Feet and Your Pelvis: The Intricate Neurological Link
- Dr. Heather Swain PT, DPT, CIDN, CPT
- Mar 21
- 8 min read
Are foot fetishes really a neurological abnormality? Is chronic ankle pain that no one can seem to see, or fix, secretly a pelvic problem? Do twinkle-toes potty dances actually help kids hold it until they get to the bathroom? At first glance, our title might seem like a bit of a stretch.
That is, until you realize that the nerves that supply your feet literally stretch down from your pelvis. The connections don't end there. While the cliche saying was that "all roads lead to Rome", in the human body, all nerves lead to the brain. Even your brain is organized in a way that the foot is right next to the pelvis.
Foot and ankle problems and pelvic problems have a lot of overlap. If your experience in physical therapy has been primarily orthopedic, you may have been told that you need a lift in your shoe because your legs are different lengths and it's throwing off your pelvis. The neurological links between the feet and your pelvis, however, may be just as influential.
Let's take a look at:
The Foundation:
The Nerves Out in the Body
When it comes to nerves, it's easiest to think of them like a vast network of streets and highways (See: Nervous System Highways). They are responsible for carrying information from the brain out to the body, and from the body back to the brain. Like cars on a highway, they transport many different kinds of messages. Some function as major highway thoroughfares like the sciatic nerve, which supplies the entire back side of the leg. Some of the nerves serve as smaller side streets so that every inch of the skin on the bottom of the foot has sensation.
To help you with the basics, we'll look at two nerve maps. The first map highlights the bigger "highway" nerves. These are the major nerves that go down to the leg. Some of these nerves have more recognizable names, such as the sciatic nerve. These nerves trace back to the spinal nerve roots. Below each nerve, the nerve root levels are listed with "L" meaning lumbar, and "S" meaning sacral, to indicate which spinal level the nerves originate from. From there, the nerve roots connect into the spinal cord, which serves as the ultimate road back to the brain.
The second nerve map covers the superficial nerves that go to the skin from the spine. They are medically mapped into what we call dermatomes. Each dermatome region corresponds to a different level of the spine. You may find some variation in dermatome charts online. That is, in part, because there is more variation in the smaller nerves to the skin between individuals. This makes sense when you think about how variable the paths are of the side streets in a neighborhood compared to major highways, which tend to follow more consistent structure patterns.
Regardless of what dermatome chart you look at, generally speaking, the nerves labeled L4, L5, S1, and S2 will be mapped covering the foot and ankle. These correspond to the fourth and fifth lumbar vertebrae, and the nerves that exit in this area, and the first and second sacral nerve roots. The lower sacral nerve roots then supply the back of the upper leg, and the pelvis.
The Nerves in The Brain
Visualizing the brain can be tricky. The truth is that a lot of the parts of the brain look pretty similar. Figuring out which part of the brain is responsible for what function requires advanced research equipment. That's because brains, and the nervous system in general, are somewhat similar to the circuit panel and wires in your house. Taking a picture of the wires doesn't necessarily tell you what they do, or even if they work at all. Looking at the switches on an unlabeled circuit panel doesn't give you enough information to know what each switch does. If you've ever had imaging taken that comes back without any reason for the pain you're having, you aren't alone. That's because pain is processed in the nervous system. (See: The Invisible Illness: Why Can't My Doctor See My Pain?)
Your brain is both genetically one of the most individual things about you at birth, and it even grows, adapts and changes based on your life experiences.
If you are a fine art lover more than an anatomy guru, you're in luck. An artist created a sculpture that proportionally displays the brain area, known as the homunculus, on a person. If we looked like the amount of space our brain gives to the different parts of our body, this is who we'd be:
Like you'd expect, our brains give lots of space to our hands and our mouths. Think about the way that little kids learn and build a sensory map of their world. Anyone who has been around babies and toddlers knows they are generally curious to touch everything with their hands, and if possible, put it in their mouths.
The feet are larger too, which makes sense given that they are also a primary way that we balance and serve as a touch point to gain information about the world underneath our feet.
It's also no surprise that our brains allocate a significant amount of space to our genitals and pelvis. They are both important from a reproductive perspective, and a major sensory contact point for understanding the need to empty our bowel and bladder, not to mention sexual pleasure and function.
