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You may be curious if foot pain can cause leg pain. The foot is connected to the ankle which is connected to the leg. It is not unusual that if you have certain foot conditions, you may experience leg pain.
Achy legs can limit your activities, especially if you are required to be on your feet for long periods while at work or even when running.
In this article, we’ll discuss all the ways foot pain can cause leg pain, along with solutions on what to do about it.
Let’s dive in…
Posterior Tibial Tendonitis
If you have a flat foot structure and pronate (roll inwards) as you walk, you may notice pain along the inner ankle and foot along the posterior tibial tendon. The posterior tibial muscle originates in the leg and inserts into the foot. It is responsible for supporting and holding up your arch.
If you suffer from posterior tibial tendonitis as a result of flat feet, you may notice radiating pain from the foot into the leg where the muscle belly is. The more you pronate as you walk, the more you strain this tendon and cause it to become inflamed. It can cause your feet and legs to feel achy and weak. Posterior tibial tendinopathy is the most common cause of progressive flatfoot deformity in adults (1).
Solution
Arch supports are very important if you suffer from posterior tibial tendonitis. By wearing an insert with an arch, you are relieving pressure along the tendon when you are standing and walking.
If you have mild to moderate flat feet, I would recommend the Powerstep ProTech orthotic. It has a firm arch with a deep heel cup that will provide adequate support for when you stand and walk. The goal of the insert is to keep your arch from collapsing. The deep heel cup will keep your feet from sliding.
If you have a severe flatfoot, I would recommend the Powerstep Maxx Orthotic. This orthotic has the same features as the Powerstep Protech orthotic but it has an additional heel wedge to help prevent overpronation.
Make sure to remove your shoe liners before you place these inserts in your shoes. However, if the shoe liner in the shoe is stitched or glued on, you can leave it in the shoe and place these inserts on top of the shoe liner.
These inserts will typically last for 6 months to 1 year before they need to be replaced.
If you need a custom orthotic that is specifically designed for your foot structure, make sure to see your foot doctor have your feet molded to get custom orthotics made. Custom orthotics can be made to fit your unique foot structure.
Custom orthotics can be pricey, so make sure to check with your insurance if this would be a covered option. The price can vary from $300-$800 a pair. The pros of custom orthotics are that they can last 5-10 years.
If an orthotic is not supportive enough, and you feel you need more ankle support, I would recommend you wear the Zenith ankle brace. It’s a figure-eight lace brace that’s effective in providing ankle stability.
Remember, the posterior tibial muscle originates in the leg. Sometimes, inserts are just not enough to provide your foot and ankle with support when you have a very inflamed tendon. This is where the ankle brace comes in. You can wear the brace over your socks. Your foot should still be able to fit in your shoe with the brace on.
Physical Therapy can also help reduce inflammation of the posterior tibial tendon. Your physical therapist can show you exercises on how to improve tendon strength.
Here’s a link by sportsinjuryclinic.net on how to perform posterior tibial tendon stretching exercises.
Shin Splints
Shin splints (also known as “Medial Tibial Stress Syndrome”) occur when there is damage to the muscles and periosteal tissue in the legs. The periosteum is a thin layer of tissue on the outside of your bones that supplies it with blood and nerves. Shin splints are a very common injury experienced by runners and military personnel (2).
Typically, the anterior and posterior tibial muscles and the sheaths that cover them in the leg are involved. If you increase your activity too soon, wear unsupportive shoes, or have flat feet, you may notice pain in your shins.
When you have flat feet and roll inwards as you walk, you put more shock on the bones when walking and running. Tightness of the shin muscles can also cause dull, achy pain in your shins. Shin splints can be exacerbated if you are running or pivoting while playing sports.
Solution
RICE therapy can be beneficial to help reduce pain associated with shin splints. NSAIDs can also be beneficial to reduce pain and inflammation.
Make sure you are checking your shoes for wear. If you notice the bottom outsole of your shoe is worn, it is time to replace them. Make sure you pick out your shoes at a local running shoe store or ask your foot doctor for recommendations on shoes that may be appropriate for your feet.
When picking shoes, you should go to the shoe store at the end of the day when your feet are the most swollen to get your feet measured for length and width. Then, try on several pairs of shoes before purchasing them.
Stretching is crucial to prevent shin splints. It is recommended that you stretch before and after exercising to limit discomfort. If you ignore shin splints, you can go on to develop stress fractures of the leg. If this were to happen, you would need to rest for 6-8 weeks minimum until your fracture heals.
Achilles Tendonitis
The two muscles on the back of your calf (gastrocnemius and soleus muscles) make up your Achilles tendon (heel cord) which inserts on the back of your heel. This tendon is a robust tendon and aids with flexing your foot and ankle when you walk. You also use this tendon when walking, jumping, or standing on your toes.
