Sciatica from flat feet can exist due to several theorized causative mechanisms. However, the solution to all of these causations is usually quite simple. In fact, most patients can end flat foot-related sciatica without any ongoing or invasive care, if their feet are the actual source of pain. However, this presumption is never a given, since sciatica can come about from a vast multitude of possible origins.
We have discovered some very plausible explanations for why sciatica might be linked to flat feet. However, we have also heard of some theories that make us cringe with doubt. There are certainly some very far fetched theories of causation circulating, so patients must be very careful what they believe in order to improve their chances for satisfying therapeutic outcomes. Remember, if you go about treating an incorrect cause of pain, then the therapy is almost sure to fail, often miserably.
This essay provides analysis of various ways in which sciatica might be related to the expression of flat feet, also known as fallen arches.
Flat feet are well known to enact changes to the entire lower body anatomy, including the knees, ankles, hips, pelvis and lower spine. The angle of the body in relation to the ground is slightly different in flat footed people, creating possible variations in pelvic alignment and even altering lower spinal alignment. These changes can cause or exacerbate compression conditions in the sciatic nerve, or in the formative lumbar and sacral nerve roots that create this nerve, through the following mechanisms:
Changes in pelvic alignment can cause or exacerbate piriformis syndrome, wherein the sciatic nerve is compressed via the piriformis muscle.
Changes in pelvic alignment can cause sacroiliac pain that might radiate and feel like sciatica in the buttocks and upper leg.
Changes in spinal alignment can cause or exacerbate compression of the L4 through S3 nerve roots which go on to form the sciatic nerve, most often due to changes in the patency of the foraminal spaces from excessive or deficient spinal tilting.
Flat feet can enact changes in gait that might cause other types of muscular nerve compression syndromes, affecting the sciatic nerve or any of its peripheral local branches.
Flat footedness is usually easy to correct with special insoles or shoes. These orthotics create arches where nature failed to provide. Shoe inserts are often used in combination with special postural corrections and exercises to help reduce the collateral effects of flat feet, which have often accumulated over many years in adult patients. Some patients can manage with postural corrections and exercises alone. These practices are most often reserved for patients who prefer to be barefoot most of the time and therefore will not utilize orthotics enough to render them effective.
There are also highly specialized foot surgeries that can recreate deficient arches, but these interventions are rarely used. Most often, they are held in reserve for patients with very severe pain who have not responded to more traditional and conservative care.
All of the information in this article is valid and might describe some cases of sciatica that is truly related to flat feet. However, we would be greatly remiss if we did not provide the counterpoint argument why many instances of sciatica symptoms and flat feet are mistakenly linked during diagnostic evaluation.
Most sciatica is misdiagnosed and cases theorized to be caused or worsened by flat feet are no exceptions. There are simply so many possible sources of sciatica that it is difficult to pin down a singular exact causation. In fact, many patients suffer pain due to a multitude of causative contributors working together. Worse still, some of these contributory factors are psychoemotional in origin and not structural/physical.
The human body is wonderful in its innate ability to adapt. There is no reason to think that it is incapable of adapting to flat feet, since the condition is very common and most affected people do not demonstrate sciatica or any problem as a result of their fallen arches. Therefore, we caution patients to always get more than one diagnostic opinion and be very wary of accepting a diagnosis of flat-footed sciatica, especially if this verdict is a revision of a previous diagnosis or the condition does not respond favorably to indicated conservative care within the expected therapeutic timeline.