Heel pain is a common complaint at our clinic here in Burlington Ontario. Maybe it’s because so many people are active here…not sure. Regardless, most patients come to our clinic thinking they have plantar fasciitis. Plantar fasciitis is not the only condition that causes pain in the foot and heel. Stress fractures, fat pad syndrome and arthritis are a few other causes of foot and heel pain. A pinched nerve can also cause pain in our heels.
Our spinal cord is basically a collection of nerves. At various levels of the spine the nerves branch off and travel to their destination. In the case of the heel, the nerves come from the lower levels of the spine and travel as part of the “sciatic nerve”. The sciatic nerve gets smaller and smaller down the leg since much of the nervous tissue has branched off to their destinations. A pinched nerve can occur when a physical structure (like bone, tendon or muscle) bears down on it, similar to stepping on a garden hose.
Symptoms of a pinched nerve in the foot are variable but commonly consist of burning, sharp, stinging pain. Pins and needles, numbness, tingling…these all commonly occur with a pinched nerve. Entrapment of the calcaneal and plantar nerves can send pain to the area of the heel, mimicking conditions like plantar fasciitis. Baxter’s nerve entrapment and tarsal tunnel syndrome are examples of nerve entrapments around the heel and foot. These examples of pinched nerves can have similarities with plantar fasciitis, such as pain during or after weight bearing that improves with rest. Severe pain after rising from bed can also occur in each of these conditions.
Heel Pain Treatment
The treatment for a pinched nerve in the foot and heel is variable, depending on the skill set of the treating practitioner. Supportive footwear or orthotic devices can prove helpful as can soft tissue therapy targeted at the entrapment site. Being certified in Active Release Technique Nerve Entrapment Protocols, we usually start with this approach at our clinic since it tends to achieve good results. As always, the starting point for recovery is to have your condition diagnosed properly; remember, plantar fasciitis is not the only condition to cause pain in the bottom of the foot!
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Alshami AM, Souvlis T, Coppieters MW. A review of plantar heel pain of neural origin: differential diagnosis and management. Manual Therapy 2008; 13:103-111.
Hudes K. Conservative management of a case of tarsal tunnel syndrome. Journal of the Canadian Chiropractic Association 2010; 54(2), 100-106.