This patient suffered for more than 1.5 years with unsuccessful yet aggressive therapy for her suspected plantar fasciitis, but she never improved. She had many treatments for this. One of the podiatrists that she was seeing eventually diagnosed that she may have tarsal tunnel syndrome with compression of the calcaneal nerve and plantar nerves in addition to her plantar fasciitis. Some of the clues that helped make the diagnosis of tarsal tunnel syndrome and compression of the medial plantar, lateral plantar, and calcaneal nerves in addition to chronic plantar fasciitis was the fact that this patient has not just plantar heel pain at the attachment of the plantar fascia to the heel, but also she had numbness, tingling, burning, shooting sensations in the medial ankle, posterior heel, and the sole of the heel.
Some of the findings that give the diagnosis away are a strong Tinel sign (“funny bone”) sensation when the tibial nerve and the plantar nerves are gently tapped on. The “funny bone” or Tinel sign typically radiates down into the heel and arch and toes.
This patient had pain for 1.5 years and now 6-7 weeks after surgery is completely pain-free. She is now back to walking 3 miles daily without the severe sharp pain that was debilitating prior to surgery. We are very excited for her. She is back to her walks!
Dr. John Senatore, a podiatrist, that we work with on a regular basis helps me with these patients, and we have extensive experience with these refractory patients who have combinations of diseases -- plantar fasciitis and peripheral nerve compression. The collaboration had been a tremendous addition for our more complex patients that cross specialties.
Many patients with refractory heel pain have nerve compression disorders.