Piriformis Syndrome and the big toe bailout.

Yes, the big toe when working properly is a powerful ally in addressing Piriformis Syndrome.  Why?  Early and overpronation of the foot require the Piriformis to work hard to control the femur from too much internal rotation.

During the stance phase of gait the Piriformis receives help in two phases.  When the heel strikes, and when the foot travels over the big toe. (these things happen at the same time on opposite feet)Image result for gait cycle

When the foot travels over the big toe an effect referred to as the ‘Spanish Windlass’ takes place where the plantar fascia supinates or pulls an arch into the foot.  Up the kinetic chain this allows for external rotation or a ‘shortening’ phase for the Piriformis.  During the stance phase of gait the Piriformis should act as the following:

  • heel strike = Piriformis rest (shortening)
  • foot flat = Piriformis working
  • heel off = Piriformis rest (shortening)

So 2 x break and 1 x work.  In a person that pronates too early and their foot does not travel over their big toe then the piriformis is under increased workload.  Issues of entrapment can result in ‘Sciatic’ pain from the facilitated Piriformis.

If you suffer from Piriformis syndrome, experiment with heel strike as well as allowing the foot to hinge over the big toe as you deliberately push off during gait.  See if this gives your ‘Piriformis’ a break.

This is surely not the only reason, but a commonly overlooked one.

Image result for spanish windlass foot

In reference to the previous post, the foot type associated with piriformis syndrome is often opposite of that associated with IT-band syndrome.  Rigid foot versus a loose foot in the kinetic chain.