven’t had these results yet).
I’ve done everything I can for treatment and exercise, have spent thousands on shoes (every brand) inserts drs visits etc and I’m still in pain.
The ortho who did the MRI says my only options are PRP or a cast for 6 weeks.
And I’m still yet to get the nerve test back but that ortho (different from
The mri ortho) thinks it might be baxters nerve or tarsal tunnel.
I know this is a very long post but I’m miserable and I’m absolutely desperate for advice here. I’m on my feet a lot and nothing I do gives relief, and lately all stretching/rolling does is flare up some Achilles tendinitis. If anyone reads this and has advice I’d love to hear it.
I’m sorry for the tl;dr
This post was edited on 7/31/23 at 7:59 pm
6
Posted on 8/1/23 at 2:53 am to gsvar2004
I'm not tGEAUXT and am only a little ole NP, but here's my two cents on PF vs sub-calcaneal bursitis. I've talked with and treated a few PF patients (injections). I had one that had ongoing PF for almost 15 years. I know you're miserable.
Ya know, there's not much going on under the calcaneus other than the plantar fascia and the sub-calcaneal bursa. Having two different podiatrists think the opposite makes it tricky.
Is the pain at its worst first thing in the morning and slightly improves during the day? - likely PF
Is the pain mild in am and progressively worse throughout the day? - likely sub-calcaneal bursitis
I also believe that the exact location of point tenderness under the heel should help with the diagnosis.
If it's PF - inserts, stretches, NSAIDS, ice rolling. May need to consider the cast.
If it's sub-calcaneal bursitis...I'm not sure, but I do know a surgeon can perform a bursectomy.
"During a foot bursectomy, your orthopedic surgeon will remove one of the painful bursae sacs around the heel. New bursae that are less likely to become irritated will form in the place where the removed one previously was."
I'm not familiar with Baxter's nerve entrapment or tarsal tunnel, but I would also think that a good physical exam and pain history should help rule in/out any of these four conditions.
Good luck!
Ya know, there's not much going on under the calcaneus other than the plantar fascia and the sub-calcaneal bursa. Having two different podiatrists think the opposite makes it tricky.
Is the pain at its worst first thing in the morning and slightly improves during the day? - likely PF
Is the pain mild in am and progressively worse throughout the day? - likely sub-calcaneal bursitis
I also believe that the exact location of point tenderness under the heel should help with the diagnosis.
If it's PF - inserts, stretches, NSAIDS, ice rolling. May need to consider the cast.
If it's sub-calcaneal bursitis...I'm not sure, but I do know a surgeon can perform a bursectomy.
"During a foot bursectomy, your orthopedic surgeon will remove one of the painful bursae sacs around the heel. New bursae that are less likely to become irritated will form in the place where the removed one previously was."
I'm not familiar with Baxter's nerve entrapment or tarsal tunnel, but I would also think that a good physical exam and pain history should help rule in/out any of these four conditions.
Good luck!
Posted on 8/1/23 at 4:20 am to Volt
Generally speaking I’m better in the morning, altho I do have some fore foot (4th and 5th metatarsal) stiffness but little to no actual heel pain. I’m worse usually around 10/11 am until I go to bed
Posted on 8/1/23 at 6:57 am to gsvar2004
Has your interventions (rolling/scraping/etc) been limited to your foot and heel?
If you haven’t yet, really focus on your calves for a while - I’m convinced calf issues are a big culprit for lots of people.
If you haven’t yet, really focus on your calves for a while - I’m convinced calf issues are a big culprit for lots of people.
Posted on 8/1/23 at 8:12 am to LSUfan20005
Yep. Have hammered calf so much so that my “hurt” foot is more ROM than my non hurt foot
Posted on 8/1/23 at 9:26 am to gsvar2004
Look into shockwave therapy and try to find a PT clinic near you that has a machine. It is miraculous.
