Unexplained Heel Discomfort
Person: Female, early 30s For the past three months, I have been struggling with pain in my left heel and arch. Currently, I'm relying on crutches, making it difficult to navigate even my modest apartment. Both my podiatrist and orthopedic surgeon have labeled my case as a "mystery." My foot is extremely sensitive, necessitating the use of highly cushioned footwear (specifically, Hoka Bondi 9) along with extra gel insoles just to manage any weight on it. Walking on hard surfaces is particularly intolerable. This issue began in December after I experienced discomfort in my heel and arch the day following a lengthy walk. At the time, I was accustomed to such walks, although I was wearing unsuitable shoes. After several visits to a walk-in clinic, I was diagnosed with plantar fasciitis and advised to reduce my walking, while focusing on icing and stretching. Despite my attempts to walk carefully, the pain has progressively intensified over time. It escalated to the point where I decided to use a knee scooter for mobility. After consulting a doctor, I underwent an ultrasound and X-ray, but when my pain and symptoms worsened, I went to the emergency room for further evaluation. They performed an X-ray (which appeared normal), a CT scan (normal), a Doppler test (normal), and recommended an MRI. **Ultrasound Findings:** - Plantar fascia: Mild thickening at 4 mm with a small spur observed. - Additional soft tissue thickening noted near the left heel, corresponding to the area of concern. **MRI Results:** - Edema detected within the pre-Achilles fat pad (Kager's fat pad) and irregular subcutaneous edema in the heel pad, consistent with heel pad fat syndrome, which may explain my condition. No indications of plantar fasciitis were found. I've been attending physical therapy for seven weeks, where we have incorporated various techniques including stretching, strengthening exercises, ultrasound treatments, laser therapy, electrical muscle stimulation, manual therapy, cupping, and dry needling targeting the heel, arch, and calf. During a consultation with a podiatrist, she expressed confusion regarding my condition. She noted that my heel fat pads are slightly spongy and that the left one is marginally thinner, although this difference is hardly perceivable—similar to what the MRI showed. The left pad is also slightly misaligned. She remarked that nothing appears seriously wrong or adequately explains the intensity of my symptoms. Orthotics are being crafted for me, but considering my foot's extreme sensitivity even in the softest shoes, I am doubtful I will be able to manage them. An orthopedic surgeon reviewed my imaging and reiterated that I present as a puzzle, advising me to continue with physical therapy and possibly explore a corticosteroid injection. In the meantime, I have been engaging in stretches, mobility exercises, strengthening activities, using a massage gun on my calf, massaging my foot and calf, taking hot baths up to my knees twice daily, applying a heating pad, rolling my foot on a frozen water bottle, cupping, and trying any other remedies I can think of. A few individuals have suggested the possibility of Raynaud’s phenomenon; hence, I am pending an appointment with a rheumatologist. However, my family doctor believes this may not be relevant since my foot still has blood flow. **Work:** I have a remote job that necessitates limited movement. Nevertheless, I am still using crutches and find it challenging to manage. I was feeling somewhat better before a recent work trip, yet even during that time, I required wheelchair assistance at the airport and restricted my total daily walking to 0.6-1 mile. Upon my return, I was in tears due to the pain. Does anyone have any suggestions?
Answers (1)
3/19/2025, 4:30:57 AM
OpenHealth AI
It sounds like you are experiencing significant and persistent discomfort in your left heel and arch, despite seeing multiple specialists and undergoing various treatments. This situation can be frustrating, especially when the exact cause remains unclear. The symptoms you're experiencing may relate to padding around the heel and sensitivity, alongside some structural changes. Here’s how to approach your discomfort further.
Key Points:
- Potential Diagnosis: You have already been diagnosed with heel pad fat syndrome, which can explain the discomfort you've been feeling. It's good that you're pursuing further investigation, including seeing a rheumatologist for Raynaud’s phenomenon, even though your doctor believes it may not be related at this time.
- Current Management: You are actively participating in physical therapy and have been trying many self-care strategies to manage the pain.
Explanation:
The heel and arch discomfort you're experiencing, particularly with the findings from your imaging tests, suggests that the issues may originate from improper weight distribution or soft tissue sensitivity rather than structural issues like plantar fasciitis. The treatments you've undergone so far, like physical therapy and the use of specialized footwear, are appropriate, but the pain intensity suggests that your condition may require adjustments in approach.
Next Steps:
-
Manage Activity Levels: Continue limiting walking and standing as much as possible. Consider using mobility aids, like crutches or a knee scooter, to relieve pressure on your foot as you have been doing. If you can, adjust your workspace to facilitate less movement and more comfortable positioning.
