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The text above is a follow-up to ...

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I have had plantar fasciitis for 5 years and have undergone many treatments- physiotherapy, ultrasound, cryogenic ablation, ESWT, and finally 4 months ago a gastroc slide with radiofrequency ablation.  The 2 surgical sites healed fine but since then I have had burning pain on the lateral side of the heel about 1/2 an inch above the sole.  I can feel touch all along the lateral part of the foot.  First my Dr. attributed the pain to the nerve having to stretch to match the new length of the gastrocnemius.  A nerve block given into my lower leg took away all pain for 24 hours.  However now after  4 months he says he has no idea why it is hurting. It was x-rayed to check for a stress fracture. It is worse than before surgery.  He has given up and referred me to a pain specialist.  Could it still be the nerve lengthening or do you have any other ideas what could be causing the pain.  I have been off work for 4 months now as there is too much pain while I'm on my feet.
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Hi Margaret,

Have you had an MRI?  

Since there is burning of the lateral heel, there is likely nerve involvement.  It could be from over stretch of the nerve.

However, it sounds like you may have entrapment of the nerve (Sural nerve) within some tissue, possibly scar tissue.  If the injection of the nerve helped then it would make sense to do some type of nerve destruction or release of the entrapement.  

Possibly this nerve abnormality can be seen on MRI or ultrasound.

I would recommend that you see another Podiatrist for evaluation and treatment.

I have had excellent success with a minimally invasive procedure known as Cryosurgery to relieve this type of pain. You can see my site below for Foot Cryosurgery information.

Hope that helps.

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
www.thetampapodiatrist.com
www.tampacryosurgery.com
www.fix-my-foot.com

Thanks for your prompt reply.  At least you've given me some new hope.  I thought that the Dr. was checking for sural nerve entrapment when he ran his finger along the lateral side of the foot. I have feeling all along there.I've had 2 MRI's of the foot but both were before the last surgery.  I also had cryogenic ablation twice about 3 years ago in Idaho for the plantar fasciitis. Also the podiatrist snipped something at that time but I'm not sure what. It didn't stop the fasciitis but the burning along the heel that I had before the cryogenic ablation disappeared. Now it's back again since the latest surgery.  
Could it be the sural nerve when I have feeling all along the foot?  Before the cryogenic ablation, one podiatrist had diagnosed nerve entrapment, I think of the first branch of the lateral plantar nerve (Baxter's nerve).  The surgeon told me that he checked to see it was free during surgery.
Thanks so much for taking time to answer.

Margaret
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Hi Margaret,

It still sounds like nerve entrapement of the sural nerve.  You may have pain with no numbness on the side of the foot.  This is different than Baxter's nerve.

Also, you may want to see a neurologist and have a nerve conduction study to see if there is abnormality of the sural nerve.

I believe Cryosurgery may be a viable option.

Hope that helps

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
www.thetampapodiatrist.com
www.tampacryosurgery.com
www.fix-my-foot.com


Thanks for your reply Mark.  I'm seeing my Dr. tomorrow to ask for a referral to a neurologist. I've scoured the internet for days now and think that your sural nerve entrapment theory is quite plausible.  Hopefully nerve conduction testing will show something but I gather it doesn't always.

I've also reread all about cryosurgery.  I may go for it even though I'm Canadian and it is not approved up here.  However I'm only a few miles from the border.  

I really appreciate the service you provide.  I think it's great of you to do it!

Margaret  

Answer
Margaret,

That sounds like a good plan.  Lots of luck.

Below is the only Canadian cryosurgeon

Calgary
John Smith
Calgary Pain Management Center
304-1011 Glenmore Trail SW
Calgary, Alberta, Canada  T2V 4R6
403-278-3444
403-271-1558

Also search here for other locations:

http://cryotechllc.com/DoctorLocations/Defaut.htm

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
www.thetampapodiatrist.com
www.tampacryosurgery.com

www.fix-my-foot.com