THERE are many causes of pain in the foot. Some are due to local problems around the foot and leg and others are sometimes caused by problems with the lower back. Patients who have foot problems due to spinal issues will usually experience pain in the leg and thigh; foot pain, without associated leg pain is rare if the source is the spine.

To understand how lower back conditions may be the source of foot pain we need to discuss the sciatic nerve. The sciatic nerve is composed of 5 nerves that join together in the lower spine. The nerve splits and extends down each leg, branching off until it reaches the toes. If the sciatic nerve becomes impaired in any way a series of symptoms may manifest in the form of neurological pain or disturbance.

One condition is described as a herniated lumbar disc. This occurs when a disc’s inner core pushes or leaks out through its outer core. This will put pressure on the nerves root and may cause pain to radiate down the sciatic nerve to the foot. Symptoms will vary according to which disc is herniated. Patients may feel tingling, numbness, burning, sensitivity, or pain.

The second condition that can cause sciatic pain is lumbar spinal stenosis. This refers to the spinal nerve root being compressed which may lead to muscle weakness, numbness and tingling sensations in the leg and foot.

Sponylolisthesis is another condition where one vertebra slips over another thus compromising the spine segment and potentially leading to pinching of the nerve and this also can cause pain to travel down to the foot.

Osteoarthritis in the lumbar region can also cause sciatica. Bone spurs can form as they try to stabilise the arthritic joint. This can lead to entrapment and irritation again causing foot pain.

During pregnancy many women suffer with sciatica due to the pressure on the spine.

Muscle spasms in the back or buttocks may also cause sciatica.

Treatment

1. Anti-inflammatory medication and muscle relaxants.

2. Chiropractic care which will work on manipulation of the spine and surrounding structures.

3. Orthotic shoe devices that will realign the body to alleviate symptoms.

4. Massage therapy

5. Yoga

6. Exercise and physiotherapy

7. Epidural steroid injections

8. Surgery: This is usually considered if a patient has had unremittent symptoms for about 6 weeks and all other treatments have been exhausted.

The real lesson here is to note that just because the pain is felt in the foot, that may not be the root or source of the problem. We must look at the human body holistically.