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New patient last month, Requested MRI, Got results today.

Pt C/o Burning pain L/heel duration > 5 years +

Specific site of pain = peroneal retinaculum inferior attachment that radiates to the plantar aspect of the calc unspecific.

pt describes this as very painful especially at night in bed. pt also claims she has leaned to deal with the pain and only occaisionally takes NSAIDs when really sore. pain comes and goes from day to day.

No significant patho mechanics.
Footwear = good

Treatment Hx

Functional orthoses.
Steriod injections, gave some relief, last one 2006.
Heel cushions, silicone, gives some relief.

Was thinking nerve impingment, tumour, cyst = Surgical referral for investigations/treatment

MRI results attached.

Would varicosities cause irritation?? coagulated blood??

Going to refer on to Podiatric surgeon.

Any opinions/thoughts??

 

By your description alone I would suspect a branch of the sural nerve in entrapped.

I would perform a percussion along the sural N to find the location of the entrapment I perform a diagnostic local anaesthetic block at this level.

Relief would be suggesting local entrapment and treatment would likely be surgical release of the nerve branch.

LL