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Sunday, January 13, 2013

Foot Nerve Pain: Does It Always Start in the Foot?

Yes, it was my birthday on 1/9. 

My great Medical Assistant Shawanna surprised me with a cake. 

This Standing AP Pelvic Xray shows that the right hip is 6 mm or 1/4 inch short with compression of the right L4/5 disc which can lead to pain in the nerve's distribution in the foot. 

See how the marker at L4/5 disc shows right side compression with lean of the lumbar spine to the right. This patient has Morton's Neuroma pain in the right foot in the 3rd metatarsal area, consistent with L 4/5 nerve pain.

The same patient above has a collapsed metatarsal arch also leading to possible nerve irritation at the foot level. The yellow line from the bottom of the 5th metatarsal to the bottom of the sesamoids should be the lowest points in the metatarsal arch. See how the 3rd and 4th metatarsal heads fall below this plane in your Plantar Axial Foot Xray. This patient could easily be irritating the nerve at the back and at the foot causing a "double crush syndrome."


  1. What should be done for this situation?

    1. Thanks for your comment. This particular patient benefitted by using lifts for the short leg and metatarsal supports for the foot pain. This is the mechanical support, and took several months of inserts, some trial and error, to get right. The patient is also doing core exercises for the back, and anti-inflammatory measures like ice packs and contrast baths for the foot. Rich Blake


Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.