Mark W. McFarland, DO
When I consult with patients about their spinal conditions, I often see them for pain which occurs in their limbs, shooting down an arm or a leg, perhaps even into the foot and toes. These patients are typically surprised when, after x-rays and a thorough physical examination, I tell them that I suspect their pain is caused by a spinal issue. In this article, I will discuss the phenomena of referred pain and how it is commonly seen with disorders of the spine.
First, let’s talk a bit about human anatomy. Our spine is composed of 26 vertebrae and houses the spinal cord – the major communications wire from the brain to the rest of the body. Nerve roots emerge from the spinal cord and travel down the limbs so that the brain can tell every part of the body how to function and move.
So, can your foot pain be caused by a spinal issue? Absolutely! Sometimes, it’s hard to make sense of a foot that is throbbing, aching, feels like it is on fire or has electric shocks running through it, when you can’t see any injury to it and know that you’ve done nothing to harm the foot itself. However, the pain can be caused by an injury, irritation or inflammation to a nerve root that originates from your spinal cord, exits through your spinal column of boney vertebrae and travels down your leg to your foot.
What can injure or irritate a nerve root in your spine, you may ask? It could be a traumatic accident, like a sports injury or a car crash, but it could be something as simple as a twisting motion when picking up a box or a bunch of microtraumas over time. Nerve roots can also be compressed by bulging or herniated spinal discs, bone spurs, or spinal stenosis, which is a narrowing of the spinal canal.
Thankfully, inflamed nerve roots of the spine, which cause foot pain, can be treated conservatively at first, with oral medications, ice, heat, or both, topical rubs or creams, Physical Therapy, activity modification and perhaps even bracing.
If those don’t work, we can try an epidural steroid injection, which will allow me to place steroid medication right next to the irritated nerve root. I use live x-ray, called fluoroscopy, and contrast dye, to ensure that I get the medication in exactly the right spot for the best effect on your foot pain. This epidural is not like the one’s given to pregnant women in the delivery room and won’t make you go numb and lose feeling from the waist down. The medication typically takes a few days to work, but some people get months or even a year’s worth of relief from the injection.
If your foot is still hurting, there may be more going on than meets the eye. I will order an MR scan, so that I can better visualize your spine and the soft tissues around it. I may see a bulging or herniated spinal disc which is pressing on the spinal nerve causing the pain in your foot. There could be osteophytes, a fancy word for bone spurs that have grown, which are pressing on the nerve. You may have developed spinal stenosis, which is a narrowing of the spinal canal, which also could be impinging on the nerve. These problems can be managed without surgery; however, surgery could be the best treatment option if we can’t get pain relief any other way.
You and I will discuss the best treatment options for you, based on your work, your activity level, lifestyle and what you want to do, moving forward. Together, we’ll come up with a plan to get your foot feeling better, as well as addressing the root cause of the problem in your spine.
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