If you have pain on the bottom of your foot, it is common that the source is a pinched nerve in your low back. As this image shows, nerves L4, L5, and S1 send signals to the foot. You can have a compressed nerve that does NOT create back problems, but instead creates pain, numbness, or tingling on the bottom of the foot. The plantar fascia is connective tissue on the bottom of the foot, which, when tight, can also produce pain on the bottom of the foot. A McKenzie clinical evaluation diagnoses the true SOURCE of the problem - which leads to an individualized treatment plan.
Last night was a great night! Runner's Depot in Davie hosted my presentation on the spine and how it relates to running injuries. Runners have a reputation for having a lot of injuries and, worse, a lot of recurrent or persistent injuries. The crux of my talk is that a lot of injuries in the lower extremities are misdiagnosed as local injuries and not correctly as injuries originating from the nerves in the lumbar spine. For example, plantar fasciits is commonly misdiagnosed. Yes, it exists, but not as frequently as it is diagnosed. The hallmark sign of plantar fasciitis is extreme foot pain with first steps in the morning. That usually eases throughout the day, but returns each morning since the plantar fascia is on slack all night as you sleep and is then stretched with your first steps out of bed. If that sign is present, I still investigate the spine to rule it out. But when that hallmark sign is absent (for example, the pain is variable throughout the day or week), the diagnosis of a lumbar spine injury is more likely (or another diagnosis). More specifically, a nerve may be being hit or pinched in the lumbar spine and producing pain along the part of that nerve in the foot. IT band issues, patellar tendonitis, hip labral tears, and meniscal damage are a few other pathologies that come to mind when I think about regularly misdiagnosed injuries. Irritated nerves from the spine can produce pain in any area of the lower extremities and must be ruled out in the decision-making process. And remember, just because something is on an x-ray or MRI does not mean it is causing your symptoms. Images are full of problems in people without symptoms so a clinical diagnosis, in which structures and tissues are individually stressed, is needed.
I don't think that spine injuries are more prevalent in runners; nearly everyone will have a spine injury at some point. We just need to be able to diagnose them correctly when they do exist. That way, runners, like everyone else, can get back to doing what they love to do as soon as possible! --Laura
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