Plantar Fasciitis or Sciatica….You Decide.

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An extremely pleasant female runner came to my office last week.  Before I met her I was looking over her chart and saw that she was seeking help with her foot pain.  I read through the rest of the file and noticed she also suffered from back pain.  No matter, I thought, I will deal with her foot and if there is any time I will ask her about her back issues.  I proceeded to the reception area and was introduced to her by one of my assistants.  When she got up from her chair she was completely bent over at the waist.  She followed me to the examination room hardly able to straighten up.  “I know your file says you are here for your foot but you obviously have a pretty significant lower back problem” I said.  She admitted she did explaining it had been like this for days.  I asked “Have you seen any other doctor’s for either your foot or lower back”?  She replied “I went to my doctor the other day for my foot.  When I originally made the appointment my back was fine.  By the time I got to the appointment my back was in a lot of pain and I was bent over like this.  The doctor told me I had Plantar Fasciitis and not to run”.  I let that sink in for a moment then asked “But he saw you bent over like this?  Did he not ask about your back”?  She replied “He did say it looks like you have a back problem but that was about it”.  I sat back and thought about what kind of doctor would let a patient stand in front of them twisted over in obvious pain and say “It looks like you have a back problem”.  Really genius!  How about helping her with that back problem!  I said to her “I know you are here to see me about your foot, and I will address it, but your back problem is infinitely more important at this time so I am going to examine your back if that is Ok with you”?  She said it was.  After a thorough orthopedic and neurologic exam I determined she had a herniated disc at her L4-L5-S1 regions (lower lumbar spine).  I told her I could treat and help her but an MRI would be necessary to at least see if she might be a surgical candidate.  She agreed and I treated her.

When she returned two days later she was standing erect and her back pain was decreased but not gone.  At this appointment I examined her foot.  After a thorough exam it was obvious her foot pain was actually part of her nerve pain from her back.  After careful questioning she admitted that the pain radiates from her back, down her leg and then into her foot.  What her doctor had diagnosed as Plantar Fasciitis was actually nerve pain.  That should have been obvious as she had none of the “textbook” signs and symptoms of Plantar Fasciitis.

Bulging, protruded and herniated discs in the lower back cause predictable symptoms in most everyone that suffers from them.  Because of this it is a simple process to diagnose the patient and predict the exact location of the disc problem as well as the severity of the bulge.  Plantar fasciitis also has predictable symptoms that most all patients will suffer from.  One of those is arch/heel pain that is worse when getting out of bed in the morning.  When a patient does not complain of this symptom typically they DO NOT have plantar fasciitis.  When a patient is bent over at the waist and complains of lower back pain and radiating pain into their foot it is obviously NOT a foot problem.  More and more the art of diagnosis is being lost in the traditional medical model.  Diagnosis means ‘to know”.  By performing a thorough history and examination “to know, to discern, to distinguish’ is quite easy.  It is a little like being a detective.  You have to eliminate “suspects” and you do this by process of elimination and using your experience and common sense.  When you take a patient’s history and they tell you where it hurts you can eliminate most other area

By | 2012-12-07T18:01:31+00:00 December 7th, 2012|Running Injuries|21 Comments

About the Author:

Dr. Runco is a U.S. Navy and Gulf War Veteran. He began private practice in 2000 primarily treating and fixing running injuries. He has been a professor of Anatomy, Physiology, and Biomechanics at various colleges and continues to teach continuing education in the fields of rehabilitation, custom orthotics and athletic taping. He is also a member of the American College of Sports Medicine, National Strength and Conditioning Association and is a Certified Strength and Conditioning Specialist. He has completed over 15 Marathons in 15 states and has run 11 50 mile Ultramarathons.

21 Comments

  1. Jason April 19, 2015 at 1:46 am - Reply

    This is a brilliant article that lets people know of when they actually have Plantar Fasciitis. Many people tend to get worried when they have pain for extended periods in their foot and lower legs, however one only has Plantar Fasciitis when he/she finds it difficult to move his/her foot and upon experiencing severe pain in the heel.