Posted on 8/1/23 at 2:04 pm to gsvar2004
I’m not geauxt but I used to have this problem so I switched to red wings with steel shanks and I get the special insert that they cook to your foot
I also lost 40 lbs
ETA: I’d also recommend walking around barefoot outside
I also lost 40 lbs
ETA: I’d also recommend walking around barefoot outside
This post was edited on 8/1/23 at 2:08 pm
Posted on 8/1/23 at 5:08 pm to gsvar2004
I’m following this closely. I’ve actually had an extremely similar course that you have except I only had one steroid shot that didn’t help at all. My injury was June of ‘22 and I felt a pop at the time. Didn’t know what it was but it hurt like hell. Nevertheless I just stayed off of it and was convinced it would get better if I just stayed off of it. Looking back now, I really think I tore the plantar fascia. However an MRI 3 months later showed nothing.
I went to PT, was put in a boot, tried acupuncture, stretching, you name it. My Ortho also suspected Baxters or Tarsal Tunnel, but I Had a nerve conduction that was negative.
Getting a PRP this week. Only other option at this point is surgery which I really don’t want to do. Will let you know how it goes.
I went to PT, was put in a boot, tried acupuncture, stretching, you name it. My Ortho also suspected Baxters or Tarsal Tunnel, but I Had a nerve conduction that was negative.
Getting a PRP this week. Only other option at this point is surgery which I really don’t want to do. Will let you know how it goes.
Posted on 8/1/23 at 6:36 pm to gsvar2004
As a whole injections and PRP have very little success in research trials. You’ll hear word of mouth that it’s great, or that an ortho swears by it, but the science doesn’t support it.
Have you tried physical therapy? If so what did they have you do? Basic exercises that don’t help, or actually get after it and try to help? Did the rule in/out your back? Pain symptoms can refer to different areas than where they originate.
What lifestyle modifications have you made? How’s your nutrition? Physical activity levels? Hip to waist ratio?
Have you tried physical therapy? If so what did they have you do? Basic exercises that don’t help, or actually get after it and try to help? Did the rule in/out your back? Pain symptoms can refer to different areas than where they originate.
What lifestyle modifications have you made? How’s your nutrition? Physical activity levels? Hip to waist ratio?
Posted on 8/1/23 at 9:13 pm to gsvar2004
Sounds like it could be a calcaneal stress fracture. Often confused and treated as PF that doesn’t improve. MRI typically shows this but not 100%. Bone scan also will pick it up. If you place your hands on either side of your heel and squeeze your heel between them does this recreate your pain?
Have you tried any immobilization and protected weight bearing?
I would also guarantee you have tight achilles. If you aren’t already, you should be doing stair stretches to get your Achilles stretched out.
Have you tried any immobilization and protected weight bearing?
I would also guarantee you have tight achilles. If you aren’t already, you should be doing stair stretches to get your Achilles stretched out.
Posted on 8/2/23 at 4:49 am to h0ll@yaboy
quote:
Have you tried physical therapy? If so what did they have you do? Basic exercises that don’t help, or actually get after it and try to help?
both, ive got through periods where I was super aggressive, even got up to 60# single leg on plantar facia high load exercises (towel under toe). ive worked with PT and Chiro. ive done every exercise you can imagine, a lot of stretching too, so much so that i gave my self achilles tendonitis.
quote:
What lifestyle modifications have you made? How’s your nutrition? Physical activity levels? Hip to waist ratio?
i had to back off of a lot my cardio/heavy lower body stuff. i still work out 3-4x week, but limit my lowerbody ex to mostly machine and some body weight squatting, bc im worried it will trigger pain, im on my feet no less than 8 hours a day m-f..
Im 6-1 215 lbs, and fluctuate between 12-14% body fat depending on the time of the year. my diet stays pretty tight year round. i battled IBS for years so i eat pretty clean 95% of the time so i don't get flare ups from that. i stay in my little box when it comes to that. ive learned to eat to live not live to eat.
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