From the Guidelines
The nerve root that connects to the heel is primarily associated with the L4-S3 nerve roots, specifically through the tibial nerve, a branch of the sciatic nerve. This association is crucial for understanding the etiology of heel pain, especially when considering neurologic heel pain that can arise from irritation or entrapment of nerves innervating the heel, as discussed in the context of neurologic heel pain 1. The tibial nerve, originating from these nerve roots, travels down the back of the leg and divides into the medial and lateral plantar nerves behind the medial malleolus, supplying sensation to the heel and sole of the foot.
Key points to consider include:
- The tibial nerve provides both motor function to the calf muscles, which control heel movement, and sensory information from the heel area.
- Damage to the tibial nerve or its spinal nerve roots (L4-S3) can result in heel pain, numbness, or weakness in the foot.
- Conditions such as tarsal tunnel syndrome, which involves compression of the tibial nerve, can specifically affect heel sensation and function, highlighting the importance of the L4-S3 nerve roots in heel innervation and function, as implied by the discussion on neurologic heel pain 1.
Given the information provided and focusing on the most relevant and recent evidence, the connection between the heel and the nerve roots is primarily through the tibial nerve, which is influenced by the L4-S3 nerve roots. This understanding is essential for diagnosing and treating heel pain, especially when neurologic causes are considered, as outlined in the study on diagnosis and treatment of heel pain 1.
From the Research
Nerve Root Connection to the Heel
- The S1 nerve root is connected to the heel, as it innervates the muscles in the lower limbs, including those in the foot and heel area 2, 3.
- The S1 nerve root supplies the medial head of gastrocnemius, soleus, and abductor hallucis muscles, which are involved in heel movement and sensation 3.
- The connection between the S1 nerve root and the heel is important for diagnosing and treating lumbosacral and radicular pain, as well as for performing effective S1 nerve root blocks 2, 4.
- Anatomical analysis of the S1 neural foramen using three-dimensional computed tomography imaging has provided insights for effective S1 nerve root block, including the optimal fluoroscopic angle and safe puncture depth 4.
Muscle Innervation
- The L5 nerve root supplies tibialis anterior, extensor hallucis longus, extensor digitorum brevis, and the lateral head of gastrocnemius muscles, while the S1 nerve root innervates the medial head of gastrocnemius, soleus, and abductor hallucis muscles 3.
- Most muscles have a dual innervation, with one nerve root being dominant, but there can be variations in the pattern of muscle innervation by the L5 and S1 nerve roots 3.
Clinical Implications
- The connection between the S1 nerve root and the heel has implications for the diagnosis and treatment of lumbosacral and radicular pain, as well as for physiotherapy and spinal nerve root adhesion 2, 3, 5.
- Patients with spinal neuropathic pain, including those with scar tissue around the nerve roots, require special consideration and gentle, individually tailored exercise to avoid exacerbating their condition 5.