Can foot pain and hip pain be related?

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I edited the emails for brevity and I’ve bolded what I deem most important. From an email exchange:

“Brian,

Seriously. Your Blog is awesome. I found you last night while searching for TFL stretches, which in fact, truly is the Best stretch. Kudos to you.

I just finished reading your article on lateral pelvic tilt. I suffer occasionally from right foot pain. It goes away with stretching ‘something’ on my right lateral trunk. When I hit the ‘sweet spot’, hip pain goes away, thigh pain goes away, and best ever, foot pain goes away. I also feel like I can breath deep into that area when its released, as well as sit up straight.

Now, I wish I could be the person that just says, ‘welp, good, it’s gone’ and move on. But I’m a Physician Assistant, in medical, obviously, and anatomically speaking, am dying to figure out what the problem is to begin with, so it doesn’t happen yet again.

I’m curious as to what insight you might have on this. I was thinking quadratus, and maybe lower lat both pulling and pinching at the waist. I don’t know. You talk a lot about external obliques. Could that be the issue as well?

Thank you in advance for any insight!

Jennifer”

I then asked Jennifer for a little more info,

I’m starting to wonder if my quads are the issue + stooping to write in charts all day. In essence, something anterior, not posterior?

And some more,

I always have ‘some degree’ of hip and back pain. Nothing usually long standing. That’s been gone now for the past 24 hrs or more. The foot has been bothering me (eeeek) since August, 3 months after purchasing a treadmill. Which I use at a level 4 incline, 4.5 MPH, at least an hour a day.

I bike as well, about 100 miles per week.

I’m not always pain free barefoot, but more so than with shoes.

Oh, and the stretch I did that gave me the greatest relief? Weird I know, but I leaned back against a wall and did a pelvic tilt and stretched forward with my arms. 

Ok, yes. I was running up a hill, maybe 6% grade(?), steeper than I usually use on my treadmill. I felt a sharp stabbing pain R forefoot, 3 or 4th metatarsal. I stopped, and felt a painful ‘knot’ in that area every time I took a step.

I’ve always had a ‘stiff’ R upper back/lat that I attribute to my work.

I don’t recall any worsening of my ‘usual’ back pain at that time, although I remember feeling as if the whole R side of me was just locked together, like how myofascial therapists describe fascial pain and tightness.

For example, I swore that every time I raised my arm over my head I felt pain and a tightness down to my toes.

Ok, so there is a lot going on here. Really, without seeing someone like this, I’m making guesses. However, for fun, I’m going to run with it. Even with guessing I think I can give some insight.

How the feet and hips are connected

Watch this video. First, watch the knees, then watch the feet.

Notice how the knees are rotating inward, then outward, AND when the knees rotate the feet reciprocate?

That is, when the knees medially rotate the feet tend to pronate; when the knees laterally rotate the feet tend to supinate. Watch the video a few times and you’ll see it.

Now, watch what is going on with the hips during this:

There tends to be a relationship between the position of the hips and the position of all the joints below.

Specifically, if the hips rotate forward (anterior pelvic tilt) the knees tend to medially rotate and the feet tend to pronate.

If the hips posteriorly tilt then the knees tend to laterally rotate and the feet tend to supinate.

These aren’t guarantees, merely tendencies. For instance, while the above person tends to compensate with rotation, the following person compensates more with hyperextension at the knees.

While there is little rotation here,

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There is plenty of hyperextension here,

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When the feet tend to hurt

The more common of the two sequences I just went over is far and away: Hip(s) rotated forward – > Knees medially rotated -> Feet pronated. (As opposed to the opposite sequence of Hips rotated back -> Knees laterally rotated -> Feet supinated.)

And when the feet pronate too much is when they tend to hurt.

It’s important to mention here both limbs don’t have to follow this. That is, the right (or left) side may be the side where there is a rotated hip, knee and foot, while the other side may be ok.

If you look at this video again you’ll notice the right leg (left in video) rotates more than the left.

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It’s also important to mention while this sequence of hips -> knees -> feet can happen, feet -> knees -> hips can also happen. Bringing us to,

Being barefoot mitigates things

One explanation for your relief while barefoot is being barefoot makes a person much less likely to rotate the foot.

Think of it this way, are you more likely to sprain your ankle stepping near a curb or on completely flat ground? The curb, of course.

Why is this? The curb essentially gives the foot / ankle room to “roll over.”

This is because the foot has become elevated. In other words, it’s much harder to roll over flat ground than to roll over a curb.

Think of wearing shoes as putting your foot on top of a curb, except in this case instead of the foot potentially rolling out, it potentially rolls inward.

