I posted previously about suffering constant chronic dull heel pain( on the sides and back of my right heel), which I think was brought on a month or so after I started a job standing around 10 hours a day. I am convinced my pain is from insertional achilles tendonitis but I don’t have any tender spot in my achilles(although I did have it for few days but in mid portion area that went away after 3-4 days) now it’s just dull ache in the sides and back of heel without any tender spot so my pain specialist thinks it might be coming from my spine. So I had mri of lumbar spine without contrast which mentioned this.
Clinical History: No active complain regarding lumbar spine. C/O at right heal for 3 months. Suspicion of radiating pain.
Technique: Multi-planar multi-echo MRI of lumbosacral spine done.
Reports: Straightening of lumbar lordosis due to muscular spasm. Disc desiccation signal at L5. Lumbar vertebrae are normal in height. Posterior elements are intact. Ligamentum flavum is normal.
L5/S1 Disc: Focal central disc extrusion with radial annular tear minimally compressing ventral central canal indenting right lateral recess exit nerve roots and foramina. Rest of the lumbar vertebrae are normal with well hydrated discs and no evidence of any remarkable disc bulge or herniation. Lower thoracic cord and conus appear normal.
IMPRESSION: Minimal disc degenerative change with radial annular tear at L5/S1 level
Straightening of lumbar lordosis due to muscular spasm.
Even after this report I am convinced my pain is achilles because walking and driving usually cause increase in pain although not right away, driving is worse maybe because my foot is dorsiflexed more?? If I dorsiflex my foot (achilles is stretched) it makes like pop sounds, so I know thats my problem area but now after mri report I am worried I might have more pain issues to deal with possibly in future like disc extrusion or straightened spine?? Im 33, I don’t have any other back pain or leg pain but Im worried my pain specialist is going to think my spine is causing heel pain?? If so should I let him try some treatment on spine to see if it alleviate my heel pain even if as patient I’m 99% sure it’s my achilles??
I wouldn’t second guess a health professional in a discussion forum before they’ve had a chance to talk to you. Go in there with an open mind and ready to ask the right questions so that you can satisfy yourself if the next step seems right. If you scan a human body lots you will find stuff. Someone with experience in this would understand that and I doubt they would blame Achilles pain on anything other than a perfect spine.
In your previous thread you were asked about physio but I didn’t see an answer. I think most people here would initially see a tendon issue as something that should be treated with physiotherapy.
It seems like this is a relatively recent problem so I’m not sure how long you might of been doing physio, if at all. Tendon issues can take time to respond to the right exercises so, assuming you have exercises to follow, stick at them and revisit the professional who prescribed them so you can progress them and fine tune your technique. Good luck.
I posted previously about suffering constant chronic dull heel pain( on the sides and back of my right heel), which I think was brought on a month or so after I started a job standing around 10 hours a day. I am convinced my pain is from insertional achilles tendonitis but I don’t have any tender spot in my achilles(although I did have it for few days but in mid portion area that went away after 3-4 days) now it’s just dull ache in the sides and back of heel without any tender spot so my pain specialist thinks it might be coming from my spine. So I had mri of lumbar spine without contrast which mentioned this.
Clinical History: No active complain regarding lumbar spine. C/O at right heal for 3 months. Suspicion of radiating pain.
Technique: Multi-planar multi-echo MRI of lumbosacral spine done.
Reports: Straightening of lumbar lordosis due to muscular spasm. Disc desiccation signal at L5. Lumbar vertebrae are normal in height. Posterior elements are intact. Ligamentum flavum is normal.
L5/S1 Disc: Focal central disc extrusion with radial annular tear minimally compressing ventral central canal indenting right lateral recess exit nerve roots and foramina. Rest of the lumbar vertebrae are normal with well hydrated discs and no evidence of any remarkable disc bulge or herniation. Lower thoracic cord and conus appear normal.
IMPRESSION: Minimal disc degenerative change with radial annular tear at L5/S1 level
Straightening of lumbar lordosis due to muscular spasm.
