When the Pain Isn’t Where the Problem Is: A Look at Piriformis Syndrome

Why Your Leg Pain Might Have More to Do With Your Hip Than Your Foot

Leg pains may be difficult to diagnose

You’ve had surgery on your knee, ankle or foot — a meniscus clean-up, a bunion corrected, maybe even a full reconstruction. You’re diligent with rehab. You’ve swapped your footy boots for sensible runners. And yet... here you are, weeks or months later, still limping around with a deep, nagging ache down your leg.

The pain might shoot or throb. It might be sharp one day and dull the next. But the one constant? It’s always there. No matter how you sit, stand, lie or shuffle, you can’t quite escape it.

Panadol? Laughable. Anti-inflammatories? Sometimes take the edge off, but the pain doesn’t exactly pack up and leave. And while the surgery site might have healed beautifully, thi

s new pain feels like it’s got nothing to do with the foot at all — except it’s still ruining your life from the waist down.

This is when things start to smell a bit like piriformis syndrome.

So What Is Piriformis Syndrome?

There’s a small but mighty muscle in your bum called the piriformis. It’s one of your external hip rotators — meaning it helps turn your leg outward. Useful, right? It also happens to sit smack-bang over the sciatic nerve, the largest nerve in your body.

In most people, the sciatic nerve runs under the piriformis. In some, it pierces through it. Either way, if that muscle becomes tight, inflamed or overused — say, from compensating for post-surgical changes or altered gait — it can clamp down on the sciatic nerve like a vice.

Spinal vs muscular sciatica

That nerve doesn’t just hang around the hip. It travels all the way down the back of your thigh, into the calf, and even the foot. So the symptoms — pain, numbness, burning, weakness — are often felt in the lower limb, far from where the problem starts.

It’s the classic case of the site of the symptoms is not the site of the problem.

A Recent Case (And a Classic Clue)

We recently had a patient referred to us for orthotics, thanks to what looked like lower limb overload. Fair enough — their foot posture, alignment, and loading pattern absolutely justified the support. But something wasn’t adding up.

This patient had stubborn burning pain and weakness, especially during long walks or sitting in the car. Foot and ankle function were reasonable. But they described a deep gluteal ache and a constant “pull” down the leg. They had a history of knee immobilisation post-op, which altered their gait for weeks.

"It hurts everywhere?"

Red flag? Not quite. But definitely a neon orange one. Then – cue sinister, Jaws-like music! – the pain started moving around. Outer ankle, inner ankle, behind the knee, into the calf muscle. Then the hip.

After assessing their range of motion and strength patterns, and metaphorically poking around the gluteal region, we strongly suspected piriformis syndrome. And bingo — targeted stretches and progressive strengthening started to bring relief within days.

Yes, we still provided orthotics (actually simple innersoles in this case) — the foot did need support, especially with altered biomechanics and compensations. But it was a great reminder that sometimes people come in for foot pain, and leave with hip advice.

How Does Piriformis Syndrome Happen?

Some common triggers:

• Knee or ankle surgery → altered walking patterns or prolonged immobility

• Long hours sitting (especially driving)

• Sudden increase in activity like walking or running after a long break

• Muscle imbalance between glutes, hip flexors, and core

• Foot posture issues that shift the load up the kinetic chain

It’s often not one thing, but a perfect storm of altered mechanics, timing, and compensation.

Rotational sports commonly trigger piriformis syndrome

How Can a Podiatrist Help?

While piriformis syndrome isn’t a “foot condition”, it’s absolutely within our scope — because it’s often driven by how you walk, stand, and load your limbs.

Here’s how we can help:

• Assessment of your biomechanics from the foot up

• Stretching protocols to loosen the piriformis and surrounding tissues

• Strengthening programs to activate the right gluteal and pelvic stabilisers

• Footwear advice and orthotics if compensation is part of the picture

• Referral to allied specialists (physios, sports docs, or neurologists) if nerve studies or imaging are needed

• Specialised treatment: Shockwave and laser available here at Silver Podiatry, and in this case, we also discussed a particular injection to relax the muscle.

Sometimes the hardest part of treating these syndromes is simply recognising them — and understanding that pain in your calf or foot might actually be coming from your hip.

Shockwave can help thump the muscle back to normal

When to Suspect Piriformis Syndrome

• Pain that radiates from the buttock down the back of the thigh or calf

• Radiating pain that does not seem to resolve with… anything!

• Worse with prolonged sitting, climbing stairs, or getting out of the car

• Numbness or tingling in the leg or foot

• Weakness or fatigue in the leg with walking

• No obvious back issues, yet sciatic-like symptoms persist

• Pain relief doesn’t follow a typical anti-inflammatory pattern

  

  Piriformis pattern of pain

Final Thought

If you’ve had foot or knee surgery and your recovery’s been hijacked by persistent, hard-to-pin-down leg pain, don’t assume it’s “just part of the process”. Piriformis syndrome might not be the most glamorous diagnosis, but when it’s the right one, treatment works — fast.

And if you’re limping through life wondering if it’s your foot, your back, your hip or just bad luck — we’re happy to help unravel it.

Because at Silver Podiatry, we don’t just look at where it hurts.

We look at why.

I'd like to Book Now

Caveat: This example reflects a particular case we’ve seen at the clinic, and involved much more than described. Given my (Elan’s) background, it’s important to note that piriformis syndrome and spinal nerve compression affecting the same sciatic nerve branches can occur separately — or simultaneously. In these circumstances, we don’t make the formal diagnosis, but we play a key role in identifying patterns, guiding assessment, and facilitating the referral process.