Leg Pain or "Sciatica"

The term sciatica simply means leg pain.  It is the pain that travels along the path of the sciatic nerve and is caused by damage to the small roots that form the nerve.

The sciatic nerve is the longest and largest nerve in the body.  It is three-quarters of an inch in diameter and two feet long.   It originates in the sacral plexus in the pelvis and extends to the lower leg.  The sciatic nerve and its nerve branches serve motor and sensory functions (movement and feeling) in the thigh, knee, calf, ankle, foot, and toes.

If the roots forming the sciatic nerve are injured or inflamed, one develops symptoms called sciatica. The pain extends from the back, down the leg and to the foot.

Q. When is leg pain an emergency?

A.  You should see a spine specialist immediately if you have any of the following:  severe pain extending down your leg; if the leg pain increase when you lift your knee to your chest or bend over; if you have had a recent injury; if the pain lasts more than three to six weeks; if your back pain becomes worse at night or wakes you up from sleep;  if the pain is accompanied by a fever; or, if  you have bladder or bowel problems.  Night pain can be caused by some tumors. Bladder and bowel problems may indicate the presence of a cauda equina syndrome, that is a compression of all of the nerves in the low back, which needs to be fixed immediately.

Q. Are there other causes of sciatica?

A. Not all leg pain is caused by herniated discs.  Other causes of leg pain include: fibromyalgia (a generalized pain syndrome); sacroiliitis (inflammation of the sacroiliac joint); lumbar facet syndrome (damage to the small joints in the back);  piriformis syndrome (a pinched nerve deep in the muscles of the buttock); Iliolumbar syndrome (inflamed ligaments of the pelvis); or, lumbar spinal stenosis (a narrowing of the space for the nerves).  Each of these problems are treated differently.  Most can be handled with needle procedures.

Q.  What is a Drop Foot

A. Drop foot is not a disease but a symptom.  It is caused by weakness of the muscle that lifts the foot up at the ankle (the tibialis anterior muscle).   The drop foot may be temporary or permanent. Drop foot is most frequently caused by injury to the L₅ nerve root.  The L₅ nerve is usually injured by a bad L₄-L₅ disc.  Occasionally, a drop foot can be caused by an injury to the peroneal nerve.  The peroneal nerve is a branch of the sciatic nerve and can be injured during hip or knee surgery. It can be injured by a deep bruise or a bad  laceration.  Drop foot can also be caused by Amyotrophic Lateral Sclerosis (ALS) and Multiple Sclerosis (MS). The cause can be determined using MRI (magnetic resonance imaging), and EMG (electromyogram).   A drop foot can be an emergency condition, and you should see your spine doctor immediately if you develop this problem.

The type of treatment is dependent on the cause of the drop foot. An ankle foot orthosis (AFO) brace, can prevent falls. The damaged nerve should, however, be repaired as soon as possible.  If a disc is the problem, it should be corrected immediately.  If the nerve is damaged by a knife wound, repairing it is also urgent.