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Pain in Back of Heel

Heel pain can be intense, and despite resting the foot and trying a variety of other conservative measures to try to get relief, oftentimes it persists.

Have you tried it all over the past few months? Ice, pain relievers, calf stretching, braces, physical therapy, and so on? Are you considering, or have you already pulled the trigger on, steroid treatments despite the awful side effects?

Would it surprise you to hear that this persistent heel pain may actually be a warning sign that you have a problem in a seemingly entirely different part of your body—your lower back? So the key to relieving your heel pain likely lies in treating the lower back.

The Back Bone’s Connected to the Heel?

The back bone may not be directly connected to the heel — however, it is connected via the nerve supply.

The structures that make up the heel contain nerve branches that are rooted all the way up in the lower back. And that nerve branch is responsible for both sending and receiving signals between the foot (part of the peripheral nervous system) and the spine (central nervous system).

This nervous system wiring is, in fact, one massive network, so if our S1 nerve becomes irritated in the lower back, for example, it can affect any structure down the leg—the hip, knee, ankle, heel, and so on.

Interestingly, with an irritated nerve in the back, you may or may not have pain in the back. In fact, the only warning sign you may have is that heel pain, perhaps plantar fasciitis, that just won’t subside. This is why it’s so critical to have your back checked when the heel pain warning sign first appears.

The longer you wait, the more damage that can be done, and treating a small issue is much easier than cleaning up the mess a much bigger issue can cause. Ignoring your heel pain could lead to not only chronic back problems and more issues but also, for example, Achilles tendon or calf muscle tears.

In addition to heel pain, the irritated nerves in your back can cause chronically tight or twitching calf muscles, wreaking havoc on your plantar fascia (the broad connective band of tissue that lines the sole of the foot) over time. Why hasn’t your doctor or the foot and ankle guy told you your heel pain may not actually be a heel problem? They are trained to focus on the area of pain, in this case the heel, not on how to identify a potential low-back root cause. Learn more by watching Dr. Centeno’s video below:


Avoid Unnecessary Surgery and Steroids for This Condition

Your goal for treating your heel pain should be to avoid unnecessary surgeries. One of those is a brutal surgery on our top-10 dumb surgeries list (read more about it here), the gastrocnemius recession. Traditionally done for some deformities in the legs, in recent years it’s begun to be performed for elective orthopedic surgeries for conditions such as plantar fasciitis, calf tightness, and heel pain. The surgery involves cutting the calf muscle to force it to lengthen, but as with any surgery that attempts to rearrange the body’s biomechanics, in most cases, it’s just a bad idea. In addition, if your heel pain is being caused by a problem in your back, and you let a surgeon go in and cut up your calf muscle, how is this going to help your heel pain?

Steroids should also be avoided for heel pain as not only does relieve lessen with each subsequent injection, but steroids are associated with both cartilage and local stem cell destruction.

Conditions That Cause Heel Pain

Achilles Tendonitis

Heel pain is one of those issues that can affect most of what you do in a day and can be disabling. A common cause of heel pain is the Achilles tendon. What is the Achilles tendon? What is Achilles tendonitis? What are the different injuries? Is stem cell therapy for Achilles tendonitis a viable option? Where & What Is the Achilles Tendon? A tendon is a thick fibrous band of connective tissue that connects a muscle to bone. There are more than 30 million tendon and ligament injuries annually. The Achilles tendon, which is the thickest tendon in the body connects the calf muscles to the heel bone. It consists of the gastrocnemius and soleus muscles that unite to form a thick band that is immediately above the heel tab on your shoe. It enables the downward movement of the foot and bending of the knee.

Read More About Achilles Tendonitis

Baxter’s Neuropathy

It is an entrapment syndrome, like carpal tunnel syndrome in your hand. This is an entrapment of a nerve in your foot, right around your heel, on the inside part compressing a branch of your tibial nerve called your inferior calcaneal nerve, and that is the Baxter’s nerve. Now, the inferior calcaneal nerve is the first branch of the lateral plantar nerve, which is a branch off your tibial nerve. It lives between a muscle belly called your abductor hallucis muscle, as well as the medial calcaneal tuberosity, which is a small bump where a common heel spur occurs in the foot.

Read More About Baxter’s Neuropathy

Failed Back Surgery Syndrome

Failed Back Surgery Syndrome also called failed back is a clinical condition in which patients who have undergone low back surgery continue to have pain and dysfunction.  Said another way the surgery that was intended to reduce pain and increase function FAILED. That is right, the surgery failed. You had the surgery, struggled with the pain postoperatively, diligently participated in physical therapy and yet the pain and limitation are still there.  Unfortunately, this occurs frequently.   Estimates range from 20-40% of patients who undergo low back surgery will develop Failed Back Surgery Syndrome. Pain is the most common symptom of Failed Back Surgery Syndrome…

Read More About Failed Back Surgery Syndrome

Plantar Plate Tear

The plantar plate is a fibrocartilage structure located at the ball of the foot. The ball of the foot involves a joint which anatomically is called the metatarsal phalangeal joint (MTP) joint. The MTP joint is where the long foot bone (metatarsal) meets the toe (phalanx). Each toe in the foot has an MTP joint which is numbered 1 through 5. The plantar plate allows the foot to absorb the enormous forces of walking and running in addition to limiting extension (1). There are ligaments that attach the plantar plate to the long bones of the foot which are illustrated by the red and blue bands in the picture. The plantar plate and the supporting ligament provide critical stability for the MTP joint.

Read More About Plantar Plate Tear

Spinal Stenosis

Spinal stenosis is the narrowing of the central spinal canal and is a cause of significant pain and disability.  Common causes of spinal stenosis include disc protrusion, facet overgrowth and ligamentum flavum thickening.  Surgery is often chosen when conservative therapies fail despite the lack of convincing evidence that it is a superior treatment option.  Are there alternatives to back surgery for spinal stenosis?  Yes. Regenexx DDD utilizes precise platelet injections into the facets, muscles, and ligaments to treat the lumbar stenosis, treating all of the components of the issue, which is crucial. Spinal stenosis is often an age-related condition attributed…

Read More About Spinal Stenosis

Treating Your Foot and Back Issues with PRP

Your interventional orthopedic (IO) physician will not only examine your heel pain but also trace it to the source of the problem. If there is an issue in the low back, he or she will not only address the heel pain but also the low back and any problems in between. Using the the SANS approach, he or she will assess stability, articulation, neuromuscular function, and symmetry.

Following assessment, your IO physician will treat the affected areas with your own precisely guided platelet-rich plasma (PRP) for an issue in the heel and/or growth factors isolated from your platelets (platelet lysate) and injected around the irritated nerves in the back to help stimulate the local stem cells to wake up and start the repair process.

The biggest take-away here is to pay attention to your heel pain right away. This could be an early warning signal that something much bigger is at play, such as an irritated nerve in the back.

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