Foot Nerve Pain can come from the Back: And it is alittle confusing!

https://youtu.be/E0E60NpOSHg

As a podiatrist, I deal with pain all the time. The 3 types of pain with sometimes different treatments are mechanical pain (produced by mechanics or treated by mechanical changes), inflammatory pain (caused by inflammation or treated with anti-inflammatory measures), and neuropathic pain (caused by nerve problems or treated with neuropathic treatments). The article below is very good explaining how a disc herniation or bulge can affect the nerves into the foot, and that there is some innervation cross over. This cross over means that the same problem can actually affect 2 nerves, not one as my video describes. It is because at each disc level there is an exiting nerve and transversing nerve. For example, at L4L5 disc, the disc between the vertebrae lumbar 4 and vertebrae lumbar 5 has L4 nerve root exiting and L5 nerve root transversing (and will exit at the L5S1 disc). And, just to make matters even more confusing, a disc herniation on one side can give you symptoms on the other side. When I am talking to patients about their right foot pain for example, I always ask if they have sciatica or low back pain, and other spinal cord symptoms. So many patients that have nerve pain in one foot, have all their back symptoms on the other side. I wish I could tell you the percentage, but it is not rare. I hope this video, and article, will give you a better idea of how this process works, but it is so important in the treatment.

https://www.spine-health.com/conditions/spine-anatomy/radiculopathy-radiculitis-and-radicular-pain

Achilles Pain: Possibly from the Low Back

Hello Dr. Blake.

 I attempted to post this as a comment in your blog, but I was unsuccessful. I hope that this email finds you well. I have been dealing with achilles pain since March. I believe it started because I was putting all of my weight on my heels when doing the elliptical, to avoid stressing an injury I have on my forefoot. I have tried PT and it did not work, the therapist kept telling me that all the exercises that make patients better were working the opposite on me-making me worse. The exercises included the type on your blog, the eccentric calf exercises. No negative heel drops. I am wondering if I have no relief because I have an over stretched tendon. The calf stretches and exercises replicate my pain, I have no relief from them. The pain that I get is exactly the pain created when I bring my entire foot upward toward my body (picture a negative heel stretch but without weight bearing). I had an MRI which showed a normal tendon, with some non specific swelling at the heel. The pain started bilaterally, but now, the right side is much worse and the left has improved. I have completely rested from all activity for months. Still nothing. Heel lifts work a little. I can't even sleep on my back because my own body weight is enough to cause pain on my heel. Could you please share some thoughts on treatment of an over stretched tendon? Thank you so much! You are an amazing resource.

Dr Blake's comment:

    You could have an overstretched tendon that the PTs should be able to measure, but it sounds like radiculopathy which is localized nerve pain below the low back. Stretching of the hamstrings and calf make radiculopathy worse. Sometimes, MRI of the back can help. I would see a chiro or physiatrist to help the PT develop a plan. When you held your heels back, you probably also could have hyperextended your knee causing the problem. Any postures, movements that effect the sciatic nerve can effect this problem. Try ice packs 2 times daily to the low back and neural flossing 3 times a day (seen on my blog), but avoid calf and hamstring stretches for the next 6 weeks. Keep me in the loop. Rich