Question: Pain felt on the top of the foot and in the big toe during prolonged sitting indicates an injury to the:

a. foot and toe
b. toe
c. hip joint
d. low back

Answer: d. Low back.

Sitting is not a stressful activity for the foot and/or the toe. Only the low back can refer pain into the foot while sitting.

The low back can refer pain to the hip, buttock, thigh, lower leg and foot. Injury to the hip joint also refers pain, but only into the thigh as far as the knee. Muscle injury in the low back can cause referred pain in the leg, but not in the foot or toes. However, there are two possible sources of referred pain from the low back into the leg and foot.

First, pressure on a disc in the low back can refer pain to the foot and toes. Such pain may also be felt at the site of the injury, in the low back, in the buttock, at the thigh and in the lower leg. Often, though, the pain pattern from a low back disc injury does not include any of these intermediate sites, but appears only in the foot.

However, back pain due to disc protrusion accounts for less than five percent of low back pain and referred pain to the leg and foot. Another source of such pain may be injury to one or more ligaments in the low back and sacral area. Low back disc and ligament sources of pain are often confused with one another, because they can create similar referred pain sensations. Prolonged sitting stretches the ligaments and exerts posterior pressure on the discs in the low back. This may be the immediate cause of pain in the back, or the referred pain described above.

When pain in the feet and toes is referred from a low back disc or ligament injury, massage or other treatment applied to the feet and toes will not affect the pain, but work on the low back often will cause the pain to abate.