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I have a thickening in front of my left heel, feels like…

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I have a thickening in...
I have a thickening in front of my left heel, feels like extra fat padding. Hurts when running due to pressure, but not during walking. Standing also puts pressure on it, so cant stand for longer than a few minutes, then foot inflames. Plantaar Fasciitis has been ruled out.
Submitted: 10 months ago.Category: Neurology
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10/6/2017
Neurologist: drphophalia, Other replied 10 months ago
drphophalia
Category: Neurology
Satisfied Customers: 39,097
Experience: Regularly deal with musculoskeletal neurology, spinal issues, bowel and bladder dysfunctions etc.
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Customer reply replied 10 months ago
Cycling also causes pain and stinging in heel
Neurologist: drphophalia, Other replied 10 months ago

Please send a picture.

Is the area tender?

What did your x-ray or other medical imaging show?

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Customer reply replied 10 months ago
Cannot be seen on a picture, felt by a finger. Area is tender when running or standing, less when walking. Imaging shows extra fad padding, but not out of the ordinary.
Neurologist: drphophalia, Other replied 10 months ago

Thanks for the additional information. I am writing the answer for you and will get back to you in 4-5 minutes. If you get a phone call request, you may ignore it as that is an automated site trigger. Thank you.

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Neurologist: drphophalia, Other replied 10 months ago

The possibilities of the diagnosis are;

1) Calcaneal bursitis

2) Fat pad syndrome (atrophy, heel bruise)

3) Plantar fascia rupture

4) Plantar fibromatosis; Painful nodule or lump is palpable in the plantar fascia.

5) Calcaneal periostitis

Following investigations if not yet done are recommended;

a) Soft tissue ultrasound

b) MRI

1) Moist heat or ice compresses; whatever suits you

2) Anti-inflammatory analgesics like Ibuprofen

3) Local analgesic ointment /spray

4) Physical therapy

5) Deep electrotherapy like iontophoresis, phonophoresis, short wave diathermy, electrical stimulation etc.

6) Consideration of steroid shot

7) Shock wave therapy

8) Custom-fabricated inserts in shoe-wear.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.

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Customer reply replied 10 months ago
Ultrasound/MRI shows nothing (except minor extra padding). Cortisone has no effect, neither does shockwave. Inserts even seems to worsen symptoms, but have to use them. Chronic issue, 1 year.
Neurologist: drphophalia, Other replied 10 months ago

There is a new therapy called as autologous blood injection in which your own blood is injected at the pain site, is said to be quite effective.

It is privilege assisting you.

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Customer reply replied 10 months ago
I would like to get it diagnosed before going into experimental treatments. Have been reading about suggested possibilities: 1: not on back of heel, so not relevant. 2: extra padding, not missing. 3: nothing shown on MRI. 4: too large area to be this.have not heard about Calcaneal periostisis: Tell me more, please
Neurologist: drphophalia, Other replied 10 months ago

Bones have a covering called periosteum.

It gets inflamed ((specially in people who may be athlete or overdo physical activity) and also inflames the surrounding soft tissue.

This is called as periostitis (calcaneum is the heel bone).

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Customer reply replied 10 months ago
Treatment options? - I have already tried long term rest, ice and the gereral RICE.
Neurologist: drphophalia, Other replied 10 months ago

The diagnosis is done by quantitative scintigraphy.

Shortwave diathermy, phonophoresis, Iontophoresis and laser are the treatment with physical therapy.

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Customer reply replied 10 months ago
I have a sceletal scintigraphy, is this the same
Neurologist: drphophalia, Other replied 10 months ago

Skeletal Scintigraphy is same and can tell if there is inflammation going on as increased activity around the bone and its covering could be seen.

Apart from the specific diagnosis, more important is steps to treat it and deep electrotherapy mentioned above with physical therapy plays a huge role.

Also acupuncture many times gives dramatic results.

Trans cutaneous electrical stimulation too is very helpful.

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Customer reply replied 10 months ago
Will i make it worse by walking or running? . Cycling causes small stings, is this normal symtoms? What physical therapy will help?
Neurologist: drphophalia, Other replied 10 months ago

You may need to ask the physical therapist to get the exercises for the intrinsic muscles.

Any activity which is painful should be avoided.

It is privilege assisting you. Please let me know if you have further queries or unanswered questions.Please consider a positive 5 star rating if this interaction has been satisfactory, as this is the only way we experts are credited and compensated for the time and work. You are not charged again for giving a rating. The rating button is on the left upper side of this thread.Thank you.Wishing you all the very best in life.http://ww2.justanswer.com/help/how-do-i-rate-answer-hl
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Customer reply replied 10 months ago
When I read about Calcaneal periostisis, it seems very similar to Plantaar Fasciitis, but I have no pain in the morning, only after prolonged activity, standing or running. There is no pain touching the area, but it seems like the swelling is pushing against a nerve causing sweeling. The entire foot feels twice as big, but only on the enside, as there is no enlargement of the foot, bruising or miscoloring. Does these symptoms match with Calcaneal periostisis? I have been diagnosed with Posterior Tibial Tendonitis as well, which is why I need orthotics.
Neurologist: drphophalia, Other replied 10 months ago

Medical diagnosis in the book and in an individual are slightly different and also there are overlapping in the medical conditions in the presentation.

So a rigid mimic of the symptoms should not be tried to found.

Also it is more important to ascertain the guideline of management.

Main aim is to differentiate between joint issue or soft tissue. And in soft tissue to find out tissues involved; fascia, ligaments, tendons, bursa, muscles. Majority of the time, a combination of tissues are involved.

Copy book presentations are rare.

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Customer reply replied 10 months ago
I dont understand that?
Neurologist: drphophalia, Other replied 10 months ago

There is always difference between presentation in individuals and books.

So reading medical literature and comparing symptoms do not work.

Also more important is line of management.

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Customer reply replied 10 months ago
line of management?
Neurologist: drphophalia, Other replied 10 months ago

Investigations and treatment.

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Neurologist: drphophalia, Other replied 10 months ago

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