As I sit around recuperating from the Tenex procedure, I began wondering

if there is a connection between Fibromyalgia and foot pain, especially

Achilles’ tendon problems like I’m currently battling.  I started researching

“Fibromyalgia and Foot Pain” and was immediately reminded of one of my

grandmother’s favorite sayings, “be careful what you wish for”.  If one does

enough digging, one can find a connection between Fibro and just about

anything.  I’m going to take an educated guess and say that’s why FM is

usually classified as Primary or Secondary Fibromyalgia.  In Primary Fibromyalgia, the patient is usually diagnosed with Fibro and then at some later time is diagnosed with one or more additional medical conditions.  In Secondary Fibromyalgia, Fibro is usually diagnosed after some other medical condition has been diagnosed.  A characteristic of Fibro is that there are usually one or more concurrent

conditions endured by the same patient.  Another potential for foot problems in FM may be the existence of trigger points in the leg, foot, and ankle.  Finally, Fibromyalgia affects the soft tissues of the body; muscles, nerves, ligaments, and tendons.  Guess what, all of these tissues are found in the foot.  Anyway, a quick tour of the Goggle machine illustrates that many people with Fibromyalgia also suffer from foot problems.

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Back in February 2012, Madeline Vann, MPH wrote for Everydayhealth.com about the issue of Fibromyalgia and foot pain.  Ms. Vann wrote, “Fibromyalgia treatment should extend from the top of your head to the tips of your toes — literally.” [1] Personally, I’ve experienced the best management of my Fibro symptoms back when Dr. Carey B. Dachman of the Schaumburg Pain Center was my Rheumatologist (FM doctor).  He believed in a multi-modal pain management program and was in constant consultation with my other healthcare providers like Dr. Ida Washington my former GP.  As a matter of fact, he was the one that insisted I have a cardiologist and podiatrist even though I didn’t think I needed them.  I was eventually diagnosed with Long QT syndrome and plantar fasciitis.  Unfortunately, Dr. Dachman has retired and Dr. Washington has relocated to Las Vegas.  I know I digressed but I just wanted to illustrate that people with Fibromyalgia do better if their treatment is coordinated and “extends from the top of [their] head to the tips of [their] toes — literally.”

 

A study by Palomo-López et al. in the May 2019 issue of  Archives of Medical Science , reported that people with Fibromyalgia “may experience significantly more pain in the foot [and] impaired quality of life than healthy subjects”. [2]  The researchers suggested questioning about feet may be a valuable tool in the management of Fibro, reporting “foot health-related quality of life measurements may be necessary in order to determine the impact of fibromyalgia”. [3] It has been reported that between 50-60% of people with Fibromyalgia experience some level of pain in their feet. [4] [5] 

 

Foot pain in Fibromyalgia may be related to a variety of concurrent conditions such as:

(the following is not an all-inclusive list)

 

• Plantar Fasciitis

• Bone (Heel) Spurs

• Ankle Fracture

• Achilles Rupture/Micro-tears or

       Tendonitis

 

I’ve been diagnosed with all of the above over the years.

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Plantar Fasciitis: The Mayo Clinic advises that “Plantar

fasciitis is one of the most common causes of heel pain.

It involves inflammation of a thick band of tissue that

runs across the bottom of your foot and connects your

heel bone to your toes (plantar fascia).

 

Plantar fasciitis commonly causes stabbing pain that usually occurs with your first steps in the morning. As you get up and move, the pain normally decreases, but it might return after long periods of standing or when you stand up after sitting.”[6]

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Bone (Heel) Spurs: WebMD reports that a bone spur aka “heel spur is a calcium deposit causing a bony protrusion on the underside of the heel bone. On an X-ray, a heel spur can extend forward by as much as a half-inch.” [7] Looking at an x-ray of my own foot, I immediately said “that looks like a fish hook on the bottom of my foot sticking up into the plantar fascia!!” WebMD continues “without visible x-ray evidence, the condition is sometimes known as ‘heel spur syndrome.’” [8]

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Ankle Fracture: is commonly referred to as a broken ankle.  The American Academy of Orthopedic                                                                     Surgeons advises that when a healthcare professional speaks of a

                                                         broken or fractured ankle, he/she “means that one or more of the 

                                                         bones that make up the ankle joint are broken.  A fractured ankle can

                                                         range from a simple break in one bone, which may not stop you from

                                                         walking to several fractures, which forces your ankle out of place and

                                                        may require that you not put weight on it for a few months.” [9]

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Five years ago, I broke my left ankle, the one that now has a heel spur and on which, I underwent Tenex surgery last week.  After I fell down a flight of stairs, I went to urgent care and had x-rays.  The doctor at Urgent Care told me I had a very bad sprain.  I hobbled around on that foot for three weeks until it started to turn blue.  My GP sent me to a podiatrist who informed me I had a slice fracture.  He said that a portion of the bone was sliced off and fell back into place.

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Achilles Rupture or Tendonitis: Approximately 25% of all cases of ruptured Achilles’ tendons are misdiagnosed as severe ankle sprains. [10]  A rupture of the Achilles tendon is experienced as pain in the back of the lower leg.  The pain starts in the ankle and can run up the calf. [11] The Mayo Clinic reports “the Achilles tendon is a strong fibrous cord that connects the muscles in the back of your calf to your heel bone. If you overstretch your Achilles tendon, it can tear (rupture) completely or just partially.” [12] After suffering for 4 months, my podiatrist finally ordered an MRI to determine the extent of my rupture.  The MRI showed that I had several micro-tears instead of one main rupture. 

