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Back injury as a cause of PF

Posted by Julie on 9/20/00 at 12:23 (028748)

Hello

I've been scouring the net for information about my recently acquired plantar fasciitis. I don't know whether what I'm going to say will strike a chord with anyone, but here goes. Mine began with a slight back injury, in which a disk impinged on the sciatic nerve. My heel pain began two weeks later. At first I thought it was a coincidence, but my osteopath said she was sure the the one was the result of the other, and the podiatrist to whom she referred me to agreed.

His diagnosis: the sciatic nerve impingement caused adverse neural tension down the back of my leg, affecting the calf muscles and the Achilles tendon, resulting in 'early heel lift' which is the cause of the pain. What's more, he believes that many, if not most, cases of PF start with the back.

He is a sports injury specialist (treats two football teams!) and has treated many PF cases that started with a back injury. He himself has PF, owing to an old and recurring ski-ing injury to his back: whenever the nerve gets impinged again, he gets heel pain a week later.)

For me, he recommended continued osteopathic treatment of the back until the adverse neural tension subsides, as well as the usual stretching/icing/ taping regime.

As a yoga teacher and trainer with a basic knowledge of anatomy, and as one who knows that everything in the body is related to everything else, it makes perfect sense to me that a 'pain in the heel' can result from something other than the usual causes mentioned. But in all my trawling of the web I have come across not a single reference to back problems as a cause of PF.

So - if you are a PF sufferer it might be useful to have your back looked at for possible involvement.

I would be very interested to hear what others have to say about this.

All the best

Julie

Re: Back injury as a cause of PF

salina on 9/20/00 at 13:09 (028751)

I think there could be a connection with me also. I have always had back pain due to a car accident in my teens. I went from gymnastics flexibility to no flexibility after that. Then as an adult I got to add neck pain to that. And now PF goes on my list. I am stiff as a board. I have been seeing a chiropractor, and homeopathic (sp?) doctor for my neck, and they still can't get my neck loosened up.
My back used to go completely out on my about once a year.
But for some reason I was able to go through two pregnancies right after each other, and it didn't go out at all. Then I got pf.
I would gladly trade this constant pain of pf for my old back problems.

Re: Back injury as a cause of PF

YvonneC on 9/20/00 at 14:32 (028756)

Julie, I concur with you analysis. I am a PF sufferer of 5 + years, and have tried everything. Last year I herniated a disk and ended up having surgery in Dec 1999, what I noticed was that while suffering from the herniated disk sitting on my siatic nerve and traveling down my leg I had no pain at all in my feet. When the pain subsided it returned and when I had the disk operated on the pain was gone again. I am now suffering again, because I have not kept up with my back stretching workout, I hope to get back into it as I can not deal with the pain. I also used Mike's PFT and found it to help but then again it could be a combo of things. I hope this helps.

Re: Back injury as a cause of PF

Dr. Biehler on 9/20/00 at 15:02 (028758)

Nerve impingment in the back is a very common cause of pain felt in the heel. It is hard for a lot of heel pain sufferes to believe the pain they feel in the heel really is a back problem. The very first test that is done is the straight leg raise. Lie on your back with hips parrallel to the floor. have someone raise your staight leg up ( one at a time). If you feel a nerve sensation shoot up or down the leg, you have involvment with the nerves higher up.

Re: Back injury as a cause of PF

john a on 9/20/00 at 16:22 (028765)

If you mainly have calcaneal PF insertion point pain, can nerves in the back pretty much be ruled out as a cause?

Re: Back injury as a cause of PF

Julie F on 9/20/00 at 17:15 (028768)

Hi John

That's the very pain I have. The sciatic nerve isn't just 'in the back'. It's the longest nerve in the body, supplying the muscles in the back of the leg, and ending in the heel. As I understand it, impingement of the SN can affect the calf muscles and the Achilles tendon (causing the adverse neural tension my podiatrist speaks of). Their shortening will increase tension in the plantar fascia and cause the typical calcaneal PF insertion point pain. So sciatic nerve impingement can't be ruled out as a cause.

I hope this makes sense. I'm just at the start of what is clearly a huge learning curve, so I may not have explained it well. But it was because I have seen nothing about back problems being a possible cause of PF that I made my original posting, wondering if it would ring a bell with others.

