Heel Pain Sciatica and Piriformis Syndrome Downtown Toronto Podiatrist and Physiotherapy
Sciatica can be a debilitating and frustrating condition. Sciatica can manifest in many ways in the lower extremity. Did you know that sciatica can present as a tingling, numbing, burning or zapping sensation in the foot? Pain can be in the heel region or along any path that the sciatic nerve runs. It can present near the achilles on the outer side of the heel, the plantar heel, sole of the foot or even in the great toe! Along with foot pain manifestations, this nerve injury can present along the buttock, hamstring and calf!
It is important to note that sciatica can come from either the back or the buttock. Which is why it is important to rule out which is which. Nerve pain stemming from the back may include asymmetries of the pelvis, particular movement from the back can elicit symptoms. In an L5 or S1 radiculopathy, forward flexion of the back while standing is equivalent to a straight-leg raising test and may produce pain in the buttock or posterior thigh. In an L4 or L3 radiculopathy may produce groin or anterior thigh pain. These conditions usually manifest in weakness of the foot and lower extremity which can alter gait mechanics.
This article will focus on sciatica pain that is due to the piriformis, also known as piriformis syndrome.
What Is Piriformis Syndrome
This is a condition which is due to tightness of the piriformis muscle. This muscle is an external hip rotator and can be overworked when the muscles surrounding it are not functioning properly. The piriformis muscle is compressing the sciatic nerve, resulting in a sciatic neuropathy. It is controversial the root cause, however when the piriformis is tight it can iterate the sciatic nerve.
Piriformis syndrome may manifest with buttock pain with or without pain going into the leg. Sitting on hard surfaces will exacerbate the symptoms of pain and occasional numbness and paresthesias without weakness. This may be seen in chronic as well as in acute situations. Activities that produce a motion of hip adduction and internal rotation, such as cross-country skiing and the overhead serve in tennis, may also exacerbate the symptoms.
Tests
Passive ( meaning the examiner) flexes the hip into adduction and internal rotation, which elicits pain due to compression on the nerve, a positive as Freiberg sign.
Muscle Function Testing of active abduction and external rotation can elicit pain or demonstrate functional weakness and that is named a Pace Sign.
A Straight Leg Test, may also eliciit symptoms of this condition.
Signs
Some signs one may be suffering is prolonged sitting. Exercises the require single leg stance or adduction and internal rotation of the leg can also aggravate this condition.
Acute Treatment
Includes anti inlammatory medication for nerve inflammation and heat therapy to loosen up the priformis muscle. Muscle relaxants may also help to relax the tight muscle. Stretching the piriformis is also suggested as well as using soft cushions for prolonged sitting.
Rehabilitation
Once the acute pain has reduced, genies rehabilitation should be introduced. This includes strengthening the hip abductors, specifically the glute medius muscle. This muscle is important in single limb stance in many walking and running motions. It is important to note that effective activation of this muscle is to internally rotate the foot, to isolate internal hip strength.
More functional rehabilitation of Piriformis is to do a single leg dead lift of little range of motion. Hold the weight in the contralateral hand (the opposite side from the affected leg) and do a slow hip hinge. This will also help to isolate the glute medius. This can be done for multiple reps to four on endurance as this muscle does function in running and walking as an endurance muscle. Training it to be fatigue resistant will help it from becoming weak while running and walking.
If you are suffering from heel pain, make sure you see a medical professional to rule out Sciatica and Piriformis Syndrome. At InStride, we believe in a holistic approach to foot pain.
