Ask A Doctor - Podiatry

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Q.
I have been diagnosed with a spur under my left heel- I have had 3 cortisone injections which helped for a couple of months. My doctor will not give any more cortisone shots. What else can be done for this condition?
A.
Heel spurs are a result of instability in gait, causing stress on the heel bone and the attached soft tissue. A strain is placed on the muscles and ligaments beyond the normal extension, causing inflammation and possible growth of a bone spur. The effected ligament is known as the plantar fascia, which connects the heel to the ball of the foot. The condition is worse after being sedentary for a prolonged period of time and once the individual begins to walk it resolves. This may also be caused by injury, bruising, shoegear that is not supportive, or inflammation of a nerve or Achilles Tendon. Your doctor is correct in not administrating further cortisone injections, this could cause a break down of soft tissue including tendon and ligaments. Other treatment options include taping, anti-inflammatory medication, icing, stretching exercises, physical therapy, and most importantly custom molded orthotics. The vast majority of patients respond to conservative treatment, however, when exhausted, surgical intervention may be necessary.

Q.
Please tell me what is it when your feet get sharp pains and are very sensitive to the touch? Also, there is a feeling of tingling to them and very hard to put shoes on.
A.
The pain and sensitivity you are experiencing may be due to tarsal tunnel or peripheral neuropathy. Tarsal tunnel is carpal tunnel of the foot. The tarsal tunnel is a narrow space that contains neurovascular and tendon structures that enter the foot. These structures have a thick ligament that covers them and keeps them in place. The Posterior Tibial nerve is within the tunnel that is compressed. The compression may cause numbness, tingling, pain, and occur suddenly. Diabetes, fallen arches, injury, or cysts within the tunnel can cause the compression and associated pain. If necessary an MRI or nerve conduction test will be ordered. Treatment includes rest, ice, anti-inflammatory medication, immobilization, injections, custom molded orthotics to decrease excessive motion, and lastly surgery. Surgery consists of decompression of the posterior tibial nerve and it’s branches. Diabetes is a common cause of peripheral neuropathy. The nerve damage may be due to uncontrolled blood sugars, high blood pressure, a high fat diet, and being overweight. The pain, numbness, burning, sensitivity, and loss of feeling is due to the nerve damage and may be worse at night. The discomfort starts in the toes and can work up to the ankle. Treatment includes regulating blood sugars and medications to alleviate the pain.