Why Can’t I Get Rid of Heel Pain?

by Chris Centeno, MD /

Have you tried everything you can think of to get rid of heel pain? Have you tried physical therapy, medications, calf stretches, devices for heel pain you see in ads—all without long-term relief? Has a doctor injected steroids into your heel to treat your plantar fasciitis. How much relief did that buy you? The truth is, there’s probably something you and your doctor are missing. Your heel pain is likely really a warning sign of another issue.

The critical thing to understand is that your heels are supplied by the nerves in your lower back. Many patients who have a back issue don’t experience much back pain. So in this case, heel pain could actually be a warning sign of a back issue. In fact, the only symptom of your irritated back nerves could be this pain in your heel that won’t go away. It’s important to address the low back issue when the heel pain, the warning sign, first appears. Taking care of it while it’s a small problem will be much easier than trying to take care of it when it becomes a big issue that goes thermonuclear.

How Does My Back Cause My Heel Pain?

When certain back nerves are irritated, you may feel pain in your heels. In addition, longstanding nerve irritation can cause your calves and other muscles to stay chronically tight, shredding your plantar fascia over time. Reducing the nerve irritation in the back is critical to get rid of heel pain by helping your heel and/or plantar fasciitis heal! Why hasn’t anyone told you this before? Because in medicine we love to segment the body. The foot and ankle guy doesn’t really know how to identify a low-back issue. It’s just not his area of expertise.

So we know “the toe bone’s connected to the foot bone” all the way up the line to “the neck bone’s connected to the head bone.” Just like Dem Bones are all connected, so are dem nerves. Segmenting the body makes it difficult to see the big-picture functioning of the whole body.The muscles attach to the bones they move by a tendon. The nerves tell the muscles to move, and when the nerves are unhappy, the muscles malfunction ever so slightly. Parts of them shut down, developing trigger points. These areas are tight bands that don’t contract and relax normally like a healthy muscle. This causes too much pulling on the areas where the tendons attach or tendonitis. The wiring of our nerves is one massive network, so if our S1 nerve in our lower back in pinched, for example, that can affect the nerves all the way down through the hip, leg, and knee, and into the ankle, heel, and foot (all the areas the S1 nerve supplies).

To learn more about how the nerves in your back could be causing issues in your heel and lower extremities, refer to the “Burning, Pressure, Numbness, or Tingling” sections on pages 7 and 12 of my free-download book Regenexx ProActive.

Gastrocnemius Recession for Referred Heel Pain?

Gastroc— what? In a post last month, I told you about a patient who’d had a gastrocnemius recession for his heel pain. It made my list of top 10 dumb surgeries. The purpose for the surgery is to lengthen a tight calf muscle, the gastrocnemius, and it involves surgically cutting the calf muscle and either letting it heal or surgically sewing it back together after partially cutting its tendon. While it might be beneficial in patients with certain leg deformities, more recently, it’s being used for patients with a chronically tight calf, plantar fasciitis, or heel pain. Your body is tuned to micromillimeter precision, and trying to rearrange the biomechanics of the body with surgery is almost always a terrible idea.

In this case, what makes it even worse is if your heel pain (and likely the tight calf muscle as well) is caused by a nerve in your back, how in the world is cutting your calf muscle going to fix your back? I talked about this referred-pain phenomenon in a recent post about nerves in the neck causing arm throbbing. It’s important to understand that where it hurts may or may not be where the damage is located. If you have heel pain and treatment there is having no effect, ask your doctor to take a closer look at your back before you make the drastic decision to undergo any invasive surgery, especially a gastrocnemius recession.

Examination and Treatment

Avoiding unnecessary surgeries and repairing the small problems before they become big problems should be your goal as you age. How does this approach help to get rid of heel pain?

First, to track and get rid of heel pain, you need a proper exam that includes all of the muscles and nerves from the neck through the foot. This is not an exam from your family doctor or a five-minute exam from the orthopedic surgeon. This should be a one- to two-hour assessment of how each and every major joint and body system functions. With the Regenexx ProActive program, we use a simple method called the SANS approach, which looks at stability, articulation, neuromuscular status, and symmetry.

On Being ProActive to Get Rid of Heel Pain

If you ignore your heel pain warning sign, chronic back issues and more foot and ankle problems, like a torn Achilles tendon and tears in your calf muscle, could be in your future. All because of a bad back nerve that you blew off.

The ProActive program provides practical advice on understanding these warning signs and taking action to maintain peak performance through middle-age and beyond. You want to be able to stay as active as possible as you age, and in my experience, staying ahead of your aging joints using advanced physical injections may make all the difference. Regenexx ProActive explains how the use of biologic treatments, such as stem cells and blood platelet procedures (when treatments like physical therapy won’t work), can help before things go awry, ensuring that small problems don’t go from bad to worse.

The upshot? Paying attention to your body’s warning signals and addressing them as they pop up is one of the best things you can do to stay active and healthy as you age. To be ProActive, you need to catch small problems, like heel pain, before they become major issues that knock you out of the game, and prevent them when possible. The first step to get rid of heel pain is to try and use conservative therapies like good physical therapy or Egoscue. If that doesn’t work, then using your own platelets or stem cells may be just what you need to address the cause and quiet those warning signals.

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2 thoughts on “Why Can’t I Get Rid of Heel Pain?

  1. Elle

    I have mild to uncomfortable heel pain and my arm when brushing my teeth or brushing my will stop the circulation of the blood. How much can i expect to pay for the regenexx procedure?

    1. Regenexx Team Post author

      Elle,
      To answer that specifically, you’d need to go through the Candidacy process, as the answer depends on the cause and what procedures would be needed. Nerve compression would need to be ruled in or out as a starting point. Two possibly related situations: https://regenexx.com/blog/a-colorado-regenexx-patient-review-pain-free/ http://www.regenexx.com/hands-numb-while-sleeping/ You’ll find the candidate form on these pages.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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