Plantar fasciitis and early tarsal tunnel

by Pete
(Hartford, CT)

Started out with pain in the iner part of my heel. got progressively worse as day wore on. Podiatrist recommended a brace and night splint. Couldn't wear splint at night, disrupted my sleep. wearing it during the day seems to help, but mornings are awful. I tried wearing the brace at night but awoke in the middle of night with a stabbing pain in the back of my heel.. went away when I took off the brace...but, as I said, next morning I was very sore...Am in night splint now with foot elevated. Much better..but without the splint I feel worse than before I went to the doc...

anyone have any similar experience? what did you do?

RESPONSE

Hi Pete,

A common mistake made by most people, doctors included is to assume it is just the plantarfasciitis that is causing all your pain.
In most cases that I see of plantarfasciitis there is usually a secondary issue going on as well. In your case, according to you, it is a tarsal tunnel, but I would suggest you also have heel neuroma ruled out by your doctor.
I use night splints essentially only when the major pain is those first few steps taken in the morning. In general, a night splint is only good for that and is not going to solve your heel pain.
If you have true plantarfasciitis, for me, the focal point of treatment is an orthotic. Why? If you do not support the plantarfascial ligament and allow it to over stretch all day long then the chances of it healing are dramatically reduced. This is a biomechanical problem meaning that for most people it is a result of the way they walk (or run). So without proper support through the use of an orthotic, the ligament continues to overstretch and thus never gets better.
An orthotic should be supplemented with either oral anti-inflammatory medication, possible cortisone injection(s) and perhaps even physical therapy depending on how much pain you are in.
That is problem number one. Problem number two is the tarsal tunnel you have been diagnosed with. That is part of the problem and it is not being addressed. A night splint is essentially useless when dealing with a tarsal tunnel.
When there is a secondary issue going on (tarsal tunnel, heel neuroma, heel bursitis, etc.) those conditions also have to be treated otherwise the chances of resolving the pain are close to nil.
Another problem is how long you have been bothered by this heel pain. We, who treat heel pain, now make a distinction between acute and chronic plantarfasciitis.
Chronic plantarfasciitis, and when I say chronic, in my office that is heel pain over three months in duration is now known as plantarfasciosis. What this means in a lot of cases is that essentially the body in incapable of healing the ligament mainly because of poor blood flow to the ligament. Blood flow to an area is how all injuries are eventually healed by the body. So, there are procedures available to address that issue as well.
Lastly, in heel pain of long term duration that seems to worsen as the day progressess you also have to rule out less common issues like a heel fracture many of which will not show up on standard x-rays and will require an MRI or bone scan.
In conclusion I think you may need a more aggressive treatment approach. Speak to your doctor.

Marc Mitnick DPM
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