Put simply, being barefoot you’re less likely to overpronate your foot. It can certainly still happen, but typically to a much lesser degree than while wearing shoes. Especially if you wear shoes with a significant heel lift or cushioning. 

Bringing us back to the hips

As you mentioned, you seem to get some relief when doing certain things for the hips. One of those things is standing up nice and straight and or posteriorly tilting the pelvis while on a wall.

If, again I’m making assumptions here, you’re someone with the aforementioned hip rotated / tilted, knees inward, feet pronated, you now have a possible explanation as to why doing certain hip movements alleviates your foot: Putting the hips in a certain alignment may put your feet in a certain (likely better) alignment.

Some anatomy for you

Since I know you’re curious as to what specific anatomy could be influencing things, I figured I’d delve in a bit.

I’m going to have to take your word you’re tight in the latissimus dorsi / lats. Specifically the right lat.

Everyone always talks about the lat relative to the shoulder. It extends, adducts and medially rotates the shoulder. But, the lat also plays a crucial role in the lower back.

By pulling on the lower back the lat can extend the lower back and anteriorly tilt the pelvis. If only one side is doing this, then some rotation at the lumbar spine and pelvis can occur as well.

If you look closely at the shirt lines on the above person, you can actually see them beginning to resemble the line of pull of the lat,

You mentioned issues when lifting your right arm; what does lifting the arm do to the lat? Stretches it (potentially). If you’re stretching an overactive lat you could end up pulling the lower back into extension and possibly rotation. See the lower back in this video

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(Ideally the lower back remains flat against the wall. However, by coming off the wall the lat is being stretched distally BUT NOT proximally. Negating the overall stretch.)

If the external oblique on the same side (right) can’t counteract the pull of the lat, the pelvis will anteriorly tilt and rotate.

Putting the tensor fascia latae (TFL) in a shortened position,

Making it more likely the knee will medially rotate (as the TFL can play a role with internal rotation of the knee); making it more likely the foot will overpronate.

Which makes it more likely you’ll have issues at the foot.

Because, in terms of an anatomical connection to the foot, by the foot excessively pronating the peroneals are put into a shortened position; the peroneals connect to the bottom of the foot.

If a particular muscle is constantly pulling on the bottom of the foot, pain at the bottom of the foot can be present.

Treadmills

Something else to consider is the extensive use (you mention an hour a day) of a treadmill.

Keep in mind by the nature of a treadmill the body isn’t doing the same type of work when bringing the leg backwards. (The tread has influence in how the leg is brought back.)  However, the body is still doing it’s normal amount of work when bringing the leg forward. (If not more.) [1]

In anatomy speak, when running on a treadmill you aren’t using your hip extensors as much but you’re using your hip flexors as normal / more.

Theorizing: It’s possible the extensive use of the treadmill has led to you having stronger hip flexors than hip extensors.

Let’s say you’ve developed your TFL (hip flexor) more than your posterior glutes (hip extensors). The TFL internally rotates the knee, the posterior glutes laterally rotate the knee. (See the videos again above if necessary.)

So, if the TFL has become a bit too dominant this could cause your knee to excessively medially rotate…which could cause your foot to excessively pronate…which could cause foot pain.

By loosening up the TFL you may be (at least temporarily) correcting this internal rotation and subsequent overpronation.

There are some other possible explanations -sciatic stuff being a very prominent factor in my mind here- but I don’t want to go on forever about this. I think your main question was how the hips / lower back could be related to your foot, and this is a good idea of how the kinetic chain can (and many times does) function together.

It’s not as simple as “This one muscle is tight” though. Not at all. There are a ton of muscles that come into play here.

General foot pain talk

Lastly, I want to mention I rarely ever go after foot pain in this manner. I first and foremost go after the foot itself, then look at other factors.

I’d start by examining what type of footwear you have as there definitely seems to be a relationship between what’s on your foot and your pain. Second, I’d look to see if you had an aberrant movement at the foot (like the overpronation discussed), third, if there’s no movement issue it’s probably coming from either your footwear or it’s sciatic related.

(And yes, you could have a multiple issues concurrently. That is, you could have a foot issue and sciatic issue at the same time.)

Where the rest of the chain can come into play is: In a regular exercise program these are movement issues that should be paid attention to anyways. Considering I pretty much always exercise the entire body with people and not just one joint, I suppose I am attacking multiple joints even when attempting to alleviate one specific condition. But it’s not like I’d go, “So her foot hurts…what’s her lat doing?” Certainly not initially. The thinking starts, “Her foot hurts…what’s her foot doing?”

Hopefully this gives you some insight!

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[1] Update 4/9/2014: Modified treadmill remarks to give a better representation of what’s going on. See the comments section for a more detailed discussion.