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Nerve Entrapment (Heel pain)

Discussion in 'Ask your questions here' started by laurensaurus, Jan 28, 2015.

  1. laurensaurus

    laurensaurus New Member

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    I have been diagnosed with bilateral nerve entrapment of the medial calcaneal nerve and/or possible first branch of lateral plantar (baxter) nerve. I'm 24, previously athletic, non diabetic, normal weight/bmi. My doctors said this was probably caused by a mixture of trauma/overuse/posture/bad luck.

    I've seen 2 orthopedists, 1 podiatrist, and currently I'm being treated by an anesthesiologist who is a pain management specialist. I have an HMO and so finding specialists can be tricky. My orthopedist said I would need surgery - but she did not do that surgery. The podiatrist said different things upon each visit... I bought presc. orthodics from him. He said I had achilles tendonitis and plantar fasciitis and needed to stretch (I had already been in physical therapy for this for half a year prior to seeing these specialists). He gave me blind cortisone shots which did not make any difference. My podiatrist then referred me to a pain management specialist (anesthesiologist) in case this was originating from my spine. After an MRI ruled that out, she got a hold of my previous orthopedist and recieved her diagnosis.

    My pain doc (as I call her) seems like a great doctor. We did an ultrasound to look for swelling, bone spurs, anything obvious. She said I had no signs of plantar fasciitis or swelling. She said that surgery to decompress the nerves results in a lot of scar tissue and isn't a sure deal, so she offered to do something called neural hydro-dissection.

    Basically, she injects a saline solution into my heels - guided by ultrasound - around the nerves in order to "push" tissue off of the nerve. ? So far I've had this done twice in each foot. First procedure was with local nerve block (yet still painful as hell). Second procedure was iv sedation. Third procedure is soon and will be general anesthesia (on account of moving too much under iv sedation).

    The procedures have some success. It seems to feel good for a week or so then goes back to normal. Since the 2nd time (a month ago) I would say my L foot is still at 30% less pain, which is better than nothing, but still can be very painful. She said we still have some options if this hydro-dissection stuff doesn't work out before she refers me for an invasive surgery. The doctors seem hesitant to do surgery, in part because the entrapment is bilateral and in part because it's not a common surgery.

    So. My question is: Does anyone have any experience with LPN or MCN entrapment or Tarsal tunnel syndrome (which is similar/related).
    Does anyone have any experience with hydro dissection? (unsure if it is called something else). Did it help you?
    Has anyone had a nerve decompression for LPN, MCN, or...any foot nerves? Was it successful or not?

    I guess I'm just feeling like nobody really knows what is going on with these nerves. I can't find a ton of info on them on the web - but I've read what I've been able to find. I don't know anyone who has had similar problems and I feel a bit unsure. I've done everything my doctors have requested or advised for the past couple years and things aren't getting much better. I still trust them and will listen to them, and I appreciate my current doctor's attempts to avoid surgery. But, it would be nice to know that this got fixed for someone else. The pain can be intense and unbearable at times, and I quit my job a few months ago due to the pain.
    Can anyone relate?
  2. Gsv

    Gsv New Member

    I just had hydro dissection to free up Baxter nerve entrapment on both feet. I had the procedure two days ago and feel better. I have been suffering for so long and feel for you. I will keep you posted on my progress. Feel free to send me a message.
  3. laurensaurus

    laurensaurus New Member

    Hi! I'm sorry to hear you've been dealing with this pain as well, but I am very glad to know that I'm not alone! I would love to hear how your feet continue to react to the treatment. My doctor is out at a conference now, but I should have my 3rd round of injections within a week or two.

    I hope that your feet continue to stay better and heal!
  4. Unregistered

    Unregistered Guest

    I'm 100% positive, you have gastroc-soleus-achilles shortening (read: gastroc contracture, Silfverskiold test..). Please do some stretching exercises. This will relieve some of the pain.