-
Enhance Physical Therapy: Communicate openly with your physical therapist about the level of discomfort during activities. They may adapt your exercises to minimize pain while still promoting healing. Focus on low-impact exercises that strengthen the surrounding muscles without straining the heel/arch.
-
Orthotics and Footwear: While waiting for your custom orthotics, keep using the highly cushioned footwear you find comfortable (Hoka Bondi 9). Once you receive the orthotics, introduce them gradually into your routine to see if they can provide better support without exacerbating sensitivity.
-
Pain Management Techniques:
- Continue with your hot baths and massaging techniques, as these can improve blood flow and reduce overall tension.
- Experimenting with different temperature treatments may also help; you may find alternating between hot and cold improves your symptoms.
- Keep using the massage gun on your calf but monitor your sensitivity. If it worsens pain, consider less intense techniques.
-
Consider Corticosteroid Injection: Discuss with your orthopedic surgeon the potential benefits of a corticosteroid injection that may provide temporary relief of inflammation or pain in the heel area.
-
Rheumatology Appointment: Follow through with your rheumatology appointment to assess the potential for Raynaud’s phenomenon or other systemic issues. If there is any vascular sensitivity, they will help address those factors.
Emotional Support:
It's completely understandable to feel disheartened by the ongoing pain and the challenge of navigating life with limited mobility. Be gentle with yourself and allow time for healing. Surround yourself with supportive friends and family, and consider speaking to a mental health professional if the emotional toll becomes too heavy.
Please keep me updated on your progress and if you have further questions or need more information.
Related Questions
Managing Early Appendicitis: Antibiotics vs. Surgery
I’m a 21-year-old who recently had a CT scan revealing mild inflammation in my appendix and lymph nodes. My doctor informed me that surgery might not be necessary if the antibiotics effectively alleviate my discomfort by tomorrow. However, I can’t shake my fears about a potential recurrence of the inflammation. The thought of going through a post-surgery recovery terrifies me, so I really want to steer clear of that option. Has anyone opted for antibiotics rather than surgical intervention? What was your experience like?
Concerns Over My Partner's Persistent Pain and Resistance to Seek Medical Help
I’m facing a worrying situation with my partner, a 40-year-old man who stands 6 feet 1 inch tall and weighs approximately 19 stone. Here's a brief overview of his medical background: Twenty years ago, he experienced two instances of deep vein thrombosis (DVT) in his left shoulder. Following the second incident, doctors discovered an abnormal growth of a rib that was pressing against a vein, which was the cause of those DVTs. More recently, he dealt with a blood clot in his calf last year. Fortunately, that was successfully treated, and he returned to his normal health. Although he was advised to continue taking apixaban for the long term, he has, unfortunately, chosen not to follow through with this guidance. He also has a history of elevated blood pressure. For the past couple of days, he has been experiencing two concerning symptoms that emerged simultaneously: a persistent cough with no accompanying cold or flu signs, and a severe pain located on the right side of his torso. He describes this discomfort as being mostly in his stomach yet extending slightly to his back. I would pinpoint the troubled area as the lower part of his ribs along the side of his body. It's unusual for him to express discomfort or complain about his health, so his recent grievances signal to me that the pain is likely quite significant. Despite my repeated suggestions for him to visit a doctor, he insists that he may have simply pulled a muscle. To manage the pain, he's been applying an ibuprofen cream (voltarol) and taking naproxen, but neither seems to provide relief. What might be the underlying issue here? I hope that some medical professionals who see this post can offer their insights, which might persuade him to consider making a doctor’s appointment. I’m open to providing any additional information you might require for a more informed perspective. Thank you for your help!
Struggling with Bleeding and Pain Since Christmas
I'm a 27-year-old woman from the UK, and I've reached a point of exasperation. I'm reaching out because I hope someone can provide insight or guidance on what I should discuss with my doctors. Please excuse any grammar or spelling errors as I have dyslexia. I've been diagnosed with endometriosis and underwent surgery in 2022 for confirmation of that diagnosis. On December 15th, I had my birth control implant removed after nearly two years. During that period, I experienced severe menstrual cramps and PMS. My GP started me on Drospirenone 3mg and Estetrol 14.2mg COCP in October to alleviate these symptoms and suppress my periods, which provided some relief. Prior to this situation, I occasionally dealt with flare-ups that typically lasted a few days or up to a week. To help manage the discomfort, I have been prescribed Duloxetine at a dosage of 90mg. I had an ultrasound earlier this summer, and the results came back normal. Currently, I am awaiting an MRI. Last year, my smear test results were also clear. After the removal of my implant in December, I began bleeding on Christmas Eve. Initially, I could manage with just a panty liner, but over the next few weeks, the bleeding intensified, requiring the use of pads due to increased blood flow and blood clots. Given my history with endometriosis, pain isn't unfamiliar to me; my average pain level is around a 4, but it has recently escalated to 7 or 8. In the past couple of weeks, the discomfort has worsened. My job demands physical activity, and bending over now causes pain in my back and legs. Additionally, I experience discomfort when my bladder fills, and urination is painful, although it doesn't feel like a urinary tract infection. I've also been waking up at night to use the restroom. My doctor performed a urine dip test that showed no signs of infection, though there was blood in my urine, which he indicated was to be expected. Recently, my GP prescribed Tranexamic acid 500mg and Mefenamic acid 500mg, which helped with the blood clots, but I'm still experiencing bleeding and significant pain. I've been diligent about taking my medication, treating it like a strict regimen. I returned to the GP, who referred me for another ultrasound and advised me to go to A&E if the pain worsens. I've been resting as much as possible while still trying to maintain some level of activity, but it hasn't provided much relief. Any assistance or advice would be immensely appreciated! Thank you!
