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heel spur, siatic nerve - dura tightness

Posted by Curb I. on 10/05/03 at 19:50 (132347)

Hi there,

I've had a heel condition for the last 10 months and have been to see chiropractors, physios, and a podiatrist. I'm a recreational ultra runner who likes running on trails; my problems started Dec. 2002 when I miscalculated my step while night running and landed hard on my left heel. Ankle/heel were sore for a couple of days but didn't seem too severe. In Jan. 2003 I developed PF which was relieved in about 4 weeks with Active Release Therapy (ART), massage and stretching/rolling on golf ball at home.I've run throughout the year and have completed a number of 50Ks and a marathon. Weekly ART and massage have helped let me continue to run & compete but since July I haven't run that much and haven't raced at all.

However my ankle/heel has never felt the same since Dec. When plantar flexing my foot I would get a strange, weak feeling through my Achilles tendon with some associated pain. Its hard to describe - didn't hurt a lot but felt like I couldn't support my weight, just felt eerie but not like it was going to tear. ART for the gastrocs & soleus plus some calf raises seems to have helped that but its still there. I would even get this feeling during swimming.

My left foot now over-pronates and has an unstable subtalar joint. The chiro and a physio have manipulated the foot with slight degrees of success. In Aug. 2003 the podiatrist diagnosed a malfunctioning spring ligament as the cause for the unstable subtalar joint and prescribed a modified insole with 2 degrees of pronation correction. This does seem to help with the heel pain but I didn't feel like this was the final solution.

The most recent (last week) physio I went to came up with the following diagnosis. My calves are really tight and I have less than required ROM in dorsiflexion. My foot flexes midway to correct for this limitation. I also have a heel spur. This is further complicated by tight dura at L5 where the siatic nerve orginates. When she did a supine hamstring stretch then dorsiflexed my foot I get a searing pain down my leg; my hamstrings are tight but my right leg does not feel like this at all.

For treatment she gave me a neural stretch (supine, left leg on wall like a hamstring stretch then dorsiflex the foot - 4 sets of 10), stretching the gastrocs & soleus in non-weight bearing, and go see a local orthotist who is well-known and respected for semi-rigid orthotics. No running for 10 days.

This information seems compatiable with what I've read on this site. My question is does this sound like a good diagnosis and recommendations? I've been stretching my calves regularly for the last few months but in weight bearing position - haven't noticed much difference and I've backed off a lot on the running. Will non-weight bearing make that much difference?

Thank you in advance and sorry for the length of the post.

Re: heel spur, siatic nerve - dura tightness

Dr. Z on 10/05/03 at 20:20 (132354)

Here is what I would like to know . Do you have pain with examination in the foot, at the insertional plantar fascia area. Are you limping when you sit for any lenght of time and then get up . Do you have what we call the classic heel spur syndrome condition.
There is no question that equinus will contribute and cause compensation such as plantar fasciitis subtalar joint pronation. I need much more information about your foot pain and the results of your physical examination.

Re: heel spur, siatic nerve - dura tightness

Curb I. on 10/05/03 at 20:31 (132355)

Thank you for the reply Dr.Z;

no I don't limp when I sit for any length of time. Before getting the correction insole if I was on my feet for any length of time then I would start to limp & get sore. This would also happen after my runs; my heel would be sore for the rest of the day and the next morning would be hellish after long runs (> 2 hours). Pain would diminish throughout the day but it would still be there.

And yes there is a tenderness at the insertion point upon palpation during examination. Degree will vary as to what I've done but its always there. Both my massage therapist and ART provider say my PF feels better and I agree so its not classic heel spur syndrome. Having PFitis earlier this year I know what that feels like; the PF just doesn't feel 'tight' but it still hurts in the heel.

thanks again,

Re: heel spur, siatic nerve - dura tightness

Dr. Z on 10/05/03 at 20:36 (132357)

What did they say about your posterior tibial tendon. Was an mri ever performed on your foot and ankle.?

Re: heel spur, siatic nerve - dura tightness

Curb I. on 10/05/03 at 20:43 (132360)

Not much was mentioned about this. Had some ART done on it. No MRI or x-rays were done. I've wondered about the post tib. myself, tried doing some modified calf stretches to lenghten it.

Re: heel spur, siatic nerve - dura tightness

Dr. Z on 10/05/03 at 21:59 (132363)

You need to have a complete history and physical examination. How was it determined that you have a heel spur without a heel spur.

Re: heel spur, siatic nerve - dura tightness

Curb I. on 10/05/03 at 22:07 (132366)

The physio felt a bump on the heel so she concluded it was a heel spur. She did mention x-rays but at the end of the session didn't recommend anything. Thanks for all the advice, I know of a couple of good sports med docs and will pay them a visit.


Re: heel spur, siatic nerve - dura tightness

Dorothy on 10/06/03 at 00:55 (132378)

I am not one who can answer your question, but I appreciated the length and detail of your post. You did an excellent job of description and I think we all learn from such things; I know I did. I hope you find good answers to your questions and improved physical condition. Best wishes ~

Re: heel spur, siatic nerve - dura tightness

Dr. Biehler on 10/07/03 at 06:50 (132557)

You said your foot ' flexes' to make up for your lack of doriflextion. This could mean you have a compensating cavus foot. If you have a cavus foot, you will never be able to streach your way to dosiflextion, but there are other ways to help compensate.