    You don't got for some therapist to do stretching exersises. You do them yourself. Like 20-50 times per day. You have to get results, not psychological treatment. Like this: http://www.sportsinjuryclinic.net/s...itis/achilles-tendonitis-stretching-exercises. Do it 100 times per day, spend 10 seconds per time. This will get results.

    All surgery and similar stuff will fail here. This is the reason why you don't find any scientific literature.

    Think of a mechanical problem. Not only biological. Something IS pressing these nerves for you.
    Last edited: Feb 16, 2015
  5. laurensaurus

    laurensaurus New Member

    You're right that my calves are tight and my ankle dorsiflexion is quite poor...but stretching isn't a magical solution. I stretch all the time. I mean, really, all the time.

    The link you showed, I do all of those stretches/exercises every day, several times a day. If tight calves is the root of this problem, then I honestly don't know what more I can do on my own to fix that.

    My podiatrist said that part of my tight calf and poor ankle flexion problem is my posture, which is default abnormal. My knees hyper-extend which puts my ankle in a slightly plantar-flexed position. My hips and elbows are also hypermobile. I do my best to stand with my knees in a neutral position, but sometimes it just happens.

    Maybe these injection/surgeries won't work, but there is literature on baxter nerve decompression surgery working and even MCN decompression surgery working.
  6. laurensaurus

    laurensaurus New Member

    Update: Last hydro-dissection procedure has failed. When standing/light walking, pain gets up to 8/10 in 2-3 hours.
    No OTC painkillers help. I'm still stretching and doing foot/ankle/leg exercises. I return to my doctor in 8 days. Pain mostly goes away after resting for a half hour or more. Comes back if I stand for very long. Ice helps.
    It is an intense pain. At first it feels like a stabbing pain. As it gets worse, it feels like a burning pain mixed with an aching pain.
    X-Rays normal. No MRI. Previously been treated with a hard cast, rest/ice/elevation, physical therapy, cortisone injections, prescription orthodics, and now neural hydro-dissection.

    I've pretty much given up any hope that a) this can be treated and/or will get better and b) i will ever be able to work again.
  7. laurensaurus

    laurensaurus New Member

    Update in case anyone is also having chronic heel pain like this.

    I had to switch my insurance plan in order to see a foot and ankle orthopedic surgeon. Costs me a bit more but it is what it is. I told this orthopedist my history, my symptoms, my past treatments, and the names of the doctors who told me to see him. He said my range of motion was fine, and that an MRI or EMG would not help confirm baxter's neuropathy which is what he thought it was. He said MRI might point to plantar fasciitis but doesn't show the nerves. EMG is often falsely negative. He said that my symptoms sounded like typical baxter nerve compression which typically caused by mechanical compression through a combination of build/structure. In 3 weeks he will release the tarsal tunnel and part of the plantar fascia. If that works then he will do the other foot. He said recovery time will vary based on the amount of nerve damage that has happened.

    He mentioned to me that nerve hydro-dissections are not shown in any literature to be helpful in this sort of neuropathy and that there is no reason to perform it. Obviously I have to agree since it didn't work. I'm kind of annoyed I was sent to a pain management doctor at all. I should have been more proactive about my own care.

    After the years dealing with this here is my advice:

    Do research on your doctors. Find a doctor who is specialized in what you need. Follow up with your PCP if you run into snags. I had an HMO so all of this has been an uphill battle for me. Don't get talked into buying a 10th or 11th pair of orthodics. If you are hurting, ask for something for pain. Be open to ideas, but if a doctor is telling you that acupuncture will make you better, see another doctor. Get a case manager. Be an advocate for yourself. Don't wait until you're in so much pain that you have to go to the UC or ER. All this has happened to me, and it has been awful. Only recently have I gotten a bit of hope that I might get my old life back.
  8. tami12311

    tami12311 New Member

    don't know how to cancel message
    Last edited: Jun 9, 2015
  9. laurensaurus

    laurensaurus New Member

    Following Up (for those with similar symptoms)

    I had a tarsal tunnel release and plantar fascia release on both feet (2 months apart) and so far this surgery was successful. I no longer have burning pain in my heels. I occasionally get "shock" sensations near my ankle, but they are starting to go away as well. My pain has decreased drastically.

