What is the relationship between spinal stenosis and foot problems, specifically peripheral neuropathy (nerve damage) or radiculopathy (nerve root damage)?

From the Guidelines

Spinal stenosis can indeed cause various foot problems due to compression of nerves in the spine, and treatment should prioritize conservative approaches, with surgical decompression considered if symptoms significantly impact quality of life after 6-12 months of conservative management. When spinal stenosis occurs in the lower back (lumbar region), it can compress nerve roots that travel down to the feet, resulting in symptoms like numbness, tingling, weakness, or pain in the feet.

Key Considerations

• Treatment typically begins with conservative approaches including physical therapy focusing on core strengthening and flexibility exercises, over-the-counter pain medications such as ibuprofen (400-800mg three times daily) or naproxen (220-500mg twice daily), and activity modification to avoid positions that worsen symptoms.
• For more severe cases, prescription medications like gabapentin (starting at 300mg daily and gradually increasing) or pregabalin (75-150mg twice daily) may help manage nerve pain.
• Epidural steroid injections can provide temporary relief for 3-6 months.
• Proper footwear with good arch support and cushioning is essential, and some patients benefit from custom orthotics.
• If conservative treatments fail after 6-12 months and symptoms significantly impact quality of life, surgical decompression may be considered, as recommended by guidelines such as those from the American College of Physicians and the American Pain Society 1.

Diagnostic Considerations

• The diagnosis of spinal stenosis and its impact on foot problems should consider the patient's overall clinical presentation, including symptoms, medical history, and findings from physical examination and diagnostic imaging, as outlined in guidelines and studies 1.
• A thorough vascular examination and consideration of other causes of leg symptoms, such as peripheral artery disease, are also important, as discussed in recent guidelines 1.

Management Approach

• The management approach should be individualized, taking into account the severity of symptoms, patient preferences, and the presence of any comorbid conditions.
• Clinicians should provide patients with evidence-based information on their expected course, advise them to remain active, and provide information about effective self-care options, as recommended by guidelines 1.

From the Research

Spinal Stenosis and Foot Problems

• Spinal stenosis can cause a variety of symptoms in the lower extremities, including leg pain and weakness, paresthesia, weakness or cramping, rest pain, or burning pain 2.
• These symptoms can be misdiagnosed as peripheral neuropathy, especially in patients with diabetes, and may cause severe disability or reduction in the quality of life 2.
• Podiatric physicians are in a unique position to identify spinal stenosis and facilitate appropriate treatment, as they focus on the patient's lower extremities 2.

Diagnosis and Treatment

• The diagnosis of lumbar spinal stenosis can be made based on a clinical history of back and lower extremity pain that is provoked by lumbar extension, relieved by lumbar flexion, and confirmed with cross-sectional imaging, such as computed tomography or magnetic resonance imaging (MRI) 3.
• Nonoperative treatment includes activity modification, oral medications to diminish pain, and physical therapy 3, 4.
• Surgery appears effective in carefully selected patients with back, buttock, and lower extremity pain who do not improve with conservative management 3, 5.

Management of Lumbar Spinal Stenosis

• Multimodal care nonpharmacological therapies, such as education, advice, and lifestyle changes, behavioral change techniques, home exercise, manual therapy, and/or rehabilitation, may be initially selected for patients with lumbar spinal stenosis causing neurogenic claudication 4.
• Pharmacological therapies, such as serotonin-norepinephrine reuptake inhibitors or tricyclic antidepressants, may be considered for patients with lumbar spinal stenosis causing neurogenic claudication 4.
• Pregabalin and gabapentin may have a significant effect on pain scores at 3 months, but adverse events were higher in the gabapentinoids group 6.