Today on the Doc On The Run podcast, we’re talking about foot pain that can truly be a pain in the butt.
Today we’re talking about referred pain and referred pain is pain that starts someplace other than where you actually feel the pain. And this does happen. You might feel the pain in your foot when you’re running. Even when you’re walking even when you’re sitting still and you think that it’s that specific spot that you touch on your foot where the pain is actually emanating from. So you think maybe you have a stress fracture there.
Maybe you have posterior tibial tendinitis there. Maybe you have tarsal tunnel syndrome or plantar fasciitis or some other condition that afflicts runners that really interferes with your ability to run and you think that trouble is actually in your foot.
Why is this important? Well, this is really important because sometimes you might have pain that is so convincing, and so localized to one particular spot, that a doctor talks you into surgery, and this episode actually comes from a discussion I had with a runner who’s had so much pain that she wound up in the operating room for what was basically an exploratory surgery that did not help at all zero, no improvement. Now obviously if you’re a runner and you haven’t been running for a year to a doctor tells.
If you’re a runner who’s been running for a year or two and a doctor actually tells you that you need to have surgery and then you go have surgery, but you don’t improve at all after the surgery. That would be really frustrating. And if you’re if you if you don’t have surgery, but you’re treating the condition, like the pain is in your foot, like it’s a tendon issue in your foot or a stress fracture issue in your foot, but it’s not getting better because it’s referred from someplace else that can be a real problem.
But how does this happen? Well, it’s really simple. If you think about this, you have nerves that go obviously from your brain all the way down to your foot. So from your brain, your spinal cord goes down and then the nerves exit through the foramen or little holes in the in between the vertebra or the sacrum and if it exits through in your sacrum bone down in your basically in your butt and an M tips down comes this one becomes the part of the sciatic nerve. You can have pain on the outside of your foot. If you have compression of the sciatic nerve in that area.
Basically deep to your all the muscles in your butt and so this can happen and if you look it up and you start researching sciatica and lateral column foot pain or those kinds of things, you might actually find something that mentions some a little muscle called the piriformis muscle. And piriformis syndrome is a thing that can actually cause pain in your butt but because it’s a band of muscle that goes across the sciatic nerve if it gets tensed and balled up and rubs on or irritates or compresses the sciatic nerve, and it happens to push on that nerve bundle. It goes all the way down and terminates in your foot. It can cause what seems to be foot pain. But it’s not foot pain. Its pain is coming from somewhere else.
I am not a back specialist don’t start sending me all your questions about back injuries because I don’t do that. But nerve root irritation or compression in the lumbar or lower sacral spine the lower back it actually can cause the sciatic pain to radiate all the way down your leg and into your foot and cause pain that’s from seemingly from running, but it’s not your foot. That’s the problem is that you don’t have to be treating an injury in your foot. When you’ve got this problem. You’ve got to treat the problem which might be compression of that S1 nerve root, which is classic sciatica. nerve roots can get compressed and irritated for lots of different reasons. And I’m not trying to tell you that I know how to treat all those things. I’m just telling you that if you have one of these weird things where you’ve had a foot injury, you’ve been treating it you’ve been trying to evaluate it.
You’ve been trying to figure out what’s going on and you’ve been trying lots of stuff or self-treatments that should theoretically help that specific problem in your foot and you’re not getting better. Maybe you should think about referred pain and if you do some stuff to evaluate it you go see a doctor and maybe they’ll have you do some stretching they’ll have you put your leg in a certain position. I’ll have you stretch the sciatic nerve or fire the piriformis or some of those other things to test and see. Does it reproduce your foot pain, because obviously, if you’re laying on a bed and you’re stretching your leg and then suddenly a pain in your foot, that’s not because of mechanical irritation of that particular structure in your foot that you might think is injured.
So if you have foot pain and it’s really a pain in the butt, it might literally be a pain in the butt. It could be referred pain. So talk to your doctor check it out. Make sure you get to the bottom of it so you can get back to running as quickly as possible.
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