Tuesday, August 12, 2014

Not a first I wanted

Last month I blogged about a pain in the heel I had been dealing with.  I thought it was plantar fasciitis setting in again.  That was something that I had dealt with before and knew what to expect.  I didn't like it, but at least I knew I would heal.

However, it is not plantar fasciitis. 

My first appointment with my foot doctor he injected a numbing solution as a diagnostic.  If my random sharp stabbing pains and constant tenderness eased, then it would confirm his suspicion. 

It did.. and didn't.  The stabbing pains stopped, but the tenderness didn't.  It also felt REALLY WEIRD to be walking around with a completely numb stripe across the bottom of your heel. 

One week later, I went back to Dr. Foot and his suspicion was confirmed.  I have "Medial Calcaneal Nerve Entrapment".  So we tried the next step.  A small solution of cortisone.  He assured me that the entire injection was only about 30% cortisone (it was about 1ml worth in the entire injection) and to watch my blood sugars, but he hoped that with the smaller concentration that I wouldn't stay in the 200's for very long

Now, I don't like cortisone.  Even before I was diagnosed with diabetes, I didn't like cortisone.  Years ago I received an injection in my hip to help with my bursitis.  It wore off in two days.  Since then I have never really needed any more, but if it was every mentioned (like with my pain in my lower back ) I would request other options.  I knew that cortisone will raise blood sugars, but I never knew how bad it would effect me.

Holy cow!!!  The next day my blood sugars were in need of an oxygen mask they were so high.  I increased my basal by 50% (hindsight tells me I should have done more) and was adding a few units to each meal, as well as eating less.  I still ran in the upper 300's to low 400's.  I was miserable.  Thankfully, the cortisone did exactly what it did the previous time I had it.  It wore off in two days.  I can almost tell you the exact hour because of what my blood sugars did.  I had finally been able to get them in the 200's and then all of a sudden, the next thing I knew my CGM was yelling at me that I was low.  I checked with my meter, and yup... 49.  I ate (read: inhaled) food and sat and waited.  While waiting, I had a sharp stabbing pain in my heel.  The tenderness, which had never really gone away, was a lot more noticeable too.  Have you ever been running barefoot and hit a rock with your heel?  The tenderness you have in your heel for the next couple days is what mine felt like.

It's been two weeks since that injection.  I still get the random stabbing, but they have decreased to maybe 2-3 a day instead of 5-6 and they are much less intense.  The tenderness is still there but not quite as pronounced.  I visited with Dr. Foot yesterday and we decided to watch it and see if it continues to improve.  I really don't want to have foot surgery (again) but know that if I don't see marked improvement I will have to.  The longer I wait, the more likely the nerve could "give up" (Dr. Foot's words), stop working, and die.  I don't want a dead nerve anywhere, especially in my feet.  I asked him what I did to have caused this.  Was it because I was walking more?  Could a pair of shoes be irritating it?  Maybe there is a voodoo doll somewhere and a small child is chewing on its foot. 

He smiled at me, that crooked smile that says so much more than any words ever spoken, and said, "In people with diabetes the nerves can build up sugar alcohols, like sorbitol, and become swollen."  I held it together and listened closely.  I asked if there was anything I could do to assist the swelling in going down.  I knew ice wouldn't do it as it wasn't "normal" swelling.  To boil it down, there really isn't anything I can DO to make it better faster, or at all.  The fact that it isn't as painful now as it was two weeks ago is GREAT news and shows that healing is taking place.  We wait and we watch. 

In the next little while, about a month at the most, if I don't see any more improvement, or if it worsens again, then we will discuss the surgical option.  It's a simple and highly successful procedure.  Just a couple little cuts that give that nerve more room to maneuver.  I don't like the idea of surgery, but I don't like the idea of a dead nerve even more.


  1. My heel problem this winter was on the back approaching the outer ankle, but it was probably a nerve irritation. I didn't get any fancy name unless it was in my chart and not told to me. I had my first cortisone shot ever and was expecting outrageous blood sugars because of the experiences of others. He told me it would at most be 30% higher and he was right. He did inject less cortisone than he might for a non-D patient. Fortunately I haven't had a slight twinge since then and hope to never have it again. Because it was my first foot issue ever, I couldn't believe how debilitating it was. Good luck to you getting this healed and hope you don't need the surgery:-)

    1. Thank you, Laddie. I hope I don't need the surgery either. I confess, I'm envious that your foot issue (and cortisone experience) was so successful.