Foot stiffness

by Lara

The first problem was entire (medial, mid, and lateral) heel plantar pain. Thought to have plantar fascitis but passed all physical tests. Now it's graduated to stiffness and a "flaring" throb at the lateral side of foot at tarsal/heel junction. It doesn't throb in and out. It flares for several seconds then goes away (much like sciatica electrodes at ankle in physical therapy). Pain is only on one area. If I sit for even 5 min the foot goes stiff and I can't bend it when I stand and walk. I also notice when this happens I get pain in 1st metacarpophalangeal joint. Ana panel has gone way down, negative for RA and lupus. What gives?

RESPONSE
Hi Lara,
Most times pain similar to the type you describe is more biomechanical in nature rather than disease driven. In other words the pain results of trauma or an abnormality in the way you walk. So the lab work being negative does not really surprise me.
It is my understanding that the pain started on the bottom of the foot but now presents itself on the lateral side of the foot. The first question I would have is do you still have plantarfasciitis
pain? In most cases of plantarfasciitis there is a secondary issue going on. Typically there will either be a heel bursitis or heel neuroma both of which may cause radiating pain throughout the heel and would explain why the pain is so diffuse. In most cases that I see, the pain on initial ambulation is related to the stretching of the tight plantarfascial ligament and after a few steps the pain will subside, however, if the patient continues walking and the heel gets worse that is usually the result of a bursitis or neuroma.
Whether the pain you are now experiencing on the outside of the foot is related to the plantarfasciitis is difficult for me to determine without having the luxury of examining you. The first thought that comes to mind would be a subluxed cuboid bone which can occur for any number of reasons and is not limited to a traumatic event.
I am just guessing here but I would think that you have not been under the care of a foot specialist, because blood work would not have been the first thing to order.
The proper course of treatment would be an x-ray to rule out stress fracture of the heel or even a bone scan or MRI if fracture is suspected. I mention this because this could be a more remote cause of the diffuse pain in your heel.
Once a diagnosis is made than appropriate treatment should be initiated. In my practice this consists of an orthotic of some type in an effort to control the plantarfascial ligament. In addition oral anti-inflammatory medication or a cortisone injection would also be considered depending on the severity of pain.
I routinely now offer immediate physical therapy to the heel (if the diagnosis is plantarfasciitis, bursitis or heel neuroma) as that tremendously speeds up the healing process.
A subluxed cuboid requires manipulation to put it back in place as well as padding in the orthotic, to hold it in place and some physical therapy.

Marc Mitnick DPM
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