July 24, 2022

Pain in the Foot and Up the Leg? Here are the Possible Causes

Written by: Marina Peric, M.D.

Foot and leg pain is a common problem, especially in those whose jobs involve a lot of standing, or who enjoy a physical activity that involves running on hard surfaces and jumping. It is often temporary and not a cause for concern. However, it can also be a sign of a more serious condition or injury.

Did the pain develop all of a sudden or gradually over time? How intense is it, and what is it like? Is it constant or occasional? These are important questions to consider when dealing with this problem.

If the pain is intensive, prolonged, followed by redness and swelling, or daily activities limiting, do not hesitate to seek out a medical professional! Meanwhile, learn about some possible causes of foot pain and pain radiating up the leg.

 

Foot Tendinopathies

Injuries of the foot tendons are among the most common, but most difficult to treat sports injuries. They are common in the Achilles, peroneal, posterior and anterior tibial, and flexor hallucislongustendons.

These tendinopathies develop from overuse, i.e. physical activity that is inadequate in intensity, duration, or frequency, or when the recovery period after physical activity is not long enough. The result is inflammation, which leads to tiny changes in tendon structure and tendon weakening, accompanied by pain and swelling.

Mild injuries can be treated with the RICE approach: Rest, Ice, Compression, and Elevation. Additionally, over-the-counter analgesics, preferably acetaminophen, can be used to ease the pain. More severe tendinopathies are treated by physical therapy, surgery, or more advanced modalities of conservative therapy, all of which require a doctor’s detailed examination and assessment.

 

Flat Feet (Pesplanus)

Pesplanus, or flat feet, is a common deformity in which the arch of the feet is lost, so the inner portion of the sole lies directly on, or near the ground. The deformity can be inherited, in which case it tends to improve over time, or it can be a result of an injury, or a medical condition such as arthropathy, obesity, or diabetes. It is estimated that 20-37% of the population has a certain degree of flat feet.

The arch of the feet is a flexible, springy base for the body, which absorbs mechanical energy from hitting the ground during walking, and especially running or jumping, and uses it to facilitate these activities. When the arch is missing, the biomechanics of the foot, legs, and the whole body is impaired – the shock waves from hitting the ground with each step strike the foot directly and are transmitted up the leg. This causes pain in the feet in the first place, but also shin splints, knee and/or hip pain, and even lower back pain!

Patients with flat feet are usually used to some degree of constant discomfort during physical activity. Pain, on the other hand, should be a reason to visit a doctor’s office. For adults, treatment usually involves orthotics and/or adequate footwear, lifestyle changes such as weight loss, and, if the pain is intense, non-steroid anti-inflammatory drugs (NSAIDs) for its management.

 

Cavus Feet (Pescavus)

As opposed to flat feet, pescavus is a foot with a very high arch. It can be an inherited foot deformity present from birth or a sign of neuromuscular disease such as Charcot-Marie-Tooth. In the latter case, the symptoms are usually more versatile, more severe, and progressive. Pescavus is sometimes accompanied by toe deformities, such as hammertoes – toes in which the joints closest to the foot are flexed and strike up while the rest of the joints are extended, or claw toes, where all the toe joints are clenched.

The specific foot position and support lead to the instability of the foot and ankle, and pain that is not limited to the foot, but extends up the leg as leg muscles have to compensate for the foot deformity to enable normal standing and walking. Blistering and calli on the soles of the foot are also commonly seen.

Cavus feet require orthotic and surgical treatment and should be assessed by a neurologist and/or orthopaedist.

 

Tarsal Tunnel Syndrome

The tarsal tunnel is a narrow space between bones and ligaments of the foot, located near the inner side of the ankle, through which the foot muscle tendons and blood vessels run, as well as the posterior peroneal nerve. The tarsal tunnel syndrome is a rare condition that develops when this nerve gets compressed within the tarsal tunnel.

The reasons for this to happen are diverse and usually easy to detect. They include trauma, scarring, diseases of joints and tendons, systemic diseases, varicose veins, cysts and tumors of this region, and many others.

The main symptom is foot pain, which spreads along the projection of the entrapped nerve, and can be difficult to precisely localize. This pain usually worsens during physical activity and improves after rest. The sensation is also disturbed, either because it is diminished, or/and because there is a tingling or burning sensation in the affected foot. Over time, foot muscles weaken and atrophy.

To solve the problem, the cause of nerve compression must be discovered and properly treated. Treatment can include medications, orthotics, specific footwear, physical therapy, corticosteroid injections, and surgery.

 

Spine Problems

Lower spine problems, such as herniated discs, degenerative disc disease, or spinal stenosis, can cause pain that radiates from the lower spine down the leg and foot. This pain is usually present only on one side of the body, and it worsens with coughing, sneezing, or bending. Sometimes a burning or tingling sensation is also present, as well as a feeling of a “heavy” leg.

Mild symptoms are usually not a cause for great concern but should be assessed by a doctor to determine the best treatment approach. Loss of bladder or bowel control, numbness in the affected leg, and/or muscle weakness/paralysis, require urgent medical attention!

Other conditions, such as blood vessel diseases or nerve damage, can be a potential cause of foot and leg pain too.

 

References

  1. Simpson MR, Howard TM. Tendinopathies of the foot and ankle. Am Fam Physician. 2009;80(10):1107-14.
  2. Raj MA, Tafti D, Kiel J. PesPlanus. [Updated 2022 Feb 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430802/.
  3. Wicart P. Cavus foot, from neonates to adolescents. OrthopTraumatolSurg Res. 2012;98(7):813-28.
  4. Kiel J, Kaiser K. Tarsal Tunnel Syndrome. [Updated 2022 May 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513273/
  5. Davis D, Maini K, Vasudevan A. Sciatica. [Updated 2022 May 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507908/
Article written by Marina Peric, M.D.
Marina is a medical doctor from Belgrade, Serbia. She graduated with high honors in 2020 and is aspiring to become a pathologist. During her studies, she took part in several scientific researches, mostly in the pharmacology niche. She was also an assisting teacher at the Department of Histology and Embryology for 5 years (2015-2020). Marina has years of experience as a writer on health-related topics. Apart from English, she fluently speaks several languages, including Spanish, Russian, and Czech.

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