Why do patients not respond to steroid injections when they have heel pain?

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Why do patients not respond to steroid injections when they have heel pain? The answer is usually because they have been misdagnosed. In most cases, it is because they also have underlying tarsal tunnel syndrome, nerve entrapment in the ankle. It is of the upmost importance that your podiatrist or orthopedist have experience in peripheral nerve surgery so that they can make the proper diagnosis. Plantar fasciitis rarely requires surgery and should respond to conservative treatment which often consists of: trigger point steroid injections, night splint, stretching, orthotics, MLS laserr therapy, etc.

    Countless times I am referred patients who continue to have pain after having had plantar fasciitis surgery or after having had multiple injections. A good clinicial will LISTEN to their patient and usually their history will provide the daignosis and the exam will confirm it. 

     The most common complaint with plantar fasciitis is ” my heel hurts in the morning on first step or when I get up after periods of rest”. Most foot & ankle  specialists are adept at hearing this and making the working diagnosis of plantar fasciitis. The next crucial question which is often never asked is ” Do you have any burning foot / ankle pain while lying in bed at night? Does it only hurt when you weightbear?”. If they say it hurts lying down and weightbearing and they confirm pain at night, then you should also suspect tarsal tunnel syndrome.

     Tarsal tunnel syndrome is entrapment of posterior tibial nerve and it’s branches (medial plantar, lateral plantar, and calcaneal nerve). The nerve entrapment often causes a “shooting pain” sensation. The clinical exam to confim it, is to check for a positive tinel’s sign. In this case, if the inside of the ankle is tapped and it creates a shooting sensation to the heel or toes, then you have a positive diagnosis of tarsal tunnel syndrome. If there is pain on palpation of the inside of the heel, then you also have a diagnosis of plantar fasciitis. It is fairly common that if you suffer from tarsal tunnel syndrome then you also have plantar fasciitis.

      Tarsal tunnel syndrom should be treated conservatively at first. I have found MLS laser therapy and botox injections to be helpful. If conservative treatment fails, then a tarsal tunnel release and nerve decomression and neurolysis needs to be performed. It is imperative that this surgery be performed by an experienced peripheral nerve surgeon. There usually is little to no pain afterwards and the patient experiences temporary numbness. 

   So the bottom line is that if you are being treated for plantar fasciitis and not getting better, find a podiatrist / orthopedist with experience in peripheral nerve surgery to ensure you get the proper diagnosis and treatment. At Houston Foot & Ankle Care, I specialize in treating this and would love to help you.

 

GAbriel Maislos, FACFAS, FAENS

Author

Houston Foot and Ankle