Unresolved heel pain over 7 yrs

by Donna
(massachusetts)

Hi,

MRI after MRI, bone density/bone scans/blood labs to no avail. Failed fasciotomy release in 2004 to eliminate pain. Bilaterial flat feet, right more than left. Gastronemcius (sp) release(Strayer technique) done March 08, gained 2.5 inches of achillies, failed to resolve heel pain, which comes with swelling at inside of ankle, and to toes. 7 months post surgery, same pain for 7 yrs. Surgeons said "good bye, best we could do." (other than total reconstruction/arthordecis. I am 53, have long way (hopefully) to go in this life, and am disabled now as I can't stand or walk on feet for any length of time. MOst debilatating issue and heartwrenching, as I teach. Your help appreciated. Pic. attached, most recent, and looks exactly like those taken in 2005, 6 and 7! Something's being missed. Pods injected, Ortho's don't believe in injections. Injections failed. Prednisone once worked, 2nd round failed. Acupuncture helped w/some burning issues which went undetermined and resolved themselves (hopefully) after 2 yrs of it. PSSD testing/other tests done @ Dellon Clinic, prior to my going surgical route. Appreciate your help/direction. Thank you

Hi Donna,
Obviously I am at a disadvantage as I cannot examine you, but based on the area that seems to be painful and swelling, two conditions you might ask your doctors about would be a rupture of the abductor hallucis muscle and/or the possibility of a heel neuroma. Good luck.
Marc Mitnick DPM

Post-op necrotic heel tissue/ pressure sores/ blood blisters

by Mary Ellen
(Dallas, TX)

I had surgery for achilles tendonitis which xrays show is healing fine. During first 2 wks post-op however, pressure sores/blood blisters formed on heel from temporary cast. Surgeon peeled away the skin; now heel is very raw & painful. I must wash & dress it daily and wear the knee-high boot, which appears to aggravate the raw skin. Why should I have to wear a hot pressurizing orthotic boot instead of airing out the wound, keeping it elevated and pressure-free?

Hi Mary Ellen,
Your surgeon is more concerned with the achilles tendon healing properly then he is with the wound that you have, and rightly so.
Having said that you should let your surgeon know that the boot is aggravating the wound. The surgeon should be able to figure out a better means of dressing the wound then the method you are now using.
Marc Mitnick DPM

Plantar fasciitis and overall foot pain

by Ann
(Texas)

I am a 48 year old female who has been running for 7 years. I am 5'4" and weigh 113. I have bunions that have not been a problem in the last couple of years since I stopped wearing any kind of shoes that bother them. I developed plantar fasciitis about 7-8 months ago while training for my first half-marathon in January, but as long as I did the stretching exercises recommended by my doctor (an orthopedist) it did not bother me much. The plantar fasciitis was mostly in my left foot and very minimal in my right foot. But about six weeks ago I started having overall foot pain in both feet; it feels as though I have been on them all day when it's just been a short time and I can feel them throbbing a little. The heel pain seems to have increased also. During this time I have worn shoes that I believe have moderate arch support (although some of these are a thong type of sandal), and I have switched running shoes to some that offer maximum arch support. I normally run about 4 miles 3 times a week but have reduced that greatly in the last couple of weeks with only a little improvement in foot pain. Do you think this is just the plantar fasciitis or something else? Should I change my everyday shoes and/or try an orthotic? If I need an orthotic, should I try an over-the-counter variety or would I do better with a prescription type? I will do almost anything to avoid giving up running! Thanks so much for any advice you can give me.

Hi Ann,
I will make certain assumptions. Because you are a runner, I will assume you are young, and since you are young and have bunions, I will assume your feet are very pronated (flat). The problems you are having would therefore be very common in an individual like yourself. As you increase your training, the pain might also increase.
If you are serious about your running, then you need to see a podiatrist before the pain gets to the point where you can no longer run. Look for one who specialized in sports medicine.
You may be able to get by with a store bought arch support, but I am not a big believer in them. Ask your doctor to get you an "off the shelf orthotic" which is very similar to a prescription orthotic and will not cost nearly as much. If that does not work then you may have to consider a prescription orthotic.
Marc Mitnick DPM

My heel hurts when I bend down

It has been diagnose as Achilles tendinitis. my question is what mechanical relation is there between my bending and the Achilles tendon?

