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Hard to diagnose heel pain. -Not plantar fasciitis. Please help!

Discussion in 'Ask your questions here' started by rjsnau, Dec 14, 2019.

  1. rjsnau

    rjsnau New Member

    Misc. info - 39-year-old female, runner for 7 years. Flat footed. Hypermobile.

    Summary - Has anyone ever had a sharp/burring pain in your heel for the first few steps in the morning and after rest that is not Plantar Fasciitis/Fat pad atrophy? My wife has been dealing with this for 4 months. I know it is long but here are the details. Also, MRI images, MRI reports, and pictures of feet links are at the end.

    End July - Started having pain/tenderness in medial side of left heel. Felt almost like a bruise. Continued to run and pain did not go away. Went to podiatrist who did ultrasounds and diagnosed Plantar Fasciitis. Prescribed Physical Therapy and to come back in 1 month. Went to PT for one month and was religious about doing exercises/stretching at home. Received stretching and dry needling at PT sessions. Was told could continue to run. Marathon planned for Oct so did slowing increase mileage while monitoring pain.

    End August - Last week of August was pain free. Was experimenting with new shoes at recommendation of podiatrist. Hoka Bondi 6 was recommended. Ran total of 5 runs and less than 25 miles the last week of August. Last run of 3 miles on Aug 26th was not able to finish due to pain in arch (felt like repeated bee stings). On August 28th woke up with burning/sharp stinging pain on left foot lateral outside heel. Went to PT again and had dry needling done. By Aug 30th could hardly walk on it. There was some swelling/puffiness right where the plantar fascia attaches on the medial side on the arch of the left foot.

    September - Sept 3rd went back to see Podiatrist who recommended MRI which showed mild stress response/edema in the inferior posterior calcaneus adjacent to the plantar facial origin, but specifically said it was not a stress fracture. It also showed very mild subcutaneous edema over the posterior lateral healed. She was told it was a "Bone bruise" and prescribed a walking boot for 2 weeks. At the very end of the two weeks she was no better in the left foot and right about this time she was starting to have a similar pain in the right foot. At one point she was getting into a bathtub and felt what she described as an explosion in her right heel. From that point on she also had pain in the heel as well. Sept 19th, we go back to the podiatrist who says to give it another 2 weeks. This time to make sure she goes zero weight bearing, even going as far as to sit for showers. At the end of September she is no better but the swelling at the plantar fascia insertion point has reduced.

    October - October 3rd we decide to see an Orthopedic who orders a second MRI of both feet. Both feet show "Plantar - lateral midfoot subcutaneous edema normal variation, pressure related change, mild inflammation, developing adventitous bursitis or developing fat pad fibrosis can cause this appearance" In addition the left shows "Small prominent vessel or fibrosynovial 3 mm cyst plantar medial cuneiform" We are told that it is a clean MRI and there is nothing wrong from an ortho perspective. Right around the same time we notice both of her heels are turning a purple color. (See “Left heel” Pictures in dropbox below) The coloring comes and goes. Around the middle of October, we visit the podiatrist again who notices the heel color as well as some color changes in her toes. We are told to follow up with a rheumatologist to see if something is going on. He mentions Raynaud’s as a possible cause of the color changes but that it is usually not linked to pain. We order a full rheumatology blood work panel that comes back completely normal.

    November - We start seeing our primary doctor who recommends checking with a vascular doctor to rule out anything vascular. Arterial ultrasound and vascular ultrasound both come back normal. She also prescribes low doses of amitriptyline and gabapentin to help with sleep and appetite as well as possibly for pain. We are also given a couple tramadol to try to see if it helps with the pain. Nothing helped with the pain but the amitriptyline and gabapentin help with sleep so they are continued. The swelling at the medial plantar fascia insertion point is back. (Seems to be in the same aera as the cyst finding). She is walking on it more which could be a cause. The symptoms have also changed a bit. The pain is now worse the first few steps in the morning and is described as a burning acid feeling for the first few steps in the heel pad. After walking for a while that sensation is reduced but a bee stinging sensation in the arch area of the left food where the swelling is. The heel color has reduced but still comes and goes and is in the same pattern when it does show up. Also, around the middle of the month she started noticing a few times a week at night one foot would get really hot and one really cold along with the hot foot turning red. We took a measurement and there as a 15-degree temp difference (78F vs 93F) (See “Temp Change” Picture in drobox below)

    December -Lower Lumbar Spinal MRI is ordered to make sure there is not a pinched nerve. Comes back normal. Appointment is made with Neurologists. We are waiting for this appointment and will advise the findings.

    Sorry for being so long winded but we have been through a lot the past 4 months and wanted to include any relevant details. Any insights at all or things we should look for next are greatly appreciated. It is very frustrating to be looking for answers and not finding them but we are open to any ideas at all!

    Unfortunately I am unable to post links unit I have posted 10 times. Until then if you want I can email the links to you if you want to contact me or post in the comments and I will find a way to get them. I will post them once I have 10 posts.

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