    • Dr. Runco April 20, 2015 at 9:43 am - Reply

      they are usually very easy to separate if a proper exam is done. Unfortunately many doctors jump to conclusions and do not perform a thorough history or exam to the patients detriment.

  2. Tyra November 22, 2015 at 7:38 pm - Reply

    2 years ago, I had a problem with bulging disc at L4, L5, S1. I had the MRI to determine it. I went through PT, chiropractic care, disc decompression, the surgeon said I didn’t need surgery. It slowly started to feel better. Most of the pain was in my right, lower back. A few months later, I discovered what the piriformis muscle was. It was awful. I went through PT, again. Then developed sciatica (all in the right hip & leg). A few mths of pain, the doc gave me Gabapintin, I got 2 EDIs, within 3 weeks & started to feel better. I started running at the gym, & developed Plantar fasciitis, right foot, I’m in PT, again, got the cortisone shot in my foot. How likely is it that it’s not PF, but actually sciatica? All my pains are on right side of my body

    • Dr. Runco November 23, 2015 at 8:53 am - Reply

      It is certainly possible that it is still coming from your back. I would need a lot more information in order to help you though.
      1. Do you still have pain in your back
      2. Is the pain radiating from your back to your foot
      3. Do you have pain in your foot in the morning when you get out of bed? Does it warm up?
      4. Did the cortisone shot help your foot?

  3. Aubrey November 23, 2015 at 12:09 pm - Reply

    Question.
    About 3-4 years ago I was in a car accident, I was diagnosed with having swollen disks in my lower back and neuropathy of the nerve that runs down my left leg between my lower back and my knee on the outside of my leg. Last summer I was told by a doctor who didn’t look at my foot that I had plantar fasciitis. I have recently started to have numbness in only 2 toes on my left leg which is the one they said I have PF in. Do you think this could be my sciatica? I’ve never gone through physical therapy for my back either.

    • Dr. Runco November 23, 2015 at 12:34 pm - Reply

      Numbness in the toes is not consistent with plantar fasciits. There are other possibilities such as mortons neuroma or as you mentioned a compressed nerve in your back.
      Do you have pain in your heel or arch of your foot?
      Do you have pain in your heel/arch in the morning when getting out of bed?

  4. Aubrey November 23, 2015 at 12:58 pm - Reply

    I have pain in the heel. It does hurt some mornings. Some morning I can get up with no pain and some mornings the pain is unbearable. But the pain in my lower back is a constant. I cant wear jeans because it intensifies the pain in my back. Any clothes I wear have to be loose around the waist or it causes pain in my back. My chiro told me I have PF but I’m wondering if its something more like it’s being caused by my back. I have a slight limp on my left side which is where the foot pain is.

  5. Dr. Runco November 23, 2015 at 4:03 pm - Reply

    Pain in the heel/arch in the morning when you get out of bed that quickly warms up and goes away is indicative of plantar fasciitis. You could easily have a lower back condition AND plantar fasciitis. They could be separate and distinct injuries meaning one may not be causing the other. What are you doing to address the foot issue?

  6. paschal May 1, 2016 at 10:43 pm - Reply

    Hi Dr.
    Since last year July I have been in pains. It started with a sharp pain at the side of my hip whenever I walk or roll over the bed and proceeded to the upper waist. After 3week bed rest and pain medications, it subsided and I was getting to normal until late December when I traveled in a bus through a very bad road in a bus without back rest for the seat. Two days later I was in pains. A sharp pain at the side of the hip that makes it almost impossible to roll over the bed. I rested for two weeks with intermittent activity. The didn’t REALLY subside. Two weeks later while driving, I noticed heel pain. The heel pain has continued till date. I noticed am glued to my foam slippers I find it very difficult walking on bare floor especially the one with tiles. When I wake up in the morning I feel pain under the whole feet especially as my body bears the weight. I also hear clicking sound on my toes as I walk. My orthopedic surgeon says I have a prolapsed disc even when the MRI I had in August last year according to radiologist didn’t not show a slipped or prolapsed disc. A recent xrays shows straightening of the normal lumbar lordosis with vertebrae in normal alignment. Another orthopedic surgeon says I have sacroilitis and need traction done. He pressed on my disc areas which did not produce pain and did a straight leg raise with no pain. Bottom line: do I have disc prolapse, plantar facitis or sacroilitis. Please help am in pains.

