Advice on Foot Care

The piriformis muscle is a small muscle which sits deep in the buttocks over the sciatic nerve. It’s action is to rotate the hip out (external rotation) and extend the thigh back. When the piriformis is tight, is in spasm or on stretch, it irritates the sciatic nerve, which send pain down the back of the thigh or into the back.

When the foot pronates (rolls in), it causes the leg and knee to rotate in (internal rotation), which causes the hip to rotate in (internal rotation). This places tension on the piriformis muscle, which will then irritate the sciatic nerve. Those with tight hamstrings and tight calf muscles will have more pronation, which causes more internal rotation and stress on the piriformis muscle. The tight hamstrings also place abnormal forces on the pelvis, which increases the stress on the piriformis muscle as well.

On a hike yesterday, someone with piriformis syndrome was complaining of pain when walking uphill. The pain was in the center of the left buttock and was a deep burning pain which occurred with hill climbing and walking on uneven terrain. Both of these activities will increase the amount of pronation in the feet, increase the internal rotation at the hip, stress the piriformis and irritate the sciatic nerve. When I asked if he had placed his orthotics in his hiking boots, the answer was no. Rigid prefabricated orthotics or custom made orthotics can be very helpful for not only foot problems, but also for knee, hip and back problems because they control the amount of internal rotation at the leg, knee and hip.

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