Foot Fetishes
On the note of sexual function, the cliche fetish that is most often talked about in jokes and media is a foot fetish. Have you ever wondered why it is feet and not some other body part? Why don't you often hear about an elbow fetish? In terms of what parts of the body are pleasant and desirable, you may not think feet would top the list. Feet are often sweaty and get dirty easily when you aren't wearing shoes. The irony of the fact that many people would consider feet to be gross makes it an easy source of humor in books and movies, that some people consider feet a point of sexual attraction.
While cultural sensitivity would dictate that we should be cautious in making judgements and assessments about another person's sexual preferences, on some level, they are neurologically influenced.
If you glance back at the map of the homunculus in the brain, you'll notice that tucked in the middle of the image, the genitals and the foot are right next to one another in the sensory cortex.
If the lines between the two regions become blurred, and the two areas develop neural connections, it can become harder for the brain to differentiate sensations between the feet and the pelvis/genitals. This process of interconnection in the brain is formally called cortical smudging. While several people have proposed this theory, that sexual attraction and arousal associated with feet originates in the brain (1), as of yet, studying this exact connection hasn't been formally studied with brain imaging. Practically speaking, there are many medical questions vying for limited research funding grants. This particular one hasn't yet been a top priority to receive funding.
The Potty Dance
Have you ever noticed that the "potty dance" is fairly similar between children? Even if a child has no older siblings and hasn't seen anyone else do a potty dance? Most kids will squeeze their legs together, hold their hands over their lower abdomens, and develop antsy feet when they need to go. They tend to rise up on their tiptoes and bounce up and down.
In truth, even for most adults, if you rise up onto your tiptoes, chances are, you are probably contracting your pelvic floor muscles at the same time. The tightening of the pelvic floor muscles function like a gate and help to close off the openings that allow emptying of the bowel and bladder. (See: The Gate Keeper). These same muscles also help us to stabilize our pelvis as we try to balance while up on tiptoe.
Performing heel raises is actually one of the recommended strategies for controlling urinary urgency in adults (2). The concept that movement is medicine can be powerful. There are many lifestyle and exercise strategies to control bladder problems that don't involve medication. (See: Bladder Boot Camp-Introduction)
Tibial Nerve Stimulation for Pelvic Problems
Pelvic floor therapists treat patients with pelvic pain, as well as bowel, bladder, and sexual function problems. While some of their treatment strategies involve pelvic floor exercises, others focus on treatment in less intimate areas. New evidence suggests that electrical stimulation of the tibial nerve in the ankle, is actually a viable treatment option for overactive bladder symptoms in children and adults (3). The tibial nerve originates from the sacral nerve roots in the pelvis. It's believed that the shared neural connections between the tibial nerve, and the nerves that control the bladder are responsible for these benefits.
Pelvic pain can have a huge impact on a person's quality of life. We tend to experience an elevated threat level with pain in areas that pertain to our vital functions, like the heart, lungs, head/brain, and reproductive tissues. There are many causes of pelvic pain, and many of these conditions are difficult to treat with traditional methods, such as medications, injections, and surgical procedures.
Tibial nerve stimulation is an alternative treatment method that is less invasive than surgery and doesn't involve medication. In patients with interstitial cystitis (sometimes called "painful bladder syndrome"), instead of placing a nerve stimulator directly on the bladder in the pelvis, doctors have actually found it to be effective to temporarily apply nerve stimulation to the tibial nerve in the ankle (4). Nerve stimulation is designed to provide low grade electrical impulses like the ones your nerves normally use to communicate. These impulses help stimulate and distract the nervous system from other unpleasant sensations.
Closing Thoughts
More research on the connections between the feet and the pelvis is needed. Some pelvic floor therapists have suggested that tibial nerve stimulation may benefit patients with pudendal neuralgia. Pelvic floor therapists have anecdotally reported noticing a correlation between patients who 1.) have tense, sore, and tight feet, and 2.) have elevated pelvic floor muscle tone and pelvic pain. There are stories of patients who have an amputation of their foot and find themselves experiencing phantom pelvic sensations.
Many of the pelvic floor therapists who observe these things, however, are busy trying to meet the demand for clinical patient care. There are relatively few pelvic floor therapists for the number of patients who would benefit from pelvic floor physical therapy. As a result, the therapists have difficulty allocating time to perform research and write case reports to publish the stories they hear from their patients.
If you are experiencing foot or pelvic problems personally, please keep in mind that the above content is intended for educational purposes and is not a replacement for individual medical advice. If you are interested in receiving advice for your unique case, you can schedule an evaluation appointment by clicking Book Online.
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