Hi. My name is Lisa. I recently had plantar fascia release to my right heel on july 10, 08. A little over a month ago , I began to get a sharp pain on the side of my foot on the very top and even bottom side of foot. I went back to my orthopedic dr and his response was using the analogy "robbing peter to pay paul." My heel pain is gone but it is becoming increasingly difficult to take 1 step with out almost crying. I have also began to have the same pain develop in my left foot. He doesnt appear concerned about this, saying its just one of the complications that can occur as a result of that type of surgery. However, he never mentioned this to me prior to surgery. I have tried the arch supports in my shoes, therapy, etc. Nothing seems to help. This pain is becoming unbearable. Please advise me as to what i can do. Sometimes it feels like something in my foot is torn or broken.

Hi Lisa and welcome.

Sounds like you got a case of lateral column syndrome. Take a peek at our article on plantar fasciitis. I think you'll get a bit better understanding of LCS.

I look at LCS as a stress reaction in the bone due to the mechanical change applied to the foot. Basically the bones are trying to understand why the load bearing is different after your surgery.

I do a fair amount of EPF surgery and believe in the technique, but you do need to talk about LCS as a known complication of EPF surgery. And I'm not immune from LCS cases. The thing that I just can't seem to determine is who is going to get it and who won't. Seems to occur in about 1/10 cases. I've got a guy in my practice now that I did an EPF on last October and he's still having troubles. It'll heal in time, but that sure wasn't an anticipated outcome of his surgery.

Jeff

Do you have any suggestions that i might try? I swear there are times when i try to take a step it feels like something is torn when my feet bend during walking. My Md doesnt appear concerned, but i swear it hurts twice as bad as my heel used to , and that was pretty bad. I bought sme inserts for my shoes, but nothing seems to help. Would taping it help? im not sure how to tape my foot but at this point, even the pain medicine he has me taking barely eases the pain and just makes it a little more tolerable. I am becoming depressed.

You need to recognize that LCS is a stress reaction in the tarsal bones (big bones of the midfoot) that is very similar to a fracture. So you need to treat it as such. I use a cam walker with a heel lift. I'd opt for the better quality walkers with the inflatable air bladder to provide some degree of compression.

The heel lift is also an important part of the process in that the lower the heel, the greater the load that is applied to the midfoot by the calf. Be sure to check our pages on CT band syndrome for more information.

I really do think you ought to have some local care. If you can't have a good conversation with your surgeon, do you suppose it's time for a f/u with another doc? I'm not one to try to come between you and your doc, but it does sound like you need to work with someone who understands what's happening to you.

Jeff

Can I ask you something else? I have also began to have the same tye of pain in my left foot. On the top side in the same area as the one I had sugery on. My Dr. had given me a cortisone shot shot in my right fot but it did not help. When I went back to him, he acted as if this was the strangest thing he ever heard. He said he would be happy to continue to search for what could be causing this pain(suggested a lower back problem,maybe) but I did not have this pain before I had plantar fascia surgery. Please advise me. I think you are right, I am going to consult another MD, I just wanted to assurance that I am not crazy. Thanks so much!

Most of the time I'm going to profess that the treatment of the foot and ankle could be accomplished by either folks in podiatry or orthopedics. But in your case, I'd be inclined to refer you to a surgical podiatrist. EPF surgery is a podiatry procedure. As such, i think you're going to find a greater knowledge base for the procedure and complications within the podiatry community.

Just a suggestion. But I think you may get to the heart of the issue a bit faster with a podiatrist.

Jeff

I'm a 43 yr old female with plantar fasciitis in my right foot for the past 5 yrs. I am 30 lbs. overweight and have gained all of it since my foot started hurting. I initially tried stretching, icing, night splints, custom orthotics, active release technique, accupuncture, ultrasound, massage, physical therapy, nerve testing. I started neurontin a yr ago, and it helped with the shooting pain that was going up the top of my ankle to my shin. I have been seeing my foot dr. (DPM) this entire time, and he almost did a tarsal tunnel surgery but we decided to do the EPF first.

I had EPF Sept. 18 2008. I woke up in recovery expecting my foot to be numb, but I was in extreme pain. The nurse asked me my pain level and I said 9-10! She gave me more pain meds in my IV, and after 20 min. asked me how it was and I said 9! She called my dr. back in, and I go, "I thought I was supposed to be numb for a couple of hrs post surgery!" He goes, what? He presses the arch area and I jumped in pain. He said he did a nerve block before the surgery (I think that's what he said) and this had never happened. He proceeded to inject a bunch of stuff in the bottom of my foot until I couldn't feel it and it looked like a puffy mess. He told me he usually has his patients walk pretty soon afterwards, but with all the injected medication, my foot wouldn't support my weight, so I had to use crutches and a walking boot for 2 days.

My foot hurt, and I wore the walking boot with no arch support and the padding underneath my toes (where the toes meet the pad of the foot) started to hurt right away. It felt like I was a skeleton, and I was walking on "bare bones". The shooting pain up my leg stopped, and also of course my heel pain. I seemed to be doing better after 6 weeks, and I was SO relieved! But then I started experiencing pain in weird areas of my foot, shooting pain in the arch, pain on the outer side of my foot etc. He ordered new custom orthotics and I've been wearing them for about a month, on and off when the pain allows it.

