Plantar Fasciitis: Seeking Answers for Chronic Foot Pain

Plantar fasciitis

Hello, doctor.
I have been experiencing numbness, swelling, and pain in the soles of my feet for five years.
I have consulted with rheumatology and orthopedics, and an MRI revealed a herniated disc at the L4-L5 level, but it is not compressing any nerves.
I have undergone an EEG and nerve conduction studies (not sure if the name is correct), as well as an ultrasound of my feet (showing slight inflammation).
I have had X-rays of my feet that indicated mild bone spurs.
Recently, both soles of my feet have been numb and swollen (with pain in the heels making it difficult to stand), accompanied by a cramping sensation in the inner and outer sides of both calves.
I cannot fully extend my legs.
I have undergone six months of rehabilitation, taken various anti-inflammatory medications, worn custom-made insoles, and have been using air-cushioned shoes for five years.
I have also tried acupuncture (including treatment at the Yongquan point on the soles) and qigong, all without success.
Doctors in orthopedics, rehabilitation, neurosurgery, and orthopedics have all suggested that my condition may not be related to their specialties.
Could you please advise me on which direction I should pursue for further examination? Thank you for your assistance.

K.D., 50~59 year old female. Ask Date: 2006/04/09

Dr. Xu Zhenrong reply Rehabilitation

Dear Mr.
KD,
From your letter, it is clear that you have been suffering from this condition for many years.
The necessary examinations include imaging studies such as X-rays, musculoskeletal ultrasound, and lumbar MRI, as well as electrophysiological tests.
You have also consulted various specialists, including neurologists, orthopedic surgeons, rehabilitation physicians, and traditional Chinese medicine practitioners.
My current recommendations for you are as follows:
1.
Gather and organize all the reports and results from these examinations.
2.
Consult a neurologist to start with the neurological system and rule out any neurological issues, including those related to the central and peripheral nervous systems.
3.
If no neurological problems are found, then focus on the musculoskeletal system, at which point you can seek evaluation from a rehabilitation physician or orthopedic surgeon.
For chronic conditions, it often requires a repetitive process to identify the true underlying cause.
I hope this advice is helpful to you.
Sincerely,
Hsu Chen-Jung
Department of Rehabilitation Medicine, Taipei Hospital

Reply Date: 2006/04/09

More Info

Plantar fasciitis is a common cause of chronic foot pain, particularly characterized by discomfort in the heel and the bottom of the foot. It often arises from inflammation of the plantar fascia, a thick band of tissue that runs across the bottom of the foot, connecting the heel bone to the toes. Given your symptoms and the extensive evaluations you've undergone, it’s essential to consider a multifaceted approach to understanding and managing your condition.

Understanding Your Symptoms
Your five-year history of foot pain, particularly the sensations of numbness and swelling in the forefoot, heel pain, and cramping in the calves, suggests a complex interplay of factors. The MRI indicating a herniated disc at the L4-L5 level, although not compressing nerves, could still contribute to referred pain or altered gait mechanics, which may exacerbate foot issues. The presence of mild bone spurs and inflammation in the foot further complicates the picture.

Potential Connections
1. Plantar Fasciitis: This condition often presents with heel pain, especially in the morning or after prolonged periods of inactivity. The inflammation can lead to pain that radiates throughout the foot and even into the calf muscles due to compensatory gait changes.

2. Nerve Involvement: While your imaging studies did not show nerve compression, conditions like tarsal tunnel syndrome could still be a consideration. This occurs when the posterior tibial nerve is compressed as it passes through the tarsal tunnel, leading to symptoms of pain, numbness, or tingling in the foot.

3. Muscle Imbalances: The cramping sensations in your calves may indicate muscle fatigue or imbalance, potentially stemming from altered biomechanics due to your foot pain. This can create a cycle of discomfort that affects your overall mobility.

4. Footwear and Orthotics: While you have been using custom orthotics and cushioned shoes, it’s crucial to ensure that these are appropriately designed for your specific foot structure and gait. Sometimes, even well-intentioned orthotics can exacerbate issues if they do not align with your foot's needs.

Next Steps for Evaluation
Given the complexity of your symptoms and the lack of improvement with various treatments, consider the following steps:
1. Re-evaluation by a Podiatrist: A specialist in foot and ankle disorders can provide a comprehensive assessment of your foot mechanics, including gait analysis. They may suggest alternative orthotic solutions or specific exercises to strengthen the foot and improve flexibility.

2. Physical Therapy: If you haven’t already, working with a physical therapist who specializes in foot and ankle rehabilitation can be beneficial. They can provide targeted exercises to strengthen the plantar fascia and surrounding muscles, improve flexibility, and address any gait abnormalities.

3. Neurological Assessment: Since you have experienced symptoms that may suggest nerve involvement, a consultation with a neurologist could help rule out conditions like peripheral neuropathy or other neurological issues that might be contributing to your symptoms.

4. Alternative Therapies: If conventional treatments have not yielded results, exploring alternative therapies such as shockwave therapy or even considering a consultation with a pain management specialist might be worthwhile. These approaches can sometimes provide relief when traditional methods fail.

5. Lifestyle Modifications: Consider evaluating your daily activities, including any repetitive motions or prolonged standing that could exacerbate your symptoms. Incorporating rest periods, stretching, and strengthening exercises into your routine may help alleviate some discomfort.

Conclusion
Chronic foot pain can be multifactorial, and it often requires a comprehensive approach to diagnosis and management. Given your extensive history and the various treatments you've tried, seeking further evaluation from specialists in podiatry, physical therapy, and neurology may provide new insights and potential pathways to relief. Remember, persistent pain is a signal from your body that should not be ignored, and finding the right combination of treatments is key to improving your quality of life.

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