Even after this report I am convinced my pain is achilles because walking and driving usually cause increase in pain although not right away, driving is worse maybe because my foot is dorsiflexed more?? If I dorsiflex my foot (achilles is stretched) it makes like pop sounds, so I know thats my problem area but now after mri report I am worried I might have more pain issues to deal with possibly in future like disc extrusion or straightened spine?? Im 33, I don’t have any other back pain or leg pain but Im worried my pain specialist is going to think my spine is causing heel pain?? If so should I let him try some treatment on spine to see if it alleviate my heel pain even if as patient I’m 99% sure it’s my achilles??
Did you examine your footwear? Is it appropriate for what you need it for? A couple years back I was managing a project which required me to stand on concrete for long periods of time for days on end. Started having all sorts of back, leg and foot pain. Training made it all worse. This went on for a few weeks before I spoke with my PT. One look at my footwear which I thought was adequate as I had been wearing the same type of shoes for years and he suggested new more cushioned and supportive shoes. Made the switch and the issues resolved pretty quick.
I suffer from insertional Achilles tendonitis. Reading this post has been the solution for me every time it starts to flare. The biggest take away for me was to stop stretching my calves. Then rehab it with static heal raises, the body weight heal raises and finally progressing to weighted heal raises and never let your heels below the front of your foot.
Responding from perspective of being a radiologist, not neurosurgeon or neurologist.
First thing I notice is the clinical history states “suspicion of radiating pain.” I assume that came from the ordering physician? If so, he/she may be concerning about neurogenic pain causing you some symptoms.
It’s helpful to google a dermatome map, which shows the distribution of sensory nerves based on the spinal nerve level. L5-S1 is where the L5 nerve exits, and in your case may be getting compressed a little bit on the right side. Not sure if your symptoms correspond well to L5 nerve root distribution (based on dermatome maps I see, it looks like the achilles region is more along S1 nerve root distribution).
Now, as far as your spine goes, degeneration of the discs is extremely common and what we see on MRI doesn’t always correlate well with how patients feel. We can read a study that looks absolutely awful and the patient has minimal symptoms. Conversely, sometimes an MRI showing minimal changes for a patient in a lot of pain. And finally, sometimes everything lines up and the images match the clinical presentation.
Annular tears may cause localized pain in the back (or be completely asymptomatic). The annular tear by itself wouldn’t cause pain in your ankle. If a disc herniates and compresses a nerve enough, it can lead to nerve pain (sciatica), sensory loss or weakness.
I think you need to have faith in the system. Your doctor will have the best handle on the whole scenario better than any lurkers like me on this forum. See your doc and find out if your symptoms have anything to do with what they found on MRI.
And I hope physical therapy is in your future to help with the achilles issue (and maybe if you need to rehab that back a bit too). PT can work wonders!
Thanks everyone for replying, To be honest I haven’t done any physiotherapy, I read how some exercises can make insertional achilles worse so I thought I would wait for pain to go away and then work on strenghting my tendon, that way I could judge by pain how much physio, exercises my achilles /foot can handle, but my pain just never went away, but I did see many podiatrists in Canada without much help. But a few weeks ago I came to another country so I could get quicker tests and see some specialists, my MRI of ankle said normal achilles, and my pain specialist thinks my pain pattern doesn’t match achilles pain, and after report said what he suspected earlier is what’s on my lumbar MRI report. So on Monday I am going for procedure in spine,he said he’s going to inject diagnostic local anesthetic , I really hope it works otherwise I wouldn’t know what to do next.
Thanks everyone for replying, To be honest I haven’t done any physiotherapy, I read how some exercises can make insertional achilles worse so I thought I would wait for pain to go away and then work on strenghting my tendon, that way I could judge by pain how much physio, exercises my achilles /foot can handle, but my pain just never went away, but I did see many podiatrists in Canada without much help. But a few weeks ago I came to another country so I could get quicker tests and see some specialists, my MRI of ankle said normal achilles, and my pain specialist thinks my pain pattern doesn’t match achilles pain, and after report said what he suspected earlier is what’s on my lumbar MRI report. So on Monday I am going for **procedure in spine,he said he’s going to inject diagnostic local anesthetic **, I really hope it works otherwise I wouldn’t know what to do next.
I like this approach. I just went through it earlier this week after an injury doing heavy squats. Thought I had a muscle tear/issue but after some injections determined it was indeed a disc issue. Some peptide and ozone and the area and all is now good just a few days later. Good luck. Let us know how it goes.