Pain in the heel is a common complaint.
In fact, it’s one of the most common foot problems treated in podiatry offices and physical therapy clinics. The culprit for this discomfort is often plantar fasciitis, an inflammation of the ligament on the bottom of the foot. However, in some cases, it may come from a more surprising source: The lower back.
“One of the first things I’ll ask is if [my heel pain patients] have any low back history, any low back pain,” says Dr. Edward McLaughlin, a podiatrist in West Islip, New York. According to Dr. McLaughlin, there are two areas this pain could be coming from. The first is caused by primary foot mechanics, and is frequently diagnosed. The second, and the most common source other than the foot, is an issue with the lower back.
Nerves stem from the spine to every area of the body, and different sections of the spine affect different body parts. For the foot, central control is located in the lower back. Sometimes, Dr. McLaughlin explains, “the nerve gets pinched, or irritated…it creates an impulse to the area [the foot].” That impulse creates tension and, eventually, the constant pull causes inflammation. It can take weeks, months, or even years after the onset of a back condition for a response to develop in the foot. But when it does, patients feel it.
“The patient will present with a complaint of more chronic heel pain, where it’s not related to just simply when they are on their foot alone.” They’ll have pain both while walking and while at rest. Many people also experience discomfort at night, while they’re in bed. These individuals are often diagnosed with plantar fasciitis, and the foot is treated with little result. “If we didn’t treat the back,” says Dr. McLaughlin, “we’re not going to get anyplace.”
He likens the situation to a circuit breaker, with the spine as the central panel, sending out wires to various areas of the house. Treating heel pain is like trying to fix a light bulb: “If the cause is not the light bulb being bad, if the cause is the circuit breaker or the switch being bad, I have to go to the switch to fix the problem.” It doesn’t matter how many times the bulb is replaced—just as treating the foot won’t make a difference if the problem is really coming from the spine.
For these patients, referral to another expert is necessary. “I’ll oftentimes send them to a physical therapist initially…and then [if that doesn’t work,] more aggressive techniques.” In any case, Dr. McLaughlin stresses the importance of determining the source of the pain:
“The key to treating heel pain in any patient that comes into your office is deciphering where the primary cause is—Is it the foot? Is it the back? Because only in treating one proper area can you render that patient’s complete relief.”