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A quick Goggle search of Achilles rupture produces one running theme, patients usually hear and/or feel a popping noise/sensation at the moment of rupture.  I did not.  I went to bed on January 6, 2021, feeling fine.  I had ongoing stiffness in my ankles and have been doing ankle exercises prescribed back in the Chronic Pain Boot Camp in 2017 at Ochsner Hospital in New Orleans.  I performed my exercises and went to sleep.  On January 07, 2021, I awoke and could not perform my morning foot exercises on my left foot.  When I tried to get out of bed, I could not stand.  It took a couple of hours for me to be able to get up.  This went on for a week; not being able to immediately rise upon awakening in the morning or get out of a chair after sitting for a few minutes, and standing or walking were almost impossible.  Finally, my daughter took me to Urgent Care where an X-ray was taken and I was diagnosed with a bone spur.  I was instructed to see a podiatrist and use crutches.  Once in the office of a podiatrist from St. Franciscan health system, after a short exam of my ankle, I was informed that the heel spur was not the source of my pain.  I was told I have a ruptured Achilles tendon.  I was fitted for a walking boot and instructed to be patient.  April 13, 2021, I had an MRI.  It was finally confirmed, I did not have one rupture, I had several micro-tears.  Finally, a discussion about active treatment.  Doc wanted to do something called Tenex.  The procedure was scheduled for May 03.

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Tenex Procedure:  Verywellhealth.com states, “the Tenex procedure is a non-surgical, trademarked procedure used to treat chronic pain associated with tendinitis (tendon inflammation). The minimally invasive technique can reduce tendon pain by breaking down and removing damaged tissues with high-frequency ultrasound energy.” [13]  Most sources on the web say that the procedure can be done as an outpatient in a doctor’s office.  My procedure was done outpatient in a surgicenter.  I don’t remember anything about the procedure after being wheeled into the operating room.  My daughter was my driver and apparently talked the doctor into including, “No Trips To Home Depot”, in the post-op instructions.  HOW RUDE, that’s been the hardest part of recovery.  I NEED ME SOME HOME DEPOT!  Anyway, she says I kept asking if Doc would write a prescription for a Hot Tub. UHHH, me ask something like this?!?!  Doc wrote the Home Depot prohibition but no hot tub. I NEED A HOT TUB for aqua therapy.  Again, I digress though. 

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Verywellhealth.com states “even though the pain relief is often striking and immediate, it can take anywhere from four to 12 weeks before you regain full function of a joint and a return to unencumbered physical activity.” [14]  My Pain level in the ankle has reduced from an 8/9 to a 5/6/7.  At the writing of this article, my ankle pain is a 7.  The biggest problem for me is numbness and stiffness.  My left foot feels like a block of cement on the end of my leg.

 

I’m going to have to squash this developing trend.  Last summer I battled a traumatic brain injury and post-concussion syndrome.  This summer I’m going to be sporting a walking boot and/or ankle brace.  I guess I should start designing fashionable braces.

 

Despite my personal clumsiness, it seems that there is a

connection between Fibro and foot pain.  Having Fibromyalgia can increase the pain of foot problems and extend the treatment and recovery periods of such conditions.  Podiatrists faced with a patient who is recovering slowly or exhibiting an abnormally high pain level should inquire if the patient has Fibro.  Pain specialist treating Fibromyalgia patients who complain of foot pain should refer them to a podiatrist.  Finally, the two different specialties should coordinate with each other when they find they have a person with FM with foot problems in the same patient.

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If you found this article via a direct link, click here to read the introductory post on Achilles.

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Endnotes:

[1] https://www.everydayhealth.com/fibromyalgia/when-fibromyalgia-affects-your-feet.aspx

[2] Palomo-López, Patricia et al. “Quality of life related to foot health status in women with fibromyalgia: a case-control study.” Archives of medical science: AMS vol. 15,3 (2019): 694-699. doi:10.5114/aoms.2018.77057

[3] Ibid.

[4] https://www.verywellhealth.com/foot-pain-in-fibromyalgia-3973002#citation-1

[5] Tornero-Caballero MC, Salom-Moreno J, Cigarán-Méndez M, Morales-Cabezas M, Madeleine P, Fernández-de-Las-Peñas C. Muscle Trigger Points and Pressure Pain Sensitivity Maps of the Feet in Women with Fibromyalgia Syndrome. Pain Med. 2016 Oct;17(10):1923-1932. doi: 10.1093/pm/pnw090. Epub 2016 Jun 1. PMID: 27257287.

[6] https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846

[7] https://www.webmd.com/pain-management/heel-spurs-pain-causes-symptoms-treatments

[8] Ibid.

[9] https://orthoinfo.aaos.org/en/diseases--conditions/ankle-fractures-broken-ankle/

[10] Cottom JM, Sisovsky CA. Neglected Achilles Tendon Ruptures. Clin Podiatr Med Surg. 2021 Apr;38(2):261-277. doi: 10.1016/j.cpm.2020.12.010. PMID: 33745656. https://pubmed.ncbi.nlm.nih.gov/33745656/

[11] https://www.mayoclinic.org/diseases-conditions/achilles-tendon-rupture/symptoms-causes/syc-20353234

[12] Ibid.

[13] https://www.verywellhealth.com/tenex-procedure-5081685

[14] Ibid.