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Back and foot pain, basketball injury. Tarsel tunnel syndrome and tendonitis detected. What is the reason for persisting pain?

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Orthopaedic Surgeon
Practicing since : 1994
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I am a 40yr old male currently taking the following meds: 10mg lipitor, 81mg aspirin, 1000iu vitamin d, 10mg astaxanthin, folic acid, multivitamin. I am generally in good health, work out 4-5 times a week eat good and am 5'6 weighing 157lbs. I have had back and foot pain issues over the last 3 years starting with a sacroilliac issue in XXXXXXX 2009. In july 2009 i ended up having blood clot in left calf. Doctors could find no genetics or other known cause, except to say, it may hv been related to the basketball injury in XXXXXXX In august 2010 i woke up one morning with bilateral foot pain. stiff, achy heels in the morning (started in both feet on the same day). the day prior to that I had been playing basketball in running sneakers. Not sure if that's what set off the pain or not, but the doctors said it was plantar faciitis and i did Physical therapy for that. It pretty much resolve by the end of 2010, but the pain morphed into different pain..more general pain and stil bilateral. This time is was burning, aching, stiff, achy, cold feet on and off. If i stood on my feet more than 20 minutes the burning would start and i would find myself leaning one way or the other to give relief to one foot at a time. Went back to doctors for this and some testing was done and they said it was tarsal tunnel syndrome. This was done in early 2011. By April i had seen a specialist who said I could do surgery but did not reccomment bc I hadn't had any nerve damage to this point and it was "bearable" for me without it. By XXXXXXX or july 2011, the symptoms seemed to recede somewhat and the next 6 months seemed fine. I even ran a half marathon in October 2011 and my feet were fine. But around thanksgving 2011 I started having arch pain in the right foot..this pretty much came in tandem w/ left SI joint pain..Went back to doctor in December of 2011, had another SI injection. However, neither back nor foot pain got better and started Physical therapy for both. The foot pain got worse and moved into both feet and was general in nature..pain on sides when squeezing, aching, arch pain, burning, etc..all the tarsal tunnel type symptoms were back along w/ new tendonitis type symptoms in both feet. It's been a few months and the feet are not getting better. i do exercises for them but to no avail. The pain is on and off..I can be sitting there on minute and they go cold and it feels as though someone twisted up a garden hose and circulation has stopped..i work on the computer all day so i am not on my feet much. however, there are days you would think i was working in the manufacturing facility for 12hrs on my feet. I'm at my wits end here and wondering if I should see a different type of doctor and what your thoughts are on what this could be..whether it be neurological, vascular related, bio mechanical, just baffles me that whatever is going on has always been in both feet.
Posted Mon, 21 May 2012 in Bones, Muscles and Joints
Answered by Dr. Praveen Tayal 1 hour later
Thanks for posting your query.
Since your symptoms are present in both of your feet, these are more likely to be related to nerve root compression. An MRI of the lumbosacral spine and nerve conduction studies will be helpful in identifying the cause. A high arch of feet might also be responsible for your symptoms.
You need to consult a neurologist for a detailed examination and related investigations.The treatment further depends on the cause.
Maintain fitness with exercises that include back stretching and strengthening exercises under guidance of a physiotherapist.
Pay careful attention to selecting the correct running shoe based upon the foot type (flexible pronator vs. rigid supinator). This is extremely important. In selected cases, shoe inserts (orthotics) may be necessary.
You can start with mild anti inflammatory drugs like ibuprofen and methylcobalamin supplements for symptomatic relief.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Dr. Praveen Tayal.
Above answer was peer-reviewed by
Follow-up: Back and foot pain, basketball injury. Tarsel tunnel syndrome and tendonitis detected. What is the reason for persisting pain? 56 minutes later
Just a little more information I forgot to mention. I have been wearing orthodics the last couple years..Not sure if they are helping or not since I am still having the issue. I do have high arches. are there any orthodics on the market that you would recommend? (preferably some with cushioning?)

I have also had nerve conduction studies done and that's where they confirmed tarsal tunnel syndrome (nerve compression in ankle somewhere)..I have also recently had an MRI done on my back and they found a small herniated/bulging disc. However, i'm certain this is not the cause because the issues w/ the feet were there prior to the back injury. I understand that nerve issues in the feet can be the cause of the burning sensation i get when on my feet too long. but can it also cause all the general pain/discomfort I've been experiencing?
Answered by Dr. Praveen Tayal 13 hours later
Thanks for writing again.
Yes the nerve issues of the feet can cause generlized discomfort of the feet too which gets aggravated due to the high arches.
You need to choose orthotics that are best for you with the help of your orthopedician. I am sorry I can't recommend one for you without a physical examination.
Right choice of shoes also play a significant role in such nerve symptoms.
Methylcobalamin supplements 1500 mg daily for 2 weeks will help in resolving the burning sensation. You can start taking these after consulting with your orthopedician.
Hope this answer is helpful.
Do accept the response if there are no further queries.
Wishing you a trouble free early recovery.
Above answer was peer-reviewed by
Follow-up: Back and foot pain, basketball injury. Tarsel tunnel syndrome and tendonitis detected. What is the reason for persisting pain? 6 hours later
I have custom made orthodics that were made for me a couple years ago that i stopped wearing because I didn't think they helped. Maybe I did not give them enough time. That's when I ended up going with the superfeet orthodic. At this point, since the customer made orthodic was molded for my feet do you think I should give that another try, since it should correct for high arches and supination? I will also try the supplement you mentioned for the burning feet. Also, do you know if there are certain stretches and/or exercises that could help alleviate pain from Tarsal tunnel Syndrome?

Thanks for your response.
Answered by Dr. Praveen Tayal 1 hour later
I do think that you should give your custom made orthotics another try. You should use it for at least 4 weeks before expecting the improvement in your symptoms.
Passive stretching exercises will be helpful after a hot fomentation for tarsal tunnel syndrome. You can do the appropriate exercises under the guidance of your physiotherapist.
Hope this helps you.
Above answer was peer-reviewed by
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