    • Dr. Runco May 4, 2016 at 5:52 am - Reply

      Plantar fasciitis would not cause hip pain plus your hip pain came first so it is possible you have a hip or back problem in addition to developing either heel spur syndrome or plantar fasciitis.
      I apologize but would not much more information to help you beyond that. If you would like this help you can email me pictures of the MRI rreports and a detailed chronological sequence of your condition(s) along with anything you have done to either help or hurt your current condition

  7. Edith May 14, 2016 at 10:16 am - Reply

    I have had lower back pain for 2 years and was diagnosed with L4& L5 bulging disks. Since then I have also developed chronic foot pain in both feet which has become unbearable. I’ve seen a Physical Therapist with no results, then a Pain Management Doctor of whom has given me injections in both sides of my hips in the bursa sacs because everytime I would lay down I get this burning pain on my side I was laying on. It helped some, but not 100%. Also injections in my sacrum and lumbar all with little results. After all those I saw a Podiatrist because my feet were getting worse in pain. He said I have Plantar Fasciitis so he ordered orthotics which helped some, so then he did injections into my feet and gave me these special boots to wear at night. Its been 4 months with no relief. I’ve also been seeing a Chiropractor for 6 months and although he had helped my stiff neck issue from probably walking bent over from back pain, I’m still hurting in my lower back, heel pain and sciatica pain in both butt cheeks down into back of my thighs.

    I can’t stand it no more!!! I’m in pain 24/7, live on Advil and Tramadol just to be able to normal activity. I’m wondering if I should see a Neurosurgeon for my bulging and if that is the cause of my back and heel pain?? Could the disk be the whole issue??

    • Dr. Runco June 1, 2016 at 2:07 pm - Reply

      Edith you need new doctors. The one(s) you are currently seeing do not seem to have a true grasp of your problem. Try the neurosurgeon as your issue could easily be coming from your back. Your MRI probably was under-read or misread. Your discs are most likely far worse than a simple bulge and are probably putting pressure directly on your spinal cord

  8. lisa June 12, 2016 at 6:27 am - Reply

    I started with foot pain where it was worse upon waking and I couldn’t walk until I got running shoes on. Then the back pain started. My back down both sides. Worse when in bed. Can hardly roll over. Then the pain in my right side of my rear end – I’ll be walking and get a sharp pain. I am on my feet all day at work and walk a lot. I am over weight and trying to lose weight but I’m in so much pain. Where do I start to get relief? Thank you

    • Dr. Runco June 13, 2016 at 4:05 pm - Reply

      It sounds like you may have multiple issues right now Lisa. How would you like me to help you? Do you live in San Diego? If so you can come in for an appointment. If not and you live too far away I can arrange a skype or phone appointment for you. If you would like either one of these option email me directly at Drrunco@sdri.net

    • Dr. Runco June 22, 2016 at 4:50 am - Reply

      Lisa it sounds like you have a serious back problem resulting in radicular nerve pain. I recommend you see a specialist and request an MRI

