plantar inflammation

Hi,

I am writing for my wife. She has had Plantar Fasciitis like pain for 1 1/2 year (text book Sx : pain with first steps of morning, pain after standing for long time). We have tried almost every therapy without any results (Orthotics, Night Splits, PT, Stretches, Ultra Sound, Celebrex, Steroid injections, Lyrica). Today we got the results of her MRI and it states that her Plantar is normal. Our Podiatrist is absolutely stumped and referred us to another Podiatrist. What do you think our next step should be?

Hi,
Every now and then I will see someone with the same scenario as your wife, you try everything and she still has pain.
You now have to think outside the box. May I assume they looked for a calcaneal stress fracture in the MRI? If not have the films re-read.
My feeling is that pain that occurs the more you stand or walk, is not really plantar fasciitis pain but rather either a medial calcaneal neuroma, or inflammation of the thickening of the nerve that runs in that area. Instead of pressing on the bottom of the foot to elicit pain, press on the medial of inside part of her heel and see if that hurts, if so she may have a neuroma.
Additionally, the standing or walking pain may also be an inflamed bursal sac known as a bursitis. Both the neuroma and bursitis generally will take longer to heal than plantar fasciitis.
Another thought. Are her orthotics hard plastic or of a softer material? Even though a lot of podiatrists prescribe plastic orthotics for heel pain I personally feel they actually aggravate the problem rather then help the problem.
Options to consider:
-if there is a neuroma, denatured alcohol injections
-extracorporeal shock wave therapy in an effort to eliminate the heel pain.
-nonweightbearing cast for a minimum of four weeks to allow everything to "quiet down", usually not a crowd pleaser in terms of options, plus you run the risk of return of symptoms.
-Trying a different anti-inflammatory medication; my preference is Mobic 15mg tablets, one twice a day with meals for three weeks keeping in mind this is double the recommended dosage and make sure your wife can tolerate this type of medication.
I could go on and on with suggestions, but get that second opinion and go from there.
One last observation, in my circle of colleagues, very few of us are operating on this condition any more, but you should keep that prospect in mind if everything else fails.
Good luck.
Marc Mitnick DPM