Heel pain, particularly when exacerbated by stretching, is a common issue that can impact daily life. This discomfort, ranging from a dull ache to sharp, radiating sensations, indicates irritation or dysfunction within the foot’s nerve network.
Understanding Heel Nerve Pain
Nerve pain, known as neuropathic pain, arises from damage or dysfunction within the nervous system itself. This differs from musculoskeletal pain, which typically originates from tissue damage in muscles, bones, or ligaments and is often described as a localized ache. Neuropathic pain in the heel can manifest as burning, tingling, sharp, or shooting sensations, sometimes accompanied by numbness or an electric shock-like feeling. Nerves in the heel area are particularly susceptible to such pain due to their confined anatomical pathways.
The main nerve supplying sensation to the back of the leg and foot is the tibial nerve, which branches off the sciatic nerve. As the tibial nerve travels down the leg, it passes through a narrow space on the inside of the ankle called the tarsal tunnel. Within or just beyond this tunnel, the tibial nerve divides into several branches, including the medial calcaneal nerve, medial plantar nerve, and lateral plantar nerve. These branches provide sensation to various parts of the heel and sole of the foot.
Common Conditions Causing Heel Nerve Pain
Several conditions can lead to nerve pain in the heel by directly impacting these nerve structures. Tarsal Tunnel Syndrome (TTS) involves the compression of the tibial nerve or its branches as they pass through the tarsal tunnel. This compression can cause burning, tingling, numbness, or shooting pain along the inside of the ankle, heel, and arch, with symptoms often worsening during activity. Flat feet, injuries like ankle sprains, space-occupying lesions such as cysts, or systemic diseases like diabetes can contribute to the development of TTS.
Another specific cause is Baxter’s nerve entrapment, which affects the inferior calcaneal nerve, a branch of the lateral plantar nerve. This nerve can become compressed between muscles in the heel or against the heel bone itself, sometimes exacerbated by heel spurs or chronic inflammation. Patients often report a radiating or burning pain under the heel, which is frequently misdiagnosed as plantar fasciitis due to similar pain location.
Peripheral neuropathy represents a broader category of nerve damage, often stemming from systemic conditions such as diabetes. This type of nerve damage typically affects the feet first, causing sensations of burning, tingling, numbness, or pain. While plantar fasciitis is primarily an inflammation of the plantar fascia ligament, chronic cases can sometimes involve irritation or impingement of nearby nerves due to prolonged inflammation or mechanical stress. Additionally, nerve compression higher up in the leg, such as sciatica originating from the lower back, can result in referred pain that radiates down to the foot, though direct heel nerve pain from sciatica is less common.
Why Stretching Worsens the Pain
Nerves are designed to glide and move smoothly within the surrounding tissues as the body changes position. When a nerve becomes irritated, compressed, or inflamed, this natural mobility can be compromised, leading to a condition known as nerve tension. When an already compromised nerve is stretched, it can directly pull on the irritated area, increasing the tension and aggravating existing symptoms. This often results in a sharp, shooting, or electric-like pain, distinct from the typical sensation of a muscle stretch.
Stretching an inflamed nerve can also have physiological effects. It may reduce the blood flow to the nerve, leading to a temporary lack of oxygen, and can trigger or intensify an inflammatory response. This heightened inflammation makes the nerve more sensitive to normal movements, perpetuating the pain cycle. Unlike muscles, nerves have a limited capacity for stretching before microtrauma can occur. Specific movements, such as dorsiflexion of the foot (pulling the toes upward), can increase tension on the tibial nerve and its branches, thereby worsening symptoms in conditions like Tarsal Tunnel Syndrome.
Finding Relief and Professional Help
Managing heel nerve pain often begins with several self-care measures to reduce irritation and promote healing. Resting the affected foot and avoiding activities that exacerbate the pain, especially aggressive stretching, are important. Applying ice packs to the heel can reduce inflammation and discomfort. Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may manage pain and inflammation. Wearing supportive, comfortable footwear and utilizing soft insoles or heel pads can alleviate pressure on the nerves.
Seeking professional medical attention is advisable if heel pain persists for more than a few weeks despite home care, or if pain is severe, worsening, or accompanied by numbness, tingling, or muscle weakness. Immediate medical evaluation is warranted for severe pain that occurs suddenly after an injury or if one is unable to bear weight on the foot. A healthcare provider can conduct a thorough physical examination, and may recommend imaging tests like MRI or ultrasound, or nerve conduction studies, to accurately diagnose the nerve involvement and its cause. Treatment approaches vary but can include physical therapy, custom orthotics, medications specifically for nerve pain, and in some instances, injections or surgical procedures to decompress the affected nerve. The aim of these interventions is to relieve pressure on the nerve and facilitate its recovery.