How is My Hip Pain Connected to My Feet?

We hear it quite often from patients who come to see us for foot pain – ‘I have this other issue with my hip/knee, but I don’t think it’s relevant so I won’t go into detail’.

They are then very surprised when our response as podiatrists is along the lines of ‘everything is connected, so it may very well be relevant’.

If I had a dollar for every time I have had this conversation with a patient, I’d be rich!

We’ve all heard the rhyme ‘the foot bones connected to the knee bone’, and the thing is, this rings very true. While there might be some details missing in the rhyme, everything in our body is connected and works together to allow us to function efficiently.

When one structure is injured or weak, the surrounding structures must then compensate for this and so begins a chain reaction that can lead to injuries or pain elsewhere in the body.

The feet are the foundation of the body when standing and moving and are responsible for supporting the entire body from the ground up. So, if the feet are not able to do their job properly, pressure then moves up the chain and other structures like the ankles, knees and hips must take on this load.

Today, we’re going to focus specifically on the connection between the hips and your feet.

The hips are quite complex and can encounter a range of pathologies or injuries. There are 17 muscles that influence the function of the hips which can be causing pain, along with various other soft tissues. Hip issues can cause foot pain and vice versa!

Keep reading to learn about the common types of hip pain you may experience.

Posterior (Back) Hip Pain

Lower spinal issues

The lumbar spine sits just above the top of the hips. Continuing on from that is the sacrum and the coccyx which is the end of the spine.

Injuries to these structures can cause pain through the back of the hips.

Sacro-iliac joint

This is a common cause of posterior hip pain.

It involves inflammation of the joint between the sacrum and the hip bone. This is common in those who are either sitting or standing for long periods of time, as well as pregnant women.

Soft tissue injuries

As we touched on earlier, there are 17 muscles around the hip that allow it to function, including the gluteal muscles.

Injury to these muscles can cause pain through the posterior hip and through the thigh region.

Lateral (side) hip pain

Bursitis

This involves inflammation of the small sacs of fluid that cushions the joints called bursae.

Bursitis of the hip is often referred to as trochanteric bursitis, which is inflammation where the top of the femur bone (greater trochanter) connects to the hip joint via a number of muscles.

This can cause pain through the outside of the hip when standing, walking, or when lying directly on it.

This is one of the most common hip pathologies that can be caused by the feet.

Tendinopathy

Tendinopathy involves inflammation of the tendon, which is what attaches a muscle to a bone.

There are a number of muscles that are situated at the lateral aspect of the hip that can be injured. This is also quite a common issue that is caused by the feet.

Fractures

Most hip fractures involve the femur at the greater trochanter and the lateral aspect of the hip.

Perthes disease

This is a disorder of the hip that affects children aged approximately 4-10.

In cases of Perthes disease, the head of the femur loses blood supply and becomes necrotic, meaning it is weakened and is prone to fractures.

It results in pain through the lateral hip which can extend down the leg and into the knee joint.

It is quite rare and affects less than 1% of the population.

Anterior (front) hip pain

Hip flexor injury

There are 4 hip flexors, 2 of which act only at the hip (iliacus and psoas major) and 2 that act on the knee and the hip (rectus femoris and sartorius).

Internal injuries

This relates more to the internal organs and can include a hernia, appendicitis, irritable bowel syndrome, menstrual cramps and so on.

These conditions will generally present very differently to a soft tissue or bony injury.

So, now that we know about the common kinds of hip pain you might experience, let’s have a look at the foot conditions that might be responsible for that pain.

Common foot conditions that cause problems for your hips

We mentioned this earlier but just to reiterate, your feet are the foundation of your body, and your foot posture and function can affect the rest of your body.

Often, we have patients who have come to see us who have been referred from their physio, osteo or chiro as they believe that their hip pain may be coming from the feet.

There are a number of issues within the feet that can affect the hip including:

Flat feet

We always have patients coming in saying that they think they have flat feet and are after an assessment.