  9. Marci April 9, 2017 at 8:58 am - Reply

    I have had back pain for 5 years. The last MRI I had (2013) noted marrow edema associated with endplate herniations at L3-4 interspace; multilevel disc degeneration with disc osteophyte ridging, disc bulge and multiple small protrusions; moderately severe lower lumbar facet degeneration, L3-4 through L5-S1, along with moderate levoconvex scoliotic curvature. I went through some epidural injections and had temporary relief. Fast forward to now; I have constant back pain; the severity depends on what I do with my days. But because during the last year I have been experiencing severe (hot fire, pins and needles) pain in my heel that always happens in the night, and has to be the worst pain I have ever dealt with (literally makes me cry and scream out, and I deal with pain daily so this is not my normal reaction), I went to a podiatrist. I was diagnosed with Plantar Fasciitis and Mortons Neuromas (both feet) and treated for both. Months later I am still experiencing the unbearable heel pain that strikes in the night, and it is definitely worse when I have done yard work or anything that makes my back pain worse. When I catch a glimpse of myself in a full length mirror, I am typically hunched over like a little old lady (which I’m not). Can this horrible heel pain be related to my back issues?

    • Dr. Runco April 10, 2017 at 6:32 pm - Reply

      It easily could be considering when it seems to strike. Plantar fasciitis usually hurts worse in the am when getting out of bed and gradually warms up. Heel spurs will get worse throughout the day and ache. You are describing nerve pain Marci. I can and am willing to help you if you want it. Let me know and I will send you a plan

  10. Sandra Hardin April 25, 2017 at 9:33 am - Reply

    I am having pain in the bottom of both feet after being pulled by a car sorta making the legs do a spilt. Prior to that I would have severe groin pain. I only have that rarely now since both feet are hurting. At first the pain in my feet was when I was walking went away when I laid down. I have been told Metamarsal, PF, Back . I have had PT over the last 2 years. I have a back fusion at L4-L5, S1. My neurosurgeon says neurophy. Since reading so much I agree it is Neurophy but the question is where is it coming from. One dr has even said that. The feet pain ate getting worse. At this time i don’t know who to see. My neuro-surgeon says he will not do any more surgery. The MRI of back showed protruding disk at L3, L4. The MRI of left foot showed spurs. No Mri of both feet. I really would like to know who or what i should do as I fear it will continue to get worse and finally I will not be able to walk. Any help would be appreciated. Sandi

    • Dr. Runco April 25, 2017 at 1:27 pm - Reply

      I am sorry your inquiry does not provide me with enough information regarding your symptoms to help you at this point. It could be neuropathy…..it could also be any of the other conditions yo umentioned like plantar fasciitis or even metatarsalgia.
      Send me a chronological list of everything you have tried and have had done. What made it better or worse and a chronological list of your symptoms. Pictures also help so you can mark the painful area and send that to me. After I look that all over I will let you know my opinion

  11. Jasmine June 19, 2017 at 3:59 am - Reply

    My pain started with my feet. I would get a burning pain in the arch of my foot and it would cramp as well. My doctor had me walk barefoot and determined it was pantar fascitis. So i bought tread lab insoles and got new running shoes. My feet got so much better no pain. Then my back pain started a couple months after. I sat on the floor for a couple hours at a friends house and from then the pain has never really gone away. I get a sharp pain down my leg and its constantly in my lower back upper butt region on the left. My doctor determined it was sciatic nerve injury. I stretch every other day and try to walk when i dont need to run. But i cant live with this pain forever. I need some type of solution. What do you suggest?

    • Dr. Runco June 21, 2017 at 6:03 am - Reply

      There are a few conditions you could be suffering from such as Ischial Bursitis, Piriformis Syndrome, Gluteus Medius Syndrome, High hamstring tear or High Hamstring Tendonosis to name a few although it SOUNDS like Sciatica in your case. If you would like my help and expertise please fill out this new patient form and respond to my email. I will have a secure invoice sent to you and we can set up a phone consultation.
      If you send me a chronological history
      anything you tried that helped or hurt
      any MRI’s, X-rays etc
      I can review everything and offer you a phone consultation. The cost is $237 and afterwards I will send you
      1. a written treatment plan
      2. any necessary video rehabilitation tutorials

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