Hi,
It depends how you bend. If you bend down at the waist without bending your knees it will overstretch the achilles tendon. Even bending the knees can sometimes cause achilles irritation because of where the muscles attach in the area of the knee.
Marc Mitnick DPM
Marc Mitnick DPM

achilles pain

by Kristen
(Michigan)

About a month ago my achilles started to hurt. It first felt like it was a bug bit being rubbed against but their wasn't. A week later it became more painfull more often; anything that touched my achilles left it in pain. I kept running and it got worse. Over that weekend it was excruciating; i could hardly run and when i did, i was practically crying. After my run i noticed a slight bumb forming on my achilles. I took a day off and ran easy the next and it was feeling better. Soon the pain went away but now there is a noticable bumb that keeps growing. It hasn't hurt for a few weeks but now it is hurting again right next to the bumb. It feels how it did when it originally started. I have iced it but i just want to know what is wrong with it. i have just started my x-c season and i really don't want to take time off. Please help me, thanks.

Hi Kristen,
The best way to find out what it is exactly would be to see a podiatrist. Without being able to examine you, I would assume it is an irritation of the achilles tendon sheath (the outer covering of the achilles tendon).
I understand it is cross-country season but your logic in not wanting to take time off is miscalculated. There is a good chance you might not have to take time off, but should you not seek treatment and the condition worsens, your whole season will be lost.
Marc Mitnick DPM

hard lump on sole of heal.

I have a hard lump on the sole of my heal it is very painful when I stand and walk the pain is under the lump, not the lump itself. The lump is about 4mm and has a hard build up of skin. It feels as if it has a core of some sort under the lump. What do you think it is.
Regards Mark

Hi Mark,
The most common cause of your type of complaint is usually either a wart of a porokeratosis (plugged sweat gland), people state they feel as if they have a stone in their shoes.
Your best bet would be to seek medical attention as both problems are easily treatable.
Marc Mitnick DPM

heel pain, arch pain and ankle pain

by LaVona
(Wichita Kansas)

I broke 4 metatasals in my left foot in october. I was very lucky as it was a straight break and did not have to have surgery to repair the damage however it has been 9 months and my foot hurts most of the time. My ankle is very stiff and aches, I have alot of heel pain and now the outside of my arch has been very painful. It has just been the last 2 weeks that the arch has been bothering me. I'm not sure what to do. This was a work related accident and I don't want to cost my employeer any more than I already have.

Hi Lavona,
You need to have the foot examined again perhaps an MRI would be indicated as there might have been some soft tissue damage that did not show up on the original examination and certainly would not show up on an x-ray
Assuming the MRI is normal, then a round of physical therapy would probably go a long way in making you feel better.
Marc Mitnick DPM

had heel spurs two years ago,both feet. Now both feet hurt terrible in the veins,help?

by Diana
(Olean,NY)

My feet were diagnosed two years ago with bone spurs. On left foot doctor stated very big spur. Had cortisone shots,did not work. Well it has been two years and my feet hurt so bad,want to cry. It is top of feet,feels like through the veins,also around achilles heel hurts and left ankle very tender,please help/

Diana Calhoun

Hi Diana,
Heel spurs very rarely respond to one shot of cortisone; usually a combination of therapies are necessary to get the heel to stop hurting. This would include oral anti-inflammatory medication, strapping of the foot, orthotics and even physical therapy.
The size of the spur on x-ray is no indication as to how bad the spur actually is. There are people walking around with huge heel spurs that have no symptoms whatsoever.
My best advice for you would be to see a podiatrist and allow he or she the opportunity to offer you more aggressive treatment.
Marc Mitnick DPM

Pain in heels and bruising on outside of arch's

by Jane
(Davisburg, MI)

I have been exercising more than normal lately and have been experiencing pain in my heels, especially in a.m. Now today I have noticed bruising on the outside of both arches. I did purchase new workout shoes a couple weeks ago - and they were not inexpensive ones. I am 43 yrs old and have been type 1 diabetic for 11 years with no complications. I have read about plantar fascitis but now am confused about the bruising.

Hi Jane,
As a diabetic you are right to be concerned about the bruising. It may be from your new athletic shoes, but your best bet would be to consult with a podiatrist to make sure it is not a sign of something more severe; it probably is not but I cannot assure you of that. Let a doctor look at your feet.
Marc Mitnick DPM

burning in my heels

by James
(Omaha, NE USA)

both of my heels burn like crazy almost every day. Not so much when I wake up in the mornings but the more I walk or excercise the more they burn when I am done.

