Back Pain May Cause Heel Pain

We have a select group of patients in our practice who have been treated for years with little improvement for what they were told or were led to believe was the common foot ailment known as "plantar fasciitis" and come into our door seeking a third or fourth medical opinion on the topic.
Many times MRI are negative or for pathology in the foot, or will show mild plantar fascia inflammation, but without real significant findings overall. They undergo countless hours of physical therapy centered at the foot and ankle, or purchase needless and numerous pairs of orthosis for their shoes without gaining any real improvement. They may have even had surgery for this and come out of it with minimal reduction in pain. Often these patients will end up with another diagnosis labeled "neuralgia" and feel as though they are hopeless.

Simply put: Not all heel pain is PLANTAR FASCIITIS

I will ask questions directed at the chief complaint, and usually even the answers to these questions will lead me away from plantar fasciitis if you say yes to any of them....  here are some examples:

Does it hurt first step in the morning? Usually they say 'no'.
Is the pain worse at night? Most often they say YES!!!
Does if feel like fire and tingling pain in the foot or heel?  YES again!!
Do you notice that it is worse at the end of the day? Definitely YES!!
Does IBUPROFEN or other NSAID seem to help at all? This is ambiguous, but can be useful to know.

These questions along with a simple physical examination can lead me in the right direction even more. Positive TINELS sign or Lesegue sign can indicate neuropathic findings suggestive of either lumbar impingement or tarsal compression. These may also be exacerbated by lymphedema and venous stasis swelling of the lower extremities, which I find to be very much under treated in these individuals.

We have a spine center upstairs at our EAST office location and if lower back pain is the root cause of the heel pain we are able to get direct referral to this location as well for faster improvement in symptoms. Disc bulging, spinal stensosis, radiculopathy, and sciatica are all possible causes of foot and heel pain as well. This needs to be differentiated from traditional plantar fasciitis and at FFLC we look at the whole patient, not just their foot and ankle to determine a sound treatment plan and better outcomes are inevitable with proper physical examination and history taking alone.

-Dr Timm