What Could Be Causing Your Heel Pain? Could It Be Nerve Irritation?

Hands Touching Naked FootA while ago I suddenly and for no apparent reason developed heel pain.I put my foot to the ground one morning and felt pain in my heel. I had never had it before and thought it would just go away. It didn’t!

 

I have treated lots of people with heel pain in my career. It is usually due to something called plantar fasciitis, which is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia).

 

Plantar fasciitis commonly causes stabbing pain that usually occurs with your first steps in the morning. As you get up and move more, the pain normally decreases, but it might return after long periods of standing or after rising from sitting.

 

Plantar fasciitis is common in runners. In addition, people who are overweight and those who wear shoes with inadequate support have an increased risk of plantar fasciitis. It is sometimes called policeman’s heel as it was thought that pounding the beat in stiff boots contributed to it developing.

 

I am not overweight, I am not a runner and I wear supportive sandals a lot. The only thing that was different was that I had moved house and there were a lot of steps to negotiate. Maybe charging up and down stairs had caused it – but I am not THAT unfit so why?

I thought it must just be irritation of the plantar fascia – what else could it be? I used ice under my heel and rested it and avoided weight bearing and waited for it to go. It didn’t in fact it got worse and in fact so bad that it wasn’t enough to just walk on my toes, even that hurt too much – so I bought some crutches! I had to get around – I could drive but not weight bear. I had no pain when sitting or lying down, only when I put my heel to the ground. After a week or so of juggling with crutches, I thought I needed to do something more to try to get rid of it so I started stretching my calf and massaging the area as well as the ice treatment. Lo and behold after a week of that treatment, I felt a lot better and two weeks’ later – I was back to normal and it has not returned in 2 years!

 

SO – was it plantar fasciitis? I have run up and down stairs more times than I care to remember since then with no recurrence of the pain. Then the other day I came across an article that made me think a bit more about what I had experienced.  It was in the Journal of of Clinical Neurophysiology 118 (1): 119-123. Researchers Chang CWWang YCHou WH,Lee XX and Chang KF discussed the possibility that heel pain could be due to a nerve irritation rather than plantar fasciitis. Is that what I had had?

 

In this study a group of patients with heel pain underwent diagnostic ultrasound fasciitis that verified that they did have plantar fasciitis. The interesting thing they found was that when they also performed  electrophysiological function tests of the medial calcaneal nerve this showed that 23% of the patients had abnormal readings in the nerve conduction studies.

 

The calcaneal nerve supplies the tissues of the heel under the heel bone – called the calcaneus.

If 23% of the all the people who ever had plantar fasciitis also had this nerve irritation that is a lot of people! Nearly a quarter in fact.

Electrophysiological abnormality is the gold standard for demonstrating peripheral nerve irritation.  Peripheral nerves are those nerves that supply your extremities – your arms hands, legs and feet – including the calcaneal nerve.

 

I have treated a lot of people with heel pain that showed no abnormalities on x-ray OR ultrasound exam. However, diagnostic ultrasound does not always show that you do have plantar fasciitis.
Maybe a lot of people – including me – with heel pain did not have plantar fasciitis but nerve irritation. No one knows but this highlights the importance of detailed and proficient examination by your chiropractor. Chiropractors at the Avenue Clinic will  palpate the nerve and structures around it to see if they can reproduce your pain, which would point more to nerve irritation. If you do not show signs of recovery with treatment, they will send you for a more detailed neurological evaluation such as a sensory nerve conduction velocity (SNCV) test and maybe send you for other nerve conduction studies because they will now bear in mind this close association of plantar fasciitis and medial calcaneal nerve irritation (neuropathy).

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