In January, I had extreme pain over my 4th/5th toes, and under them...shooting pains, spasms, tingling, and on one day, I couldn't walk at all. I went to see him and he said I had mortons neuroma and injected the top of my foot with cortisone. This seemed to help a bit, but all this time I was still experiencing pain on the outer side of my foot. I had a MRI on Friday, and I spoke with him today and he said it showed nothing, not even the neuroma. When I walk, it feels like I'm walking on "bruises" within different parts of my foot. I went to Costco yesterday, and just from walking during that time, today I have sharp, shooting pains going from the top of my 4th/5th toes (where it meets the foot) and even my arch has shooting pains. When I'm just sitting here (with my feet elevated)...at the present I have throbbing in my arch, tingling in my 4th/5th toes, spasms, etc. I CONSTANTLY had outer foot pain (I think this is what you call the lateral column pain) all the time.

I put a mortons neuroma pad (I ordered it from footsmart) in my shoes (together with the orthotics), and wore it today. I am SICK of hurting, I want to cut off my right foot.

My doctor said he's going to inject cortisone again on Friday, and I told him I put the pad in and he agreed. Oh, and I'm going to weekly accupuncture sessions ($75/week) because I'm desperate to feel better. You mentioned that this can go away...HOW AND WHEN??!!! Please tell me what to do and I will do it. I'm crying as I type this because I feel like nobody understands how much pain I'm in and how this has affected my life. I don't go anywhere, do anything, and I'm MISERABLE. I also only wear tennis shoes (asics gt2130), and I replace them every 3 months. I step into my tennis shoes, even when getting out of bed.

I'm a bit irritated that I had to discover this website on my own and am thankful that I'm not crazy, that this other patient had the same symptoms. Why does my doctor act like this is the first time he's ever heard of this, if this is a complication that can happen? I'm bringing him the MRI films on Friday. I don't want to "band-aid" this problem, I want to fix it, so I can walk again. You mentioned to Lisa that it will "heal in time". What did your patients do to have it heal? How long did it take? Please respond ASAP with your recommendation. Oh, and Lisa, could you respond and tell me if you feel better? Thanks

Hi Annette and welcome,

The first thing we want to do is to make sure that we've really got an accurate diagnosis for you. Lateral column syndrome is a complication of EPF surgery, but not every one gets it. In my practice (and this will vary), I see about 1 in ten folks with EPF's will get into trouble with LCS. So in the grand scheme of things, it's not all that common.

The most common symptoms aren't up in the forefoot, but rather a dull ache in the top of the arch and side of the foot more towards the heel. There's usually no swelling or redness. And the pain feels a bit like a fracture.

Have you talked to your doc at all about LCS? What's his impression?

Jeff

Hi Dr. Oster,
I saw my doctor today. He looked at my MRI and said it doesn't show a mortons neuroma, but it did show inflammation in a certain part of my foot. I asked him about lateral column pain and he said that the MRI didn't show that, but he said something about a cuboid? I'm sorry, I don't understand the medical terminology. All I know is that when I walk, it hurts on the entire right underside of my foot.

If you turn my foot upside down, it hurts from my bottom 4th/5th toes all the way to the heel, but on the bottom outer-side. I told him how when I walk any length of time, that the top of my 3rd/4th toes and the top of my right foot kills me, with spasms, tingling, jolts of pain, like the morton's neuroma symptoms.

Im wearing the mortons neuroma gel pad, and he put a piece of white foam under the rightside, just below the 4th/5th toe (all of this on top of my custom orthotics).

He is making me go back on neurontin, (I had weaned myself off last Sept. after surgery) and I requested physical therapy. He also wants me to see a pain management dr., but I told him I don't want to rely on any pain medicine. He also wants me to start the Voltarine tablets together with the Volteran Gel I already use.

I'm going to see him in a month. He said he has no idea what is wrong. I can tell he's confused, he says he really feels like it's my nerves, because when he presses on certain parts of my foot, it doesn't hurt. When I walked for him, I told him it feels like I'm walking on stones along the whole right underside of my foot, and when I lift my foot, the pain radiates to the inside of my arch.

So, back on neurontin --I was taking 1200 mg a day, I just took 1 300mg pill and feel drunk It's going to take me awhile to get used to it again, but it really did help before, it's just I feel it made me lethargic and gain weight (no energy).

I wish I knew somebody that had gone through this before (same symptoms). If I just had a little bit of hope that eventually this will go away, I'd be so happy. I'm so sick of this pain. Any opinions would be great, I will try ANYTHING. Thanks

Hmm, I wonder what that bit of inflammation was that was mentioned on the MRI.

Can I take you a little bit out on a limb by trying an experiment? The region in and around the cuboid bone is a pretty complex area in terms of load bearing. One of the tricks I use to weaken that load bearing and in turn, allowing a number of different problems a chance to heal, is to weaken the calf. You can weaken the calf by doing three things. First, no going barefoot. The lower the heel, the greater the load to the lateral column. Second, be sure to wear a shoe with a bit of a heel. In this case, more heel is better, but to be reasonable, be sure to have at least 3/4" to 1" heel at all time. Alternatively you can use a heel lift in lower shoes. And lastly, be sure to get started doing 6 sets of calf stretches, 6 times a day.

Another trick to off load the lateral column is to be sure to use a shoe with a stiff shank.

Give it a try for a week. If the problem is bone, joint or tendinous in nature, the symptoms ought to drop off a bit. If not, then I'd be thinking that the problem had to be a nerve issue.

Jeff