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tax_lord

Foot pain (and it's not plantar fasciitis...)

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Here's a case study for anyone who is good with feet (or knows someone who is)...  

I have been battling a foot issue for nearly 8 months now which is symptomatically kinda like PF but not actually that.  During that time I've had 3 ultrasounds and 1 MRI which have all ruled out PF as the issue but the problem still remains.  In terms of using the foot I can do most things without issue (jump, squat, walk casually, stand, etc) but if I try and run I wont last more than 800m and once I stop running the pain disappears as quickly as it presents.  Some days its better than others but generally if I try and push through it the pain gets worse and eventually the foot goes numb. 

Based on the scans to date the problem was first diagnosed (by u/s) as a tear of the flexor digitorum brevis but after 10-12 weeks of rest and rehab with my physio the problem was still there.  A 2nd u/s showed the tear had healed so I saw a foot surgeon who ordered an MRI which showed a torn flexor hallicus brevis.  The MRI report however indicated the tear was distal to the site of the discomfort which put it at odds with the original u/s.  Nonetheless a further 10-12 weeks of rest including 4 weeks in a CAM boot have done nothing with a 3rd u/s now unable to find any evidence of tears in either flexor muscle or anything else that may cause similar symptoms.  

Most recently after discussions with my GP we formed the view the problem sounded like a compressed nerve (although not indicated as such on the MRI) and experimented taking Lyrica which helped but even on the max dose I could only run for about 30 odd mins at the most.  The side effects of that stuff are pretty harsh though so I have stopped taking it and without it I am back to 3-4 mins of running before the symptoms present.  

I'm waiting to speak to the surgeon again next week once he returns from leave but has anyone experienced a similar issue before or care to offer an educated opinion? 

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2 hours ago, tax_lord said:



I'm waiting to speak to the surgeon again next week once he returns from leave but has anyone experienced a similar issue before or care to offer an educated opinion? 

Sports physio opinion

I'd need to know a bit more to be more confident but whenever someone comes into the clinic with plantar heel pain you need to consider diagnoses other than plantar fascia. The numbeness certainly isn't consistent with plantar fascia (or with FDB / FBH injury). 

Nerve entrapments are not that uncommon in that area - medial calcaneal nerve entrapment I have seen a couple times and Baxter's nerve entrapment I keep an eye out for but I don't think I've seen a true one.  You won't see either of these on imaging.  The treatment of choice here seems to be high volume saline injection which 'disrupts' the nerve entrapment.

Need to also consider a low back referral although this sounds a lot less likely from what you've said.

 

Will be interested to see what the end result is, good luck

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