Heel / rear arch pain not responding to various treatments

I am an otherwise healthy 32 year old athletic male. I am strong / normal weight (5ft 11inch, 160 lbs, 12% body fat). I had been a runner but not super high mileage (10 or 15 miles per week). I ran a half marathon two months ago. My foot felt ok after the race, but then a couple days later started feeling some soreness towards the back of the arch. I mostly stopped running and limited walking / only biked for a couple weeks. I started PT after the pain didn’t go away with lots of stretching and plantar fascia exercises. The PT thought it was post tib tendonitis, and I followed the stretches she gave me. At some point the condition started to get worse to the point that it was fairly painful to walk. I stopped going to PT and decided to get it diagnosed property by a doctor. I finally had an MRI last week and two separate radiologists ruled out a stress fracture, and my plantar fascia looks normal. I’ve been resting with very limited activity other than stretching for about a month and walking is still painful. I’ve been taking pain relievers, icing, heating pad, stretching, etc to no avail. I mostly just wear soft sandals and Hoka shoes, and have tried several different kinds of inserts. Even the stationary bike seems to bother it a bit so I’ve mostly stopped doing that as well. I’m planning to go see a foot orthopedist in a week or so, but I’m pretty much out of ideas. I am wondering if this could be Baxter’s nerve entrapment, or some other kind of nerve issue. The only other thing it could be is a tendon or muscle strain in my arch that just won’t heal for whatever reason. To summarize, I have heel pain, that hasn’t gotten any better with all of the conventional treatments + rest and it hurts to walk or stand for any period of time. MRI shows no stress fracture and normal plantar fascia. I think it is probably a nerve issue, or strained tendon / muscle, but not sure. Any ideas on what is going on and how to treat it? Thanks

One Response

  1. Foot.com

    Hello and thank you for your question. Based on your description it sounds like it may be a Baxter’s nerve entrapment however this typically shows on an MRI. When it comes to foot pathology if the radiologist reading the MRI is not adept at looking for certain pathology it may be missed. I would definately bring the disc of images to the foot orthopedist when you see him / her. Have you had any injections? I’d suggest trying at least a steroid injection if you have not done so yet. If the Baxter’s nerve is entraped then decreasing the inflammation around the nerve may require a steroid. If you do not get a diagnosis from the foot orthopedist I’d see a podiatrist but ensure they are surgeons, not that you need to have surgery but they are usually more keen to rarer diagnoses. I hope this helps.

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