Piriformis Syndrome Heel Zapping Pain Downtown Toronto Podiatry and Foot Clinic

Piriformis Syndrome Heel Zapping Pain Downtown Toronto Podiatry and Foot Clinic

 

I have frequently experienced people coming into my office Downtown Toronto office with tingling, zapping, throbbing or shooting pain in the heel. It also can sometimes happen on the inside of the toe or the tips of the big toes. Whenever a zapping sensation is described, it is important to consider nerve involvement. 

 

Nerve anatomy 

There is a large nerve that comes from the spine and branches down the leg all the way to the foot. This is called the Sciatic Nerve. It is important to ensure if there is injury to this nerve it is not due to spinal injury. That is better distinguished by a physiotherapist or sport medicine Doctor, which we do have at our Downtown Toronto Foot Clinic. The other type of injury can happen from imbalance in the hip muscles that can lead to pressure on the sciatic nerve. That is better known as Piriformis Syndrome. When the body has imbalances it responds by other muscles getting tight and other can overwork.Other causes of injury to this area can be due to a traumatic event such as falling and landing on the buttock.  That again is something that should be examined by a sports medicine doctor. 

What is Piriformis Syndrome 

The sciatic nerve and the Piriformis both lie within close  anatomical position in the pelvis. When the piriformis gets tight, due to imbalances or injury, it can put pressure on the sciatic nerve, invoking nerve symptoms down the leg . 

Symptoms:

  • Chronic pain in the buttock and hip area.
  • Pain when getting out of bed.
  • Inability to sit for a prolonged time.
  • Pain in the buttocks that is worsened by hip movements. This can happen in runners as well as running requires repetitive hip movement. 

Other Symptoms Clinically 

The FAIR test is a sensitive and specific test for detection of irritation of the sciatic nerve by the piriformis. FAIR stands for flexion, adduction and internal rotation. This test can be performed to see if symptoms are provoked. Passive hip abduction and internal rotation may compress the sciatic nerve, reproducing pain (a Freiberg sign) can be performed by a physiotherapist or a Sport Medicine Doctor.  

Sometimes bending of the hip with the leg straight can also cause symptoms

Treatment

If it has been determined your foot pain is coming from a branch of the nerve, it is best to seek care from a Physiotherapist or a Sport Medicine Doctor. They can examine other areas such as the hip and spine to help determine what is going on with you.

Initially, heat and stretching of the piriformis muscle is recommended. The piriformis can be stretched with hip internal rotation above 90 degrees of hip flexion and with external rotation below 90 degrees of hip flexion. Strengthening of the hip abductors, in particular the gluteus medius, should be emphasized. Isolated exercises include those that strengthen the hip abductors.  The gluteus medius may also be isolated with lunges, side step lunges and lunges with a change of direction. 

 

If pain is very debilitating there is the option of seeing a sport medicine physician for Ultrasound Guided Injection Therapy.

Nerve pain can be a complex condition and a reminder that foot pain can be caused from other anatomy parts and not just the foot.

 

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