If your calf muscles are tight or you have overused the tendon for months, you may develop Achilles tendonitis. This causes the tendon to become inflamed and painful. Some people experience pain where the tendon inserts on the back of the heel, however, others experience pain in the back of the leg.
Solution
STRETCH, STRETCH, and STRETCH!
Doing proper stretching exercises for Achilles tendonitis is crucial. Make sure you are stretching 3 times a day for at least 15 minutes at a time. It’s also important to make sure you’re performing these exercises correctly.
Check out this post on how to properly perform stretching exercises for Achilles tendonitis.
RICE therapy also helps to reduce pain associated with Achilles tendonitis. Physical therapy is largely encouraged for Achilles tendonitis. Your physical therapist will be able to help decrease the pain at the level of the Achilles tendon using ultrasound. They can also help to improve strength in the Achilles tendon, as well as a range of motion. Evidence from clinical trials shows that eccentric strengthening of the calf muscle can help patients with Achilles tendinopathy (3).
Physical Therapy will be needed 2-3 times a week for 1 month. You can ask your doctor for a prescription.
Inserts can also be beneficial for Achilles tendonitis. I would recommend the Powerstep ProTech orthotics for Achilles tendonitis. You need to get an insert with a deep heel cup so that your heel is seated into the orthotic and doesn’t slide. Medium arch support is also beneficial to redistribute forces when you walk.
Ankle Sprains
Your ankles have ligaments in them that help stabilize your ankle joints. When you accidentally fall and twist your ankle, you may sustain a painful lateral ankle sprain. Three ligaments make up the outside of the ankle (anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament).
If you have a partial or complete sprain/tear of the ligaments, you may experience pain and weakness in the ankle. The pain can often radiate into your leg and cause discomfort.
Read more about ankle sprains in a supplemental article “Outside of Foot Pain- EVERYTHING You Need To Know”.
Solution
If you have an ankle sprain, it’s best to start RICE therapy immediately until you can see your doctor. Your doctor will perform an exam, get an x-ray, and possibly even an MRI to assess the extent of the damage. Based on this, your doctor may recommend conservative care or even surgery.
The problem with severe ankle sprains is that your ankle may always be a bit weak after the sprain.
If your ankle is not too swollen, try wearing a Zenith ankle brace while walking around to provide your ankle with stability.
Compression stockings can also be beneficial to reduce swelling and pain. Make sure you start by wearing low-grade stockings (strength 15-20mmHg). Make sure to measure your calves and ankles before ordering the size you need. You can wear the stockings all day, and remove them at night. One pair is usually good for 6 months of compression.
Depending on the level of severity, ankle sprains can take 4 weeks to 3 months to heal. Once your pain reduces, your doctor may suggest physical therapy to improve balance and strength in your ankle.
Peroneal Tendonitis
The peroneus longus and brevis tendons are the tendons that run along the outside of your ankle and foot. The muscle belly of the peroneus longus and brevis tendon starts in the leg. The primary function of the peroneal tendons is to evert and plantarflex at the ankle (4). This means that the tendon aids the downward and outward motion of your ankle.
When your foot rolls outwards, or you walk/run on sloped surfaces, you may overuse the peroneal tendons. This can cause pain and swelling to occur on the outside of your legs and feet, causing tendonitis.
Solution
Make sure to start RICE therapy. A Zenith ankle brace can also help provide stability to the ankle. If your ankle and legs are very sore, your doctor may suggest you walk in a cast boot. I recommend the short BK boot from Amazon. It is supportive, and not as cumbersome as a tall BK boot.
Your doctor may also suggest physical therapy to help reduce pain.
You can check out this post on how to properly perform stretching exercises for peroneal tendonitis.
Tarsal Tunnel Syndrome
There is a nerve called the “tibial nerve” that runs along the inside of your ankle and courses into the foot. When the nerve becomes impinged you may experience burning and shooting pain along the inside of your ankle.
Tarsal tunnel syndrome can occur due to impingement of the nerve secondary to a flat foot structure, trauma to the ankle, as well as a mass that may be growing in the ankle that directly pinches the nerve.
If you have Tarsal tunnel syndrome, you may feel nerve pain shooting up your leg. It is seen more often in females than males and can be seen at any age (5).
To read more about nerve pain in the foot read this “Ultimate Guide To Nerve Pain In the Foot”.
Solution
Arch supports can be beneficial in alleviating pain associated with tarsal tunnel syndrome. When your arch is elevated, strain is removed from the nerve. Make sure to wear shoes with an arch in them or inserts that provide your feet with adequate support.