It is important to note that there are varying degrees of flat feet and everyone’s body works differently.

In saying that, feet that pronate excessively can cause a domino effect all the way up to the hips. So, if you’re wondering can flat feet cause hip pain, well, flat feet, or a ‘pes planus’ foot type can place excessive pressure on the ankles, knees and hips and require the them to compensate for this, which can lead to issues and pain.

High arches

In the same way that flat feet can cause hip pain, high arches can do the same. Those with a pes cavus foot type can also experience hip pain due to the alignment of the feet.

Injuries

Fractures, sprains, strains, tears and so on can affect the way in which the feet function, particularly in the short term.

This can have a flow on effect into the rest of the body and if not treated properly, can result in chronic pain in the hips.

This is usually caused by limping or compensating for pain.

What else can cause hip pain and affect your feet?

Hip pain does not always have to be caused by an injury!

There are a number of other factors that can contribute to hip pain.

  • Limb length discrepancy

This involves one leg being longer than the other.

If the difference is more than 1cm, this is when it can start to cause problems.

This affects the way in which the lower limbs and spine are aligned and can result in pain in different structures. The discrepancy can be either a functional or structural discrepancy.

Structural limb length discrepancy refers to the cause of the being within a structure. That is, that one bone is longer than the other. This can either be in the femur bone or at the lower leg in the tibia and the fibula. This can be caused by a congenital defect such as damage to the growth plate or through trauma or surgery.

A functional limb length discrepancy is caused by an altered position of the joints, muscle weakness or tightness or a restriction in the joint motion.

  • Poor footwear

Shoes that do not support your feet properly can result in the rest of the body working harder to support the body itself.

Making sure that you wear the right footwear for your foot type is incredibly important to avoid pain or injury from the feet all the way up to the hips.

  • W sitting

This is commonly seen in children and should be discouraged for a number of reasons. It affects the position of the hips and can have long standing effects on the lower legs and feet as well. These effects may not be observed until your child is older.

How can a podiatrist help with your hip pain?

Podiatrists are lower leg, foot and ankle specialists.

However, we need to assess and understand how your body functions as a whole.

It is not uncommon for us to ask if you are experiencing any hip or lower back pain while we are assessing your walking.

So what is it we are looking for?

We perform assessments when you are sitting, standing and walking to test your muscle strength and range of motion.

If we assess a structure and notice that something is not functioning quite well, we then investigate why that might be. We assess for things like a limb length discrepancy and hip weakness with a number of different exercises.

When we watch you standing and walking, we are assessing the way that your body moves from your shoulders down to your feet, as this often gives clues as to which area is not functioning efficiently.

Your feet can cause hip pain and your hips can cause foot pain, therefore it is important to make sure that we are assessing the body as a whole.

There are a number of different ways that we can help to treat your hip pain which can include:

This will help to reduce tension of the lower leg and feet, which can help the function of the rest of the body as well.

  • Orthotics

Orthotics are not always required, however if your foot posture is directly influencing and affecting your hip position then they are always a good choice.

They can help to realign the foot and ankle which in turn aligns the rest of the leg and hip and redistributes the pressure moving through the body.

  • Heel lifts for a limb length discrepancy

Placing a heel lift under the shorter limb will help to lift it up and even it out, reducing stress on the hips and the lower back.

  • Stretching and strengthening programs

We are also to prescribe various exercises to help to increase the strength within the hips to help to reduce hip pain.

  • Referral to other allied health professionals

Sometimes, we need help too! If we identify that we are not the best person to be dealing with your hip pain or you require more extensive treatment, we will refer you to one of our fellow allied health professionals.

This may be a physio, osteo or chiro depending on your needs and we are lucky to have a great network or people to refer to!

So, if you’re experiencing pain or discomfort in your feet and/or lower limbs, it might be best that you book in to see us. Book online here or call us on 03 9432 2689!

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