Hi James,
Your symptoms are suggestive of a heel neuroma which is a trapped nerve in the heel area. The more you walk, the more the nerve is inflamed, the more it burns.
The other possibility is a tarsal tunnel.
Information on both of these conditions can be found on my site.
Marc Mitnick DPM

Feels like Im stepping on a nail at the heel of my right foot!

by Erik M
(Jacksonville FL US)

Hi, last week I went walking on my usual trail. Sometimes I walk sometimes I jog. I've been doing this for the past 3 weeks. However, last week after my walk my my heel started hurting. A little pain at first but it quickly escalated into a sharp pain, kind of like stepping on a nail. This has never happened before. I am 25 years old, and very active. I am a diabetic and I do have 1st stage hypertention. I do take metaphormin 1000mg a day and Lisinopril 20mg a day. I hope its not something to do with the diabetes. I've always heard of bad foot stories with diabetes. I just wanted to see if you could explain this a wee bit better. my foot is not swollen nor have I had any surgerys on my foot. I did in college pull a ligament on the foot and recovered in 2 weeks. Any info can help.

Thank you

Hi Erik,
Your heel pain is "probably" not related to your diabetes but because you are a diabetic you should not take any chances with your foot. The heel pain sounds more like direct damage to the heel such as plantar fasciitis, or a heel bursitis both of which are readily treatable by a foot specialist.
Diabetics in general have to worry more about circulatory or neurological problems occurring in the foot as a result of their diabetes. All the horror stories you hear about diabetics and foot problems generally arise from poor circulation or lack of sensation in the feet.
But, since you are in pain and since you are a diabetic, the smart money would be to have a podiatrist look into your foot pain.
Marc Mitnick DPM

Heal Pain

by Denise Wilson
(Trenton, NJ)

My child is complaining the back of his heal hurts in his new soccer cleats. Does that mean the shoe is too small or too big.

Hi Denise,
If anything I would think the cleats are too small, but his pain may be due to other factors. I do not know how old he is but read my section on calcaneal apophysitis. If this is the case, his heel will probably be hurting regardless of the shoe that he is wearing.
Marc Mitnick DPM

severe sharp pain in my left foot arch area

by Michael McDonald
(Riceville Tn. USA)

I do a lot of standing on concrete. Pain has been gradually slowly hurting a little. Comes and goes. I pull my large toe inward to help relieve the pain. Last night i got out of my car and put weight on my foot and had a severe pain in the left arch area. Limped into house. Got up this morning and kept large toe pulled in so pain would't hurt so bad. Wife wants me to go to my doctor. I naturally don't want to. I put my arch supports out of my other shoes into my work shoes. Had some made here a while back to support my feet. It doesn't let the pain hurt so bad. Question is. Is there anything that i can do for this or is this just 50 years of hard work haunting me now??? I'm not over weight. I just stand at my new job a lot. Thanks.

Hi Michael,
Although 50 years of hard work may have lead to this problem, there are a lot of things you can do for arch and heel pain (read my section on heel pain), but the simple realization is that you are going to need some professional help in order to alleviate the pain. As much as you do not want to, I would suggest you find yourself a good podiatrist; you do not want this pain to become disabling for you.
Marc Mitnick DPM

numb foot from middle arch to heel.

I played football barefoot and 3 days later I could not stand on one foot. It felt like needles and was very painful. I went to doctor and he gave me a steroid. It has been 4 days and though the needle feeling is not as bad; my foot is still numb. I am afraid I have damaged nerves. Will it ever get better?

Hi,
More than likely the foot will further improve over time but you should consult with your doctor if you do not experience further improvement over the next couple of weeks.
By the way, playing football barefoot was not the smartest thing you could have ever done, for a number of reasons.
Marc Mitnick DPM

Heel Pain

by Erin Kelly
(Gaithersburg, MD)

I was told that I had Planter Fasciitis about a year ago but nothing seems to make the heel pain go away. I have orthodics, been giving cordisone shots, used a splint at night..Is there any other options because my doctor is not giving me anything else.

Hi Erin,
First of all, if you have had heel pain for over a year I would suggest you consider having an MRI to see if there is anything else that is causing your pain such as a stress fracture, or possible tear of the plantar fascial ligament.
Assuming there is no other problem you might want to consider a round of Physical Therapy which for many of my patients is very helpful.
Another consideration would be ESWT known as shock wave therapy; the same therapy used to break up kidney stones. See my section of "ESWT".
Marc Mitnick DPM

burning pain in heel and sharp pains in arch

by Katherine
(Ottawa)

I was walking on gravel rocks and the path was a little uneven and I lost my footing; I twisted my foot out of my sandal. While I was regaining my balance I did not place my shoe on proper but instead my arch of my foot hit the hard surface of my sandal and I landed my foot on a rock. It has been 2 weeks and the pain is not going away. My heel feels like there should be a massive bruise and the pain feels like my arch is falling down. After I take a few painful steps the pain sip-sides. The pain returns after resting the foot. Do I have plantar fasciitis or a broken/ fractures sesamoid bone on my heel?