All the best, Julie

Re: Back injury as a cause of PF

Dr. Biehler on 9/20/00 at 17:34 (028769)

An impingment in the back can be felt in the heel. This is different from an impingment causing a casacde effect resulting in heel pain, which I am sure happens and vice versa.

Re: Back injury as a cause of PF

wendyn on 9/20/00 at 18:22 (028771)

Julie - I think you are the only other person I've heard mention 'neural tension' (other than myself). Your situation sounds very similar to mine. I've experienced significant relief with acupuncture administered by a physio therapist trained in both medical acupuncture and traditional Chinese medicine. Be careful stretching your foot out to drive or ride a bike - both things in the past had a tendancy to aggravate the nerve in my leg/foot. I am at a point now where I can stretch much more freely and without as much fear of pain. I am at about the 2 year mark following what was along the way diagnosed as Tarsal Tunnel Syndrome amongst other things.

I also have lower back problems and I've had problems with most of the other things you mention.

Re: Back injury as a cause of PF

john h on 9/20/00 at 19:43 (028775)

i had back surgery 18 years ago (result of being shot down in an aircraft in laos). caused me no problems with feet. 18 years later lots of problems with feet. all the doctors i have seen (many) discount my back problems having anything to do with my foot problems. i had a cortisone shot a few months ago into the area of the platar that hurts. the pain went away for nearly 4 weeks. would this not rule out a back related problem?

Re: Back injury as a cause of PF

Julie F on 9/21/00 at 03:14 (028796)

Thank you Dr Biehler for clearly making the distinction I tried but failed to make between actual sciatic pain which is experienced in the heel and the 'cascade effect' of nerve impingement resulting in heel pain. Either way, it seems clear that there are cases of PF that have nerve impingement as their root cause, and it might help others besides me to consider whether this could apply to them, as osteopathic or chiropractic treatment might be useful. I don't know whether it would help once PF has become chronic - I will try to find out.

My podiatrist pointed out that there is usually a delay between the back injury and the heel pain - in my case it was two weeks. I have no idea whether an 18-year old back injury like yours, John H, could be the cause of delayed PF - that would be a very long delay!

Incidentally,it doesn't have to be a real 'back injury', it can be anything that causes nerve impingement, like just 'putting your back out' with an unconsidered movement.

Wendy, I'm glad to hear that acupuncture has been helping you. I intend to try it too, if my heel hasn't recovered by the time I get back from my holiday in mid-October - the agenda for which seems to be lots of swimming and little walking. Alas!

Re: Back injury as a cause of PF for dr beihler

john h on 9/26/00 at 15:04 (029194)

dr: if you have a cortisone shot into the area where your fascia pain eminates from (band from great toe to fascia where it connects to heel) and the shot stops the pain for 3 weeks would this rule out the back as a source of the problem?

Re: Back injury as a cause of PF

salina on 9/20/00 at 13:09 (028751)

I think there could be a connection with me also. I have always had back pain due to a car accident in my teens. I went from gymnastics flexibility to no flexibility after that. Then as an adult I got to add neck pain to that. And now PF goes on my list. I am stiff as a board. I have been seeing a chiropractor, and homeopathic (sp?) doctor for my neck, and they still can't get my neck loosened up.
My back used to go completely out on my about once a year.
But for some reason I was able to go through two pregnancies right after each other, and it didn't go out at all. Then I got pf.
I would gladly trade this constant pain of pf for my old back problems.

Re: Back injury as a cause of PF

YvonneC on 9/20/00 at 14:32 (028756)

Julie, I concur with you analysis. I am a PF sufferer of 5 + years, and have tried everything. Last year I herniated a disk and ended up having surgery in Dec 1999, what I noticed was that while suffering from the herniated disk sitting on my siatic nerve and traveling down my leg I had no pain at all in my feet. When the pain subsided it returned and when I had the disk operated on the pain was gone again. I am now suffering again, because I have not kept up with my back stretching workout, I hope to get back into it as I can not deal with the pain. I also used Mike's PFT and found it to help but then again it could be a combo of things. I hope this helps.

