Heel pain is a common complaint, but not all heel pain originates in the foot. For some individuals, the root cause lies in the lower back, particularly when conditions like herniated discs or spinal stenosis are present. These issues can compress nerves that travel down the leg, resulting in referred pain to the heel. On the other hand, heel pain may stem from localized conditions like plantar fasciitis, which directly affects the foot.
Understanding the differences between these two sources of heel pain—back problems and plantar fasciitis—is crucial for getting an accurate diagnosis and effective treatment. Let’s explore the symptoms, diagnostic methods, and treatment options for both.
How Back Problems Can Cause Heel Pain
Your spine houses nerves that travel down your legs and into your feet. When these nerves are compressed or irritated, such as in the case of a herniated disc or spinal stenosis, pain signals can travel along the nerve pathways to distant locations, including the heel.
Common Causes of Nerve-Related Heel Pain
Herniated Disc:
Occurs when the soft, gel-like center of a spinal disc pushes out through its outer layer, pressing on a nearby nerve. This can cause radiating pain along the affected nerve pathway, including into the heel.
Spinal Stenosis:
The narrowing of the spinal canal, which puts pressure on the spinal cord or surrounding nerves. This condition often leads to nerve pain (radiculopathy) that travels down the leg and into the foot.
Symptoms to Look For: Heel Pain from Back Problems vs. Plantar Fasciitis
Heel Pain Caused by Back Problems
Back-related heel pain often presents differently than pain from plantar fasciitis. Key features include:
Radiating Pain:
The pain often starts in the lower back, travels through the buttocks, and extends down the leg to the heel. This type of pain is typically associated with sciatica or nerve compression.
Numbness or Tingling:
You may experience tingling, burning, or numbness in the heel, foot, or toes, which is indicative of nerve involvement.
Weakness in the Foot or Ankle:
Nerve compression can lead to muscle weakness, making it difficult to walk, stand on your toes, or push off with the affected foot.
Pain Worsens with Sitting or Bending:
Activities that increase pressure on the nerves, such as prolonged sitting, bending forward, or lifting, often make the pain worse.
No Morning Stiffness:
Unlike plantar fasciitis, back-related heel pain is not typically worse with the first steps in the morning.
Heel Pain Caused by Plantar Fasciitis
Plantar fasciitis is the most common cause of localized heel pain and has distinct characteristics:
Localized Pain:
The pain is usually sharp and concentrated at the bottom of the heel, particularly where the plantar fascia attaches to the heel bone.
Pain with First Steps:
A classic symptom is severe heel pain when taking the first steps in the morning or after periods of rest. The pain often subsides after moving around but may return after prolonged standing or activity.
No Nerve Symptoms:
Unlike back-related heel pain, plantar fasciitis does not involve tingling, numbness, or weakness.
Pain Triggered by Pressure:
Pressing on the bottom of the heel, especially near the arch, typically reproduces the pain.
Activity Worsens Pain:
Physical activity, particularly running or standing for long periods, can exacerbate symptoms.
How to Diagnose the Source of Your Heel Pain
Accurately diagnosing whether your heel pain originates in the back or foot is essential for proper treatment. A thorough evaluation by your healthcare provider may include:
Medical History:
A discussion of your symptoms, including the onset, triggers, and activities that make the pain better or worse.
Physical Examination:
Your doctor will assess your range of motion, nerve function, and areas of tenderness. Tests may include:
Checking for numbness or weakness in the leg or foot.
Applying pressure to the heel to evaluate localized pain.
Imaging Studies:
X-rays: To rule out fractures, bone spurs, or other structural abnormalities.
Ultrasound of the Heel: A quick, non-invasive method to assess the plantar fascia, detect thickening or tears, and evaluate for other soft tissue conditions.
MRI or CT Scans: To identify deeper issues such as herniated discs, spinal stenosis, or more advanced cases of plantar fasciitis.
Nerve Testing:
Electromyography (EMG) or nerve conduction studies may be used to pinpoint nerve involvement and assess the severity of compression.
By combining these diagnostic methods, your healthcare provider can determine whether your heel pain stems from a back issue, a localized foot condition, or both, guiding the most effective treatment plan.
Treatment Options for Heel Pain For Back-Related Heel Pain
Conservative Treatments:
Physical Therapy: Strengthening and stretching exercises to relieve pressure on nerves and improve posture.
Medications: Anti-inflammatory drugs, muscle relaxants, or oral steroids for pain and inflammation.
Epidural Steroid Injections: For temporary relief of severe nerve pain.
Advanced Interventions:
Decompression Therapy: Non-surgical spinal decompression can relieve nerve pressure.
Surgery: Procedures like microdiscectomy (to remove herniated disc material) or laminectomy (to alleviate spinal stenosis) may be necessary for severe cases.
For Plantar Fasciitis
Conservative Treatments:
Rest, ice, and anti-inflammatory medications to reduce pain and swelling.
Stretching exercises for the plantar fascia and calf muscles.
Orthotics or supportive footwear to relieve pressure on the heel.
Night splints to keep the foot in a stretched position overnight.
Advanced Interventions:
Corticosteroid injections for severe pain.
Shockwave therapy or ultrasound therapy to promote healing.
Surgery (rarely needed) to release the plantar fascia.
When to See a Doctor
If your heel pain persists despite conservative measures, or if you experience numbness, tingling, or weakness in your leg or foot, it’s time to seek medical attention. Ignoring these symptoms could lead to worsening nerve damage or more severe complications.
Heel pain can be a frustrating and debilitating condition, especially when its source is unclear. Understanding the differences between back-related heel pain and plantar fasciitis can help guide effective treatment and long-term relief.
If you’re experiencing heel pain, contact our office today for a comprehensive evaluation. We’ll work with you to identify the root cause of your pain and create a personalized treatment plan to help you feel better and stay active.