The purpose of this article is to emphasize that there are many spinal conditions that may cause leg pain, foot pain, and other lower extremity symptoms. Most successful treatments are based upon having an accurate anatomic diagnosis for the basis of a specific pain syndrome. Spine care professionals are particularly well suited to oversee the diagnosis and treatment of these situations.
Low back conditions that are common causes of leg pain and/or foot pain are outlined below.
Lumbar Degenerative Disc Disease
As we age, our intervertebral discs dehydrate (lose water), degenerate, lose their flexibility and allow small movements, which can cause pain from the disc that may radiate down the leg. While the primary symptom of lumbar degenerative disc disease is usually low back pain, leg pain and foot pain are also common symptoms. When lumbar degenerative disc disease presents with leg pain and/or foot pain, this is called “referred pain”. Another common example of referred pain includes neck/arm or shoulder pain caused by heart attacks. The brain cannot always distinguish exactly where the pain source is, and so feels pain more vaguely in multiple areas. Referred pain is typically dull, achy, and poorly localized.
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Leg pain from degenerative disc disease can also result if the nerve root is compressed. This happens because as the disc degenerates it shrinks and moves, and as a result, there is not as much room for the nerve roots. This is also known as foraminal stenosis. Leg pain from a compressed and inflamed nerve root is typically shooting and electric. See also:
- What is Degenerative Disc Disease?
- Living with Degenerative Disc Disease
- Lumbar Degenerative Disc Disease (DDD)
- Exercise for Sciatica from Degenerative Disc Disease
Lumbar Herniated Disc
A disc herniation tends to put pressure on the weakest spot in a disc, an area that happens to be right under the nerve root. This results in pain that can radiate all the way down the sciatic nerve throughout the patient’s leg and into the foot. Depending on the nerve root affected, other nerves (beside the sciatic nerve) may also be involved. Symptoms of a lumbar herniated disc tend to vary depending upon where the disc herniation occurs. There is a wide range of non-surgical treatments that can alleviate leg pain for the majority of types of herniated discs. For severe pain or disability, a microdiscectomy (or micro-decompression) surgery to remove a portion of the disc can relieve the pressure on the nerve, which allows the numbness to subside as the pinched nerve heals. See also:
- What's a Herniated Disc, Pinched Nerve, Bulging Disc...?
- Insights and Advice About Herniated Discs
- Treatment Options for a Lumbar Herniated Disc
- Exercise for Sciatica from a Herniated Disc
Lumbar Spinal Stenosis
Spinal stenosis in the low back occurs when the spinal nerve roots are compressed or choked, usually by enlarged facet joints located in the back of the spinal column. Spinal stenosis usually, but not always, occurs in elderly patients as the facet joints enlarge due to degeneration of the spine that tends to occur with age. The narrowing can be confirmed with an MRI scan. The symptoms of spinal stenosis are often referred to as sciatica - leg pain, radiating pain, tingling, leg weakness and/or numbness. Doctors usually use the words radiculopathy or radiculitis to describe the same symptoms.
The leg pain from stenosis tends to develop gradually over time (mirroring the cumulative narrowing process taking place in the spine as the facet joints enlarge). Spinal stenosis symptoms tend to improve when the patient leans forward, a position that has the effect of opening up the back of the spinal column, taking pressure off the spinal nerve roots. See also:
- Lumbar Spinal Stenosis: A Definitive Guide
- Exercise for Sciatica from Spinal Stenosis
- Spinal Stenosis Symptoms and Diagnosis Video
Spondylolisthesis occurs when a vertebra in the spine slips forward over the next, lower vertebra, compromising the natural structure of the spine segment as well as its stability and flexibility. The resulting instability can lead to a nerve being pinched, which causes leg pain. Many patients find pain relief through a combination of physical therapy and rest during episodes of acute pain, although significant instability and persistent pain may be treated with fusion surgery. See also:
- Spondylolysis and Spondylolisthesis
- Isthmic Spondylolisthesis
- Degenerative Spondylolisthesis
- Exercise for Sciatica from Isthmic Spondylolisthesis
All symptoms of leg pain caused by the conditions listed above are often referred to as sciatica. This is because the pain often radiates along the sciatic nerve, which originates with certain nerve roots in the low back and runs through the back of each leg into the foot. Sciatica can present as either a constant pain (usually in the buttock) or a shooting pain through the leg. See also:
It is likely that a more accurate diagnosis of the cause of the patient’s pain will be made if the patient is able to provide clear information about the nature of their pain and symptoms.
Clear, descriptive terms that will help inform an accurate diagnosis include the following:
- Position or path of the pain as it radiates down the leg
- Body position when pain occurs
- Sensation (e.g. aching, tingling, shooting, lancinating, burning pain)
- Frequency (e.g. occasional, getting more frequent, constant)
- Description of what makes the pain feel better or worse
This information, as part of a comprehensive patient history, combined with a physical exam and diagnostic tests (such as CT Myelography, MRI scan, etc.), allows a spine specialist to more accurately isolate the probable causes of spine-related leg and foot pain and outline potential treatment options.