Re: Back injury as a cause of PF

Dr. Biehler on 9/20/00 at 15:02 (028758)

Nerve impingment in the back is a very common cause of pain felt in the heel. It is hard for a lot of heel pain sufferes to believe the pain they feel in the heel really is a back problem. The very first test that is done is the straight leg raise. Lie on your back with hips parrallel to the floor. have someone raise your staight leg up ( one at a time). If you feel a nerve sensation shoot up or down the leg, you have involvment with the nerves higher up.

Re: Back injury as a cause of PF

john a on 9/20/00 at 16:22 (028765)

If you mainly have calcaneal PF insertion point pain, can nerves in the back pretty much be ruled out as a cause?

Re: Back injury as a cause of PF

Julie F on 9/20/00 at 17:15 (028768)

Hi John

That's the very pain I have. The sciatic nerve isn't just 'in the back'. It's the longest nerve in the body, supplying the muscles in the back of the leg, and ending in the heel. As I understand it, impingement of the SN can affect the calf muscles and the Achilles tendon (causing the adverse neural tension my podiatrist speaks of). Their shortening will increase tension in the plantar fascia and cause the typical calcaneal PF insertion point pain. So sciatic nerve impingement can't be ruled out as a cause.

I hope this makes sense. I'm just at the start of what is clearly a huge learning curve, so I may not have explained it well. But it was because I have seen nothing about back problems being a possible cause of PF that I made my original posting, wondering if it would ring a bell with others.

All the best, Julie

Re: Back injury as a cause of PF

Dr. Biehler on 9/20/00 at 17:34 (028769)

An impingment in the back can be felt in the heel. This is different from an impingment causing a casacde effect resulting in heel pain, which I am sure happens and vice versa.

Re: Back injury as a cause of PF

wendyn on 9/20/00 at 18:22 (028771)

Julie - I think you are the only other person I've heard mention 'neural tension' (other than myself). Your situation sounds very similar to mine. I've experienced significant relief with acupuncture administered by a physio therapist trained in both medical acupuncture and traditional Chinese medicine. Be careful stretching your foot out to drive or ride a bike - both things in the past had a tendancy to aggravate the nerve in my leg/foot. I am at a point now where I can stretch much more freely and without as much fear of pain. I am at about the 2 year mark following what was along the way diagnosed as Tarsal Tunnel Syndrome amongst other things.

I also have lower back problems and I've had problems with most of the other things you mention.

Re: Back injury as a cause of PF

john h on 9/20/00 at 19:43 (028775)

i had back surgery 18 years ago (result of being shot down in an aircraft in laos). caused me no problems with feet. 18 years later lots of problems with feet. all the doctors i have seen (many) discount my back problems having anything to do with my foot problems. i had a cortisone shot a few months ago into the area of the platar that hurts. the pain went away for nearly 4 weeks. would this not rule out a back related problem?

Re: Back injury as a cause of PF

Julie F on 9/21/00 at 03:14 (028796)

Thank you Dr Biehler for clearly making the distinction I tried but failed to make between actual sciatic pain which is experienced in the heel and the 'cascade effect' of nerve impingement resulting in heel pain. Either way, it seems clear that there are cases of PF that have nerve impingement as their root cause, and it might help others besides me to consider whether this could apply to them, as osteopathic or chiropractic treatment might be useful. I don't know whether it would help once PF has become chronic - I will try to find out.

My podiatrist pointed out that there is usually a delay between the back injury and the heel pain - in my case it was two weeks. I have no idea whether an 18-year old back injury like yours, John H, could be the cause of delayed PF - that would be a very long delay!

Incidentally,it doesn't have to be a real 'back injury', it can be anything that causes nerve impingement, like just 'putting your back out' with an unconsidered movement.

Wendy, I'm glad to hear that acupuncture has been helping you. I intend to try it too, if my heel hasn't recovered by the time I get back from my holiday in mid-October - the agenda for which seems to be lots of swimming and little walking. Alas!

Re: Back injury as a cause of PF for dr beihler

john h on 9/26/00 at 15:04 (029194)

dr: if you have a cortisone shot into the area where your fascia pain eminates from (band from great toe to fascia where it connects to heel) and the shot stops the pain for 3 weeks would this rule out the back as a source of the problem?