This patient has had a long struggle with severe plantar heel pain that started after running. Initially treated as a pure plantar fasciitis, his symptoms did not resolve with appropriate conservative therapy. Rest, NSAIDS, injections with steroid, immobilization, physical therapy, and other modalities did not improve his pain. When plantar fasciitis does not improve with these measures, other causes of heel pain need to be evaluated. One of the clues that seemed to indicate that something other than just plantar fasciitis was present was the complaint by the patient that his persistent pain started behind the ankle and extended into the arch of the foot and then under the heel laterally. The pain was not purely isolated to the bottom of the heel that is more common in plantar fasciitis. One of our colleagues Dr. Jake Wisbeck knew something was different about this patient and sent him for EMG and nerve conduction testing. The result returned that he did have evidence of tarsal tunnel syndrome consistent with “Baxter’s Neuropathy” which is a version of tarsal tunnel syndrome that specifically causes refractory heel pain as one of it’s hallmark signs. However, the patient also had true findings on MRI of tearing in the plantar fascia as well. He seemed to truely have both problems.
He was referred to Dr. John Senatore and then to Dr. Williams. We took a team approach to this patient. After confirming the diagnosis the patient underwent a combined procedure with release of the tibial nerve, medial plantar, lateral plantar and calcaneal nerves as well as a plantar fascia release and lengthening of the gastrocnemius.
The patient has now recovered from surgery and is back to his favorite activities! I wanted to personally thank Dr. Jake Wisbeck, Dr. Gayle Schwartz, and Dr. John Sentatore for their excellent care in getting this patient back on his feet without pain!
Drew