Lumbar radiculopathy, commonly known as “sciatica”, is referred pain to the lower extremity due to injury or degeneration in the lower back. It may lead to pain, weakness, and numbness. People with pain in their feet often see an Orthopaedic Foot and Ankle Surgeon at some point during the course of their treatment to rule out any structural issues in the feet causing the symptoms. Examples of foot and ankle issues that may result in similar symptoms are nerve compressions in below the level of the knee. Sometimes, both areas may be causative.
Pain may be burning, knife-like, or pins and needles sensations.
When injury directly to the foot and ankle has been ruled out, the only course of treatment is direct intervention at the lumbar spine. These include nonoperative treatments such as anti inflammatory medication, core strengthening, and physical therapy, or may require invasive procedures such as injections or surgery. A spine surgeon will help you make the appropriate treatment choices based on the anatomy. The actual diagnosis is the cause of the compression of the nerve root such as a disk herniation, instability, or spinal stenosis.
Symptoms in the feet are caused by compression of the L4, L5, and S1 nerve roots. While the pain is experienced in the feet, the cause is compression of the nerve root at its start in the spine.
Neurons are nerve cells that begin in the spinal cord and send their sensory and motor branches through the neural foramina to their targets in order to send signals to and from the brain. Damage, disruption, or compression along that pathway at any point interrupts normal signaling and causes symptoms at the area that the nerve innervates. Imagine a hose is kinked near the faucet and no water is coming out at the end. It does not mean that the end of the hose is occluded or needs to be fixed; the solution is to unkink the hose at the portion where the flow is stopped. By doing so, water can flow through the length of the hose to the very end. In the same way, compression of a nerve root at the level of the spinal column causes symptoms to the feet that must be addressed in the spine.
When is a Foot and Ankle Surgeon needed for radiculopathy?
An Orthopaedic foot and ankle surgeon can help to rule out alternate diagnoses or combined problems. A foot and ankle surgeon can also recommend orthotics, physical therapy, or other treatments to address the symptoms in the foot.
In chronic cases of motor dysfunction, an Orthopaedic Foot and Ankle surgeon can assist with brace selection and modification. Sometimes, surgery can be performed to fuse joints or transfer tendons and allow for a more normal gait pattern.
When there is a foot drop (new onset weakness of the foot), a spine surgeon must be consulted immediately to minimize risk of permanent or worsening weakness. Please note also that anesthesia in the groin and loss of control of bowel and bladder function are emergent and require immediate evaluation by a spine surgeon. Proceed to the Emergency Department immediately if these occur.
References
https://orthoinfo.aaos.org/en/diseases–conditions/sciatica/
https://orthoinfo.aaos.org/en/diseases–conditions/sciatica/
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