Hi Katherine,
I doubt you have sesamoiditis since that is in the ball of your foot, but it does sound like you may either have a bone bruise on your heel bone or perhaps the large rock damaged your plantar fascial ligament which would then create plantar fasciitis.
If the pain is not getting better and it has been over two weeks, then your best move would be to seek medical care. Any pain that is not showing signs of getting better after two weeks certainly should be examined by a doctor.
Marc Mitnick DPM

Plantar Fibromatosis confirmed. Is the toe curling related?

by Sophie
(Washington)

I have had plantar fibromatosis bilaterally for the past 15 months (maybe longer but that is when I first noticed it). I had an MRI to confirm it. I have had 2 cortisone shots in my right foot. It has been the most bothersome. I have two nodules, one pea sized and the other about 1 inch x 1 inch and there is a cord that I can feel as well. I have also been getting massage to see if it will decrease the size of the nodules. They were not growing for a while but have become very painful again lately. The problem that I am having is that I have woken up lately with my toes in a downward curled position and it takes a while to get them to relax and lay flat. I also notice this if I am sitting relaxed in bare feet (ie watching TV). Is it possible that this is related to the Plantar Fibromatosis and the cord? Have you seen this before? My doctor does not want to remove the lumps unless ABSOLUTELY necessary as he says the entire plantar fascia will have to be removed and I could possibly end up with more pain than what I have now. Thanks for your help. Sophie

Hi Sophie,
I have not specifically seen toes curl as a result of plantar fibromatosis but if you are having pain on the bottom of your feet and having difficulty walking, the toes going into a spasm would not surprise me. There may also be some connection between the plantar fascial ligament and the intrinsic muscles of the foot which are the muscles that bend the toes downward.
I am not sure you understood your doctor. In surgery the whole plantar fascial ligament in not removed, but, a portion greater than the actual plantar fibromatosis has to be removed in order to diminish the chance of recurrence.
Generally speaking it is not a surgery you would want to have, however, if you are in enough pain and conservative treatments have not helped then really your only option would be to consider having the nodules removed.
Have you tried orthotics or verapamil injections? I would try either or both first and if there is no relief then surgery might be your only answer.
Marc Mitnick DPM

very bad heel pain gets worse at the end of the day

by ROCKY
(SOUTHAVEN,MS)

WHEN I WAKE UP MY FEET DO NOT HURT. BUT AT THE END OF THE DAY MY FEET HURT SO BAD I CANT STAND UP IT FEELS AS IF I AM WALKING WITH MY HEEL BONE HITTING THE COCRETE AND NOTHING ELSE

Hi Rocky,
Guess what? your heel bone may be hitting concrete. Some people do not have much fat under the heel and based on the way their heel bone is shaped, the bone may be coming directly in contact with the walking surface.
Another consideration, sometimes heel pain that occurs towards the end of the day may also be due to a heel bursitis as a result of the day long pounding your heel takes.
See a podiatrist, he or she should be able to help you with your heel pain.
Marc Mitnick DPM

Severe heel pain

by Debbie
(Ward, Arkansas)

I have been experiencing severe pain in my heels. At night, I can't lay my heels down when I lie on my back. It is getting worse. They hurt so bad,I toss and turn, usually can't even sleep. Does this kind of condition ever require surgery? Thank you, Debbie

Hi Debbie,

Sounds like you may have a posterior heel bursitis; read my section on bursitis. Do you wear heels or dress flats on a daily basis?
This condition generally does not require surgery but will probably require treatment; I would recommend you make an appointment with a podiatrist.
Marc Mitnick DPM

continued pain in heel

I have had a sharp pain in my heel for at least 5 months.
I was diagonosed for stress fracture but I am still having pain.
I am taking steriods after being on cruthces. What else can I do?

Hi,
Well the first thing I would do is stop taking the steroids as they reduce inflammation and although may help with the pain, they may also be delaying the inflammation that is necessary to heal the broken bone.
Speak to your doctor about it.
Marc Mitnick DPM