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

4 Responses

  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.

  2. Deb

    I had terrible heel pain that got worse and worse and lasted for years. No treatment worked. I could barely walk. Finally I went online and ordered insoles that are ridged. But the injury was repeated every day I got out of bed or stood up so the insoles did not work. They were meant to prevent injury.

    Nobody could provide me with answers so I bought a foot boot used for brakes. I wore that which keep my foot in one position in order to reduce re-injury and allow healing. I do not remember how long I used it, but it worked! After years and years of terrible pain, the feet healed. I used the insoles after that and have never had trouble again.

    Soft insoles let your foot bounce and that can cause injury so ridged soles are best according to the foot doc and my years of relief.

  3. RYan

    I just recently went to the foot doctor (podiatrist) and he told me I don’t have PF. That’s a relief, but I still get pain around the flexor hallucis. It is painful to the touch and radiates to the mid-arch and big toe from the origin of the flexor hallucis tendon. Unlike other folks, I do get pain once out of bed. It’s not terrible, throbbing pain. But, it’s pretty annoying and I know I’m making compensations because I often walk on the lateral/outside of my foot on my right side. I have been running around 15-20 miles a week and have recently been wearing high-arched inserts prescribed from my podiatrist. The trouble is, I think the pain is here to stay. Has anyone had a flexor hallucis origin pain and what did they do to fix it? It’s been going on for about 6 weeks, so any insight would be helpful.

  4. RYan

    By the way, ever since I was a kid, if I put my big toe in extension with an intense squeeze from my arch, I would get a throbbing/hyper-tension type of pain. The only way I could relieve this tension was to intentionally force my big toe into flexion. I’m not sure if this is related, but I thought it may be helpful. I know for a fact that my injury has everything to do with the kinetic chain involving my big toe. Thanks!

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