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Dr.Sawhney, Orthopedic Surgeon
Category: Orthopedics
Satisfied Customers: 7241
Experience:  More than a decade of post qualification experience
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Customer Question

This is a response for Dr.Sawhney who requested I answer specific questions about my case. I am a 48 year old female. We are discussing chronic foot pain. This started at least 12 years ago at a time I was not insured. I had soreness and what felt like
internal swelling in both feet that was becoming normal after any amount of time spent on my feet. The pain always begins in the plantar area. At the beginning, my GP at the local clinic thought it must be plantar fascitis. On occasion he would give me cortisone
shots in the affected area or in my hip and he gave me advice on home therapy such as stretching and of course taking anti inflamatories. For years I thought my diagnosis was correct and just learned to live with the pain and avoid too much activity on my
feet. I have had every kind of shoe and shoe insert there is for this. I have been treated by sports medical therapists and done everything under the sun. At some point a few years ago, I really began to investigate plantar fascitis and determined there were
too many things that didn't add up to this diagnosis. I have good health insurance and my spinal doctor referred me to a coleague who also said based on my symptoms that it didn't seem as if plantar fascitis was correct. He proceeded to take xrays and found
nothing. He decided to treat me with "NBA dose" of anti inflammatories and said I need to do some kind of advanced xrays while standing when my feet were flaring up. Well that is funny because they don't take walk ins for this kind of thing and I decided I
needed help somewhere else. My feet hurt severely on a regular basis. Certainly it is worse when I have been active all day, but there are times when they start to hurt for no apparent reason. It can get so bad that it radiates all the way up my calves. It
is always both feet and it expands to the entire bottom portion of the foot. This is throbbing soreness in the tissue (I think) and not necessarily in the bones. The really frustrating part is that when I have had to push through the pain and keep going knowing
it's going to get worse, then eventually I am able to sit down and put them up a while, they hurt more when I do eventually get back on them. At times I cannot go to bed and stay there because even when propped on pillow, they start throbbing and even shooting
pains, worse when I am lying down. Anti inflammatories are certainly helpful. But prescription pain meds do not target this pain. I always have some kind of pain meds (up until recently) because I have had a herniated disc. But I had fusion surgery so I won't
be getting any more meds. The point is that not even hydrocodone or anything at that level, takes the edge of this foot pain. The fact that anti inflammatories help should be some indication of where the pain is shouldn't it?
Submitted: 2 years ago.
Category: Orthopedics
Expert:  Dr.Sawhney replied 2 years ago.

Just saw the new question you have opened.

I have gone through your question and I agree that this does not sound like plantar fasciitis.

There are several others possible diagnosis which need to be considered and ruled out by an experienced foot and ankle specialist orthopaedic doctor.

Major among these are calcaneal neuritis, different forms of compression neuropathies of the foot including tarsal tunnel syndrome abductor digiti quinti nerve entrapment and medial calcaneal branch of posterior tibial nerve entrapment.

Neuropathy should also be considered and ruled out. Neuropathy can be a result of many different underlying processes and may require thorough investigation.

As you seem to have had multiple steroid injections plantar fascia rupture and fat pad atrophy may also be causing pain and should be ruled out.

You should also have nerve conduction velocity study and electromyography to better define any underlying nerve problem. This should be done by a person who has got good experience in diagnosing foot and ankle nerve problems.

Your best bet would be to see an orthopedic foot and ankle specialist in a nearby university teaching hospital. Here you can often get to consult specialists who are at the forefront of knowledge frontier in their respective fields. They have the added experience of treating complex cases like yours as most such cases ultimately get referred to teaching hospitals.

Feel free to ask any follow-up questions.