The relationship between lumbar radiculopathy and neuropathic heel pain
Background Back pain and plantar heel pain are both common problems in the general population with one in ten people experiencing inferior heel pain at some time1. Radicular pain is defined as a type of referred pain caused by nerve root compression. Typically, it is described as a sharp, shooting pain in a relatively narrow band of tissue23. Among the sources of foot pain, nerve entrapment is frequently underrecognised despite being an important source2.An association has been reported between radiculopathy and plantar heel pain secondary to nerve entrapment making it a double crush syndrome. A study has, however, not been carried out locally, either clinically or electrodiagnostically to confirm this. Upton and Mccomas, in 1973, initially described the double crush syndrome in patients with carpal tunnel syndrome and lesions of the ulnar nerve around the elbow in association with more proximal cervical root lesions19. Subsequent studies have shown a less favourable outcome with surgery for the distal lesion alone. Objective: The aim of this study was to establish the relationship between lumbosacral radiculopathy and heel pain secondary to nerve compression. It further sought to establish if heel pain was more likely to occur in plantar fasciitis if a patient had radiculopathy. Methodology: A prospective cross-sectional study based at KNH, A&E Department and the Orthopaedic Clinic over six months from November 2012 to April 2013. One hundred and two Patients seen at the A&E and the Orthopaedic clinic with heel pain were recruited into the study. Those with a history of trauma and one who presented with cellulitis following intralesional steroid injection were excluded. Demographic data was extracted and pain was scored using the visual analog scale. Presence or absence of prior or current radicular low back pain and laterality was established and imaging was reviewed for those patients who had. Results: At least 57% of patients with heel pain in all age groups had symptoms of radiculopathy. The prevalence was high in all occupation groups and presentation was not influenced by age. Conclusion: A high prevalence of radiculopathy in was found patients with plantar heel pain. In patients who had prior MRI, the root compression was at levels of L4/5 disc to L5/S1 discs.