Sciatica Referred Heel Pain - Risk Factors, Causes, Diagnosis, and Treatment

What Is Sciatica?

The sciatic nerve is one of the major nerves in our body. It is also the longest and widest nerve. It originates in the lower spine and travels through the hip and buttock region to the foot through the back of the leg. Irritation or injury to the sciatic nerve results in nerve pain, referred to as sciatica. This pain travels along the pathway of the nerve. Pain due to sciatica is more in the legs compared to the lower back.

Sciatica usually affects only one leg. Depending upon the cause, sciatic pain may appear suddenly or gradually. Pain worsens due to prolonged sitting or standing and forceful body movements like coughing and sneezing.

What Are the Risk Factors for Sciatica Referred Heel Pain?

• Age (45-64 years): Age-related degenerative changes like natural wearing down of bone tissue and disks of the spine.

• Obesity: Inactive lifestyle may result in overweight, creating extra pressure on the spine. Prolonged sitting should be avoided, and physical exercise is important.

• Improper posture while lifting weights.

• Previous history of injury.

• Diabetes: Chances of sciatica is high in diabetic patients due to the high probability of nerve damage.

• Osteoarthritis: Osteoarthritis (degeneration of joint cartilage and the underlying bone) can cause spine damage, increasing the risk of nerve injury.

• Smoking: Nicotine present in tobacco can cause damage to spinal tissue, bone weakening, and speed up the wearing of vertebral disks.

• Pregnancy: Certain pregnancy hormones can loosen the ligaments, making the spine unstable and thereby compressing the nerve.

What Causes ‘Sciatica Referred Heel Pain’?

Sciatica-referred heel pain can be caused by several medical conditions which include:

• Slipped or Herniated Disk: This is the most common cause of sciatica. Due to pressure from vertebrae, the disk’s center will bulge through a weakness in its outer wall. As a result of this herniation, the sciatic nerve gets pressed.

• Spinal Stenosis: It occurs due to abnormal spinal canal narrowing, reducing spinal cord and nerve space.

• Degenerative Disk Disease: This condition results from the natural wear down of disks between the vertebrae.

• Spondylolisthesis: It is a condition in which the vertebra (a bone in the spine) moves forward from the proper position onto the bone below it.

• Osteoarthritis: Also called wear and tear arthritis is a common joint disease affecting middle-aged and older adults. It generally occurs due to broken cartilage (the tissue that cushions the bone endings between joints).

• Piriformis Syndrome: A condition in which the piriformis muscle (a small muscle that lies deep in the buttocks) becomes tight.

• Cauda Equina Syndrome: A condition that affects cauda equina (a collection of nerves at the bottom of the spinal cord).

• Trauma Injury to the sciatic nerve or associated spine area.

• Tumors present in the spinal canal can cause sciatic nerve compression.

What Are the Symptoms of Sciatica-Referred Heel Pain?

The symptoms of sciatica-referred heel pain include:

• Pain in the buttocks, lower back, and legs. It may present as mild aches to sharp burning pain.

• Numbness or weakness in the lower back, buttocks, and feet.

• Pain can get worse while coughing, sneezing, or prolonged sitting.

• Muscle spasms (sudden constriction of muscle).

• Pins and needles feeling may be present in some cases.

• Loss of bladder and bowel control in rare cases.

How Is Sciatica Referred Heel Pain Diagnosed?

Sciatica-referred heel pain can be diagnosed through medical history and physical examination. Physical examination mainly includes:

• Straight leg raise test (Lasegue sign): Neurological testing helps spot the point of pain and identify any disk-related problem.

• Feeling of weakness while bending the knee.

• Difficulty bending the foot inward.

• Difficulty bending forward and backward.

• Difficulty in walking.

• Loss of sensation or numbness.

• Pain while lifting the leg straight up while lying on the exam table.

Depending on the physical examination, imaging and other tests may be performed, which include:

• Spinal X-rays can be done to rule out any spinal fractures, disk problems, infections, and tumors.

• MRI (magnetic resonance and imaging) and CT (computed tomography) scans can be done to assess the bone and soft tissues of the back. MRI can help to identify any conditions or injuries that cause sciatic pain, such as herniated disk or spinal stenosis (narrowing of the spinal canal). MRI can also be useful in assessing the progress of treatment.

• EMG (electromyography) can be performed to check the electric impulse traveling through the sciatic nerve and the muscle response.

• Myelogram (an imaging test that uses contrast dye and x-rays) can be performed to identify vertebrae or discs causing the pain.

How Can Sciatica Referred Heel Pain Be Treated?

The treatment may vary depending on the severity of the symptoms. Mild cases can be treated by some self-care treatments, which include:

• The affected area should be applied with ice packs for around 20 minutes multiple times a day at regular intervals. After a few days, the same procedure must be repeated with a hot pack.

• Taking over-the-counter medications, including NSAIDs (non-steroidal anti-inflammatory drugs) like Aspirin, Ibuprofen, and Naproxen.

• Performing gentle muscle strengthening and aerobic exercises.

Other treatment options include:

• Prescription medications: Muscle relaxants like Cyclobenzaprine.

• Physical therapy.

• Spinal injections: Corticosteroid injections can be given.

When Is Surgery Advised for Sciatica Referred Heel Pain?

Spinal surgery is usually performed in cases where other treatment methods have failed or have not yielded the desired results. Surgery is done within a year of ongoing symptoms. Spinal surgery is to decompress the nerves to maintain spinal stability. Surgical options include:

• Microdiscectomy: Minimal invasive procedure that is used to remove fragments of disks that are pressing on a nerve.

• Laminectomy: This procedure removes the lamina (part of vertebral bone which forms the roof of the spinal canal).

How Can Sciatica Referred Heel Pain Be Prevented?

Sciatica can be prevented by

• Maintaining a healthy weight.

• Maintaining proper posture.

• Exercising regularly.

• Avoid smoking.

Conclusion:

Sciatic pain is a common medical condition in the current generation due to a physically inactive lifestyle. In most cases, sciatic referred heel pain can be cured with self-treatment (non-surgical) methods. However, if the pain does not subside with self-treatment, seek medical help from a healthcare provider.