Back pain and heel pain are two of the most common musculoskeletal complaints. While they seem geographically distant, they are often connected because the spine houses the central nervous system pathways that extend down to the feet. A problem in the lower back can easily manifest as pain in the heel. Treating the heel alone will not resolve pain that originates from a compressed nerve in the spine.
The Direct Connection: Nerve Pathways
The link between the lower back and the heel is neurological, involving the network of nerves that exit the spinal column. The lower spine, specifically the lumbar and sacral regions, is the origin point for the nerves that supply the entire lower extremity. Compression or irritation at these nerve roots can interrupt the signals traveling to the foot.
The sciatic nerve, formed by nerve roots L4 through S3, is the largest single nerve in the human body. It travels down the back of the leg, branching into smaller nerves that supply sensation to the heel area. When the sciatic nerve or one of its contributing roots, particularly S1, is compressed, the resulting pain is often felt along the entire pathway, including the heel. This referred pain, known as radiculopathy, involves pain, numbness, or tingling felt far from the actual site of nerve compression.
Specific Conditions Linking Back and Heel Pain
Sciatica is the most common condition connecting back pain and heel pain, occurring when a structural issue in the spine irritates the sciatic nerve. A herniated disc, where material presses on a nerve root, is a frequent cause of this compression. Spinal stenosis, or the narrowing of the spinal canal, can also put pressure on the nerves, resulting in pain that radiates down into the heel and foot.
Another cause is a group of inflammatory diseases known as spondyloarthropathies, which includes conditions like Ankylosing Spondylitis. These diseases cause inflammation in the joints of the spine and can also trigger inflammation in the entheses, the points where tendons and ligaments attach to bone. Enthesitis is a characteristic feature of these diseases, and the heel is one of the most commonly affected sites.
Differentiating Referred Pain from Local Heel Issues
Nerve-related heel pain must be distinguished from conditions originating solely in the foot, such as Plantar Fasciitis or Achilles Tendinitis. Pain from radiculopathy often presents with neurological symptoms like burning, tingling, or numbness in the foot and heel. The pain is typically described as shooting or electric, and it may worsen with movements that strain the spine, such as coughing or twisting.
In contrast, Plantar Fasciitis is characterized by sharp, stabbing pain localized to the bottom of the heel, most intense with the first few steps in the morning or after rest. Achilles Tendinitis causes pain and stiffness at the back of the heel where the tendon attaches to the bone, often worsening during or after physical activity. A calcaneal stress fracture, another local cause, typically causes pain that is more severe with weight-bearing activities and is often tender when the heel bone is squeezed. The absence of neurological symptoms like tingling or weakness suggests a local foot issue rather than a radiating nerve problem.
Next Steps for Diagnosis and Relief
If heel pain persists despite common treatments like stretching and rest, or if it is accompanied by tingling, numbness, or radiating leg pain, consult a healthcare provider. A physician, such as an orthopedist or neurologist, can perform a physical examination to check nerve reflexes, sensation, and muscle strength in the leg and foot. The presence of neurological deficits strongly indicates a spinal origin.
Diagnostic tools are used to pinpoint the precise cause of the pain. X-rays can rule out fractures or bone spurs, while an MRI of the lower spine can visualize soft tissue problems like herniated discs or spinal stenosis. Nerve conduction studies or electromyography (EMG) can confirm if a nerve is being compressed and assess the severity of the damage.
Initial non-invasive treatment for back-related heel pain often includes targeted physical therapy. This therapy strengthens the core and stretches tight muscles, helping to decompress the affected nerve. Anti-inflammatory medications or corticosteroid injections near the irritated nerve root may also be used to reduce inflammation and provide relief.