    Recap: Bilateral burning heel pain, icey/hot "shocking" sensations near heal and ankles, inability to stand for longer than an hour led to inability to work. Previous treatments included:
    • RICE
    • 5-month boot immobilization
    • Physical therapy
    • Cortisone shots
    • Prescription orthopedic inserts
    • Nerve Hydrodissection

    I switched insurance plans and was able to see a foot and ankle orthopedic surgeon. I wish I had done this from the beginning. He had performed this operation before. I was in a cast for 2 weeks, a boot for 1-2 weeks, then I transitioned back into shoes. I went to physical therapy 3 times a week and did the exercises and stretches at home several times a day. Sometimes this was painful, as the muscles and tendons are still sore from surgery, but I listened to my doctor's advice.

    Currently, I have pain pushing off on my feet (due to the plantar fascia being cut when released). This pain is nothing like the original heel pain and it gets better every day.

    My advice:
    For what it's worth, staying fit, active, and healthy made these surgeries go much more smoothly than if I had been unfit or had underlying health problems. I had no blood clots interfere with healing. I made sure to move around after surgery as much as I could. I used crutches instead of "scooters" as using crutches is a pretty good workout. I ate healthy, I took aspirin every day. I took breaks when I needed them but I did not lay in bed all day.

    There are people who want to get better, and then there are people who use excuses to keep from getting better. I saw both of these people in physical therapy. If you aren't going to fight for yourself, why should your doctor fight for you? Do what your doctor says. If you are unsure, find a second opinion. Find a third opinion. Get two opinions (by surgeons) before having surgery. Be your own advocate.
  10. lalalololele

    lalalololele Guest

    Did you need to take pain relief after the procedure? Did it hurt
  11. Dieter J Fellner

    Dieter J Fellner New Member

    If the cause of the nerve pain is indeed mechanical constriction you have to ask yourself: what is going on with the foot to create the compression.

    A neurolysis, irrespective of the mechanism applied i.e. hydrolysis or conventional open surgery, will only ever address the symptom without addressing the cause of the symptoms. Neural hydro-dissection is a more recent technique. There are no long term studies to evaluate the effectiveness in nerve entrapment of the foot. As for conventional open nerve release there is a 1/3 rule.

    1/3 of patient will be delighted with the outcome
    1/3 of patients will be no better
    1/3 of patients will be worse

    If you have the opportunity to do so, have your feet evaluated for talo-tarsal instability. This is a common problem that can be taken care of effectively with a minimally invasive procedure called Hyprocure. In that way contributing mechanical factors can be effectively managed to treat the pain and more importantly, to prevent a recurrence.
    Last edited: Mar 31, 2017
  12. Cdn

    Cdn Guest

  13. Cdn

    Cdn Guest

    Hi. I am pretty sure I have nerve entrapment (after having been wrongly diagnosed and treated for P.F. ) How are you doing now that you've a few years post-surgery?
  14. Ruthieba

    Ruthieba Guest

  15. Ruthieba

    Ruthieba Guest

    Thank you for the updates on your surgery. I am scheduled to have surgery for Baxter's Nerve on Wednesday and I am started to panic that it won't work. Hearing your success has calmed me down. Everyone I tell comes up with alternatives to surgery but I have been dealing with this pain for years now. I had 2 prior procedures that didn't work, which does make me nervous about the success of a 3rd, but it is a different diagnosis this time. I just want the pain to go away.
  16. Awilson5512

    Awilson5512 Guest

    How did your surgery go? I will soon have to get my Tarsal Tunnel and Baxter's Nerve released. I'm going to see Dr. Bregman for the surgery.
  17. nxl43

    nxl43 Guest

    Hello! I saw that you got the tarsal tunnel and baxter's nerve surgery from Dr. Bregman a few years ago. Wanted to see how it went? I am thinking about getting the surgery from him soon too.
  18. Henny

    Henny New Member


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