Normal MRI and EMG Reveal Nerve Slowdown
Greetings, I’m a 23-year-old female seeking guidance about some health issues I’ve been experiencing. Recently, I've noticed weakness in both my hand and arm, particularly in my dominant hand where grip strength has been notably diminished. After undergoing an EMG, the results indicated that my nerves are exhibiting a slowdown. However, my MRI results were unremarkable. To address some swelling I experienced, I was prescribed a course of steroids (4mg for a few months), which alleviated some of the issues, yet I still experience residual swelling in my hand. Often, my hand feels cold, and I notice a popping sensation when I move my fingers. Despite these sensations, I do not have any numbness or tingling, and the swelling appears sporadic. The pain I endure is quite severe, described as a hammering sensation throughout my hand. On occasion, I take ibuprofen (600mg) for relief, but it proves to be somewhat ineffective. My wrist itself seems fine, but my orthopedic specialist is considering a diagnosis of carpal tunnel syndrome (CTS), even though my symptoms don’t align with typical CTS indicators. I would greatly appreciate any advice or insights you may offer!
Experiencing Unusual Sensitivity to Paracetamol
Hello, Reddit community! I'm a newcomer here, so please bear with me as I navigate this platform as well as the rules. I appreciate your understanding regarding my writing skills. I find myself in a situation that lacks sufficient information online, and I'm reaching out for insights from others. Currently, I have reasons to believe that I might be experiencing a unique sensitivity to paracetamol, and I’d like to share my timeline regarding this matter. Throughout my life, I generally had no issues with paracetamol. I used various brands multiple times and felt fine. However, starting in the fourth grade, I began to experience difficulties with it. My initial problems were respiratory-related, but soon they also affected my gastrointestinal system. I haven't had any formal testing yet, but I can safely use other pain relievers like NSAIDs without any adverse effects. Initially, I tolerated paracetamol relatively well; my early symptoms seemed like common side effects. Unfortunately, it escalated to severe reactions, including vomiting, tightening of the throat, blood in my mucus, and shortness of breath. In my confusion, I thought limiting my dosage could help, which it did temporarily, but eventually even the reduced amounts failed to be effective. I experimented with syrup formulations that contain less paracetamol or where it isn't the primary ingredient, and found those to be more manageable. Recently, however, even those have become problematic, making it necessary for me to seek alternatives to paracetamol, as it has become increasingly intolerable. Through my research, I discovered that such reactions often stem from cross-sensitivity to other medications or from preexisting respiratory conditions. I lack a history of asthma or other respiratory issues, so I’m inclined to dismiss that possibility, although I remain uncertain. Moreover, I have no known allergies, which adds to my confusion since my reactions only occur with this one particular medication while all others seem fine. It is difficult for me to process this change, especially since I used to have no issues with paracetamol. It is widely available and generally considered safe, so I struggle to understand the source of my suffering. Many people insist that these reactions are normal side effects, leading me to question whether I am overreacting. The immediacy of my reactions intensifies my concern; I don’t even need to swallow the medication completely before I notice my throat constricting, increased mucus production, and shortly thereafter, some blood in my mucus along with persistent coughing. This pattern has become consistent, whereas it used to depend on the dosage. Now, regardless of how much I take, the same symptoms occur. I’ve tried to dismiss it, not wanting to worry my parents or seek medical attention for a dosage safety test, fearing I’ve already pushed my body too much. However, I am considering discussing my concerns with my mother since she is increasingly worried about my use of this medication. I’m not seeking a diagnosis or medical advice—I understand I should probably consult a professional. I’m just interested in knowing if anyone else has faced similar experiences, as the confusion grows. What I once assumed were normal side effects now seem to signify something more concerning.