The Basics of Foot Pain

 

foot ankle painThere are many causes of foot pain, but not all pain in the feet arise from the foot and not all foot pain occurs as a result of an injury or trauma. Sometimes, pain in the foot occurs as a result of a problem in the lower back. Many patients with back disorders will have nerve root compression (pinching of nerves), which results in pain radiating down a nerve to be perceived as foot pain.

Symptoms associated with Foot Pain

Depending on the diagnosis, foot pain can be in the toes, the long bone region (tarsals), the bottom, or the heel. Pain of the foot can be related to walking, or it can occur at rest. Also, if the spine is diseased, specific types of foot pain symptoms arise, such as:

  • Foot heaviness or weakness – Also called foot drop, this occurs due to a diseased or damaged spinal nerve root of the lower back. The foot may feel weak or heavy, which makes it difficult to flex the ankle and bring the top of the foot upward. Foot drop is related to the fifth lumbar vertebra nerve, and it produces a pain that radiates down the outer region of the calf and over the top area of the foot.
  • Inability to bring the foot upward (heel walk) – This is characterized by a restriction of ability for bringing the foot up. This may be accompanied by numbness in the lower mid-leg region and foot. Heel walk often occurs if a spinal nerve root that innervates the sciatic nerve is affected.
  • Difficulty walking on tiptoes – The bottom of the foot hurts when the sciatic nerve is affected. This contributes to weakness of the gastrocnemius muscle, which makes it difficult to walk on the tiptoes, drive, or raise the heel off the ground.

Foot Pain and the Sciatic Nerve

The sciatic nerve runs down the back of each leg, and extends all the way to the toes. Composed of five nerves that join at the lower spine, this nerve connects the spinal cord with many muscles of the leg and foot. When the sciatic nerve is injured, compressed, or inflamed, a series of symptoms called sciatica occur, and this results in leg and foot pain.foot pain

Conditions of the Low Back that Cause Foot Pain

  • Herniated lumbar disc – This occurs when the inner portion of the cushion (disc) between the vertebrae pushes or leaks out. The material inside the disc irritates or puts pressure on the nerve root, and this can radiate down the sciatic nerve into the foot.
  • Lumbar spinal stenosis – When the spinal nerves are compressed from degeneration of the vertebrae and discs, it can lead to referred foot pain and numbness, weakness, and tingling of the foot.
  • Spondylolisthesis – This condition occurs when a vertebra slipping over the one below it. When this happens, the spine segment is compromised, which leads to a pinched nerve causing pain down into the foot.

Injection Therapy for Foot Pain

There are three types of injections used for foot pain. These include:

  • Injection of a steroid – Steroid injections are used as anti-inflammatory agents for painful joints, bursitis, nerve conditions, painful trigger pints, and post-operative scars. Steroids work by reducing inflammation and lessening the bulk of soft tissue in the area being treated.
  • Injection of silicone – Called an Innopad, medical grade silicone is used to introduce a padding into a specific foot area. This is done due to loss of fibro fat padding of the sole, painful corns, or persistent metatarsalgia due to foot deformity.
  • Injection of hyaluronic acid – This injection is used to introduce an artificial lubricant into the joint to buffer the painful area.

Injections for Foot Pain related to Spine Problems

  • Epidural steroid injection
  • Lumbar sympathetic nerve block
  • Facet joint injection

Resources

Spine Health (2014). Foot Pain Symptoms. Retrieved from: http://www.spine-health.com/conditions/leg-pain/foot-pain-symptoms

Mayo Clinic (2014). Foot Pain. Retrieved from: http://www.mayoclinic.org/symptoms/foot-pain/basics/causes/sym-20050792