Question: I have symmetric pain in BOTH of my heels Its been 13 month and been just getting worse for the most part. It does Not hurt more in the morning, actually it hurts more after standing for more than a minute or walking over 50 meters. The pain is symmetric.
I have pain in my other joints as well which I'll describe later.

I have seen many doctors and preformed many tests:

Neurologis: did not find anything she did a nerve study and some blood tests.
MRI: - show very very mild hugland deformity, but its not very likely that it would cause pain in both feet and also start suddenly
Xray: nothing is detected
Physical Therapy: No help
Rheumatologist: Thought that he identified (considering all my history) what I have as undifferentiated ankylosing spondylitis but so far no help with the medication. I took Arava 20mg for 5 weeks with no signs of improvement...he stopped that and changed it to Enbrel shots i had so far 4 shots and after 12 days there is also no sign of improvement.

So here is my history. I have listed the symptoms in a chronological order and not by severity.

Knees : Started 18 years ago mild and has not been worsening, there is some crackling noise with certain motions. Symmetric pain/discomfort mainly when standing for over 5 minutes. Walking is not as painful as standing.
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Back: Started 15 years ago but has been progressing over the years. Started with pain level of “1” and progressed to a pain level of “8” during flare ups periods. Now, it is usually at pain level of 5-6. I have 2 disc herniation L3-L4 and L4-L5. There is no radiation of pain down the legs. MRI available.

I had 3 sets of transforaminal cortisone shots at the end of 2013 and beginning of 2014 with very minimal pain relief that lasted for a short period.
The last time that I had a shot (January 2014), two days later my heels started to hurt. Its been worsening lately, 11 month later.

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Neck: Started 3 years ago with a bad movement. Pain has been there constantly after but it had its up and downs unlike the back and knees. Never performed MRI’s.

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Heels: Started a year ago 2 days after my back shots. With symmetric pain that worsens with walking or standing. I cannot walk more that ½ mile without strong pain. also cannot stand for longer that couple of minutes without strong pain. MRI and CT were performed 8 months ago showed something similar to Haglund's Deformity, since then it has been getting worse.

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Hives: A one time episode of hives when I was in Las vegas in August of 2013, lasted for about 3 weeks.

WHAT IS YOUR OPINION OR INITIAL DIAGNOSIS, ANY DIRECTION?

Thank you for you reply Dr.
So the rheumatologist was suspecting that I have undifferentiated ankylosing spondylitis but so far no help with the medication, which makes him also think that I might have something else. So far I did not respond to any medication/treatment

The following yield 0 improvement:
- Injection of steroid or cortison injection in the Buttocks
- I took Arava 20mg for 5 weeks with no signs of improvement.
- Injection in the subtalar joint => No improvement

I just started to take Gabapenitin But it's only the 2nd day...so we will have to see about that.

From a neurologist stand point, do you think that the fact that this all started 2 days after a back injection and the pain was and it is now symetric on both heels can possibly indicate on a nerve damage. the injections where around L3,L4,L5.

How would you go about diagnosing such a thing?
Are there nerve blocks that can help in the diagnosis?
If the Gabapentin will give me some relief, would that point the diagnosis towards more of a nerve related issue?

Another 3 things to mention
1. when the pain started it was more strange like shooting pain but coming from the heel not from the back.
2. There is no doubt. the pain is local. It is tender around and in the bottom of the calcaneus , but again always symmetric pain.
3. I do feel mild burning in the feet and not just around the heel, but it's very mild.

Thanks again,