Your doctor may also suggest a steroid injection to be injected directly into the nerve. This can help reduce pain and inflammation. A steroid injection is only painful temporarily. It can reduce pain in the ankle for weeks. In rare cases, surgery may be needed.
Limb Length Discrepancy
A limb length discrepancy is when there is a difference in the length of your two legs. In general, many people have a limb length discrepancy of less than 1 cm. However, if you have a limb length discrepancy of more than 1 cm, you may notice foot and leg pain. You may also notice that your feet and legs fatigue quickly.
Most people are born with limb length discrepancies, however, sometimes it can be acquired if you have had multiple surgeries on one side, causing the limb to be shorter or longer. For instance, if you broke your leg and have had multiple surgeries on it, the broken leg may be shorter due to repetitive fractures.
Solution
Make sure you go to your doctor to be assessed for limb length discrepancy. Your doctor will measure your limbs to determine the discrepancy. Your doctor will also want to see how you walk.
Your doctor may suggest you wear a heel lift on the shorter side. You will need to place the heel lift directly in your shoes. I would recommend starting with a ⅛” lift first, and increasing slowly up to the desired height. You can buy an adjustable lift on Amazon here.
Extensor Tendonitis
The extensor tendon muscle belly starts in your leg and inserts onto the top of your foot. The extensor tendon helps lift your ankle and toes. This tendon is used when walking. If you are on your feet for a long time during the day or wear ill-fitting tight shoes that press on the tops of your feet you may experience pain. The pain may persist whenever you try to walk. You may notice swelling in the foot as well. This can be uncomfortable. The pain may start in your foot and radiate into your ankle and leg.
Solution
In most cases, extensor tendonitis symptoms improve with RICE therapy. If the tendon is very inflamed, your doctor may suggest you walk in a cast boot to reduce the inflammation. Occasionally, you may need physical therapy to help strengthen the tendon. Avoid wearing tight constrictive shoes that press on the top of your foot.
Neuropathy
Neuropathy is when damage occurs to one or more nerves in your feet and legs. Neuropathy can be caused by many things including medications, diabetes, trauma, autoimmune disorders, and nutritional deficiencies. When you have neuropathy you may experience complete numbness, tingling sensations, burning sensations, and shooting pain that starts in your feet and extends into the legs.
Depending on the level of neuropathy, the symptoms can limit your activities significantly. Neuropathy can also affect your balance, which can place you at higher risk for falls.
Solution
Currently, there is no treatment to reverse neuropathy. However, there are medications widely available to manage nerve pain. If you experience painful neuropathy, you can speak to your doctor about applying prescription Lidocaine 5% cream onto your feet to numb the pain.
If you need something stronger, your doctor may prescribe well-studied medications for neuropathy such as Gabapentin and Lyrica to control your symptoms. Make sure to discuss the side effects of these medications with your doctor.
Physical therapy can help immensely with balance problems associated with neuropathy. Physical therapy will need to be done for at least a month.
Diabetic shoes and insoles are beneficial for people who suffer from neuropathy. You can check with your insurance whether this would be a covered benefit for you. Diabetic shoes are designed to be extra-depth and wide enough to accommodate foot deformities. Diabetic plastazote insoles are designed to prevent shear and blisters in sensitive diabetic skin.
Conclusion
As you can see, there are many reasons why foot pain may cause your legs to hurt. The good news is that if you address the reasons your feet may be hurting, it can alleviate the pain you feel in your legs. The proper shoes and inserts are so important to maintaining proper foot health.
Do you suffer from foot and leg pain? What helped resolve it? I would love to hear your thoughts! Leave a comment below!
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References
- Beeson P. Posterior tibial tendinopathy: what are the risk factors? J Am Podiatr Med Assoc. 2014 Sep-Oct;104(5):455-67. doi: 10.7547/0003-0538-104.5.455. https://pubmed.ncbi.nlm.nih.gov/25275733/
- Yates B, White S. The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. Am J Sports Med. 2004 Apr-May;32(3):772-80.https://pubmed.ncbi.nlm.nih.gov/15090396/
- Simpson MR, Howard TM. Tendinopathies of the foot and ankle. Am Fam Physician. 2009 Nov 15;80(10):1107-14. https://pubmed.ncbi.nlm.nih.gov/19904895/
- Walt J, Massey P. Peroneal Tendon Syndromes. 2022 May 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. https://pubmed.ncbi.nlm.nih.gov/31335074/
- Kiel J, Kaiser K. Tarsal Tunnel Syndrome. 2022 May 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. https://pubmed.ncbi.nlm.nih.gov/30020645/
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