Question
Dear Dr. Katz,
I have a 6 yr.  history of what has been dx. as plantar fasciitis.  I have a heel spur as well.  THey are both related to my right foot.   I have had 2 endo. plantar fasciotomies.  Also, then was recommended for a tarsal tunnel and baxter's nerve release- which I also had done. Nothing has worked for my plantar pain.  I still have the very same pain as always.  Many podiatrists have told me it is the "classic point" of plantar fasciitis. I can pinpoint exact area. It pierces me anytime I am standing.  much worse pain to stand in one place.   I have to feel now that it is either the actual spur itself causing pain or possibly some sort of trigger-point condition.  Podiatrists here are at a loss and tell me nothing futher to offer me.  I have also had a radiofrequncy  lesioning procedure- 2.5 years ago.   That was after surgeries failed.   I had the radiofrequency procedure not with a treating physician, I travelled out of town since there was not a radiofrequ.  provider in my local area. The podiatrist (who I saw only for the consultation and procedure, advised me before the procedure, that it may not work.   He said he felt the problem "had gone into muscle".  I felt I needed to try it and quite unfortunately, it did not work.  At any rate, I am now considering the cryosurgery for my awful heel pain.  I am depressed so and hardly even leave my chair at this point.  I need an answer to this pain -- so much.   I also cannot find a Dr.  in my area willing to remove the spur.  I am always told that the spur is only a symptom and not a cause of pain.  Do you believe the cryotherapy is a good consideration at this point.   I am asking this also based on the fact that I had also read from another heelspurs.com - Dr. Z, that the cryosurgery is only of benefit if the cause of the pain is related to medial or lateral plantar nerves.   I am willing to travel.  I live in Columbia,  SC.   however, have been here only 2 years since my husband got a promotion.   We both were both born and raised in Tampa.   I also fell down  6 months ago.  My foot and ankle - -- so fatiqued and weak. I was experiencing  lateral ankle pain and instability due to the way I walk to avoid the pain. This is even with wearing orthotics at all times.  I twisted and rolled my ankle and was at the top of concrete step- I could not recover and lost all control; fell face first down the step onto the concrete garage floor.  I broke my right ankle and tibia which required a titanium rodding.  I did so well recovering from the rodding surgery and very forturnately, have good bone growth.  The orthopedic surgeon said so far as the bone, I recovered well over what he expected.  My ortho. surgeon is a trauma surgeon hospital-referred to me ;so he could not help me with my plantar pain. He only treats traumatic injuries.  Now, that I am back on my feet from recovery from the rodding surgery, I am back in the same awful plantar pain situation.  I stayed seated and have always complied with post-surgical leg/foot elevated literally for 3.5 months this time, Unfortunately only to return to the to the original pain situation.  I know I have a long history, but thank you so much for your time to review my information and for any thoughts you may have.

Answer
Hi Leslie,

I believe cryosurgery could be an option for you.  Unfortunately you had surgical treatments with no clear cut diagnosis.  That in my opinion does not lead to recovery.  I would need to do thorough exam and feel confident with a diagnosis.  If that diagnosis can be treated with cryosurgery then I believe it would be your best option.

Removing the spur has no benefit and can cause more trouble.

Most heel pain does emanate from the medial and lateral plantar nerves. What doctors fail to understand is that the nerves are the pain source.  Of course there are other factors but the approach to chronic pain is treating the abnormal nerve.  All of these other cutting procedures are just a stab in the dark.

Sincerely,

Marc Katz, DPM

Tampa, FL
Advanced Podiatry
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