Hip pain when turning the foot inward, known as internal rotation, is a common and often discomforting sensation. This movement frequently points to an issue originating within the hip joint or its surrounding soft tissues. Pain can manifest as a sharp twinge during activities like twisting or pivoting, or a dull ache that lingers after certain movements.
Understanding the Causes
Several conditions can lead to hip pain when the foot is turned inward, each affecting different structures within or around the hip joint.
One common cause is Femoroacetabular Impingement (FAI), a condition where abnormal bone growth on either the thigh bone (femur) or the hip socket (acetabulum) causes the bones to rub against each other. This rubbing can occur during movements like hip flexion and internal rotation, leading to pain and potential damage over time. FAI typically presents in three forms: cam impingement (excess bone on the femoral head/neck), pincer impingement (overgrowth of the acetabular rim), or a mixed type combining both.
A labral tear is another frequent source of pain with internal rotation. The labrum is a ring of cartilage that rims the hip socket, providing stability and cushioning to the joint. A tear in this cartilage can result from trauma, repetitive movements, or underlying conditions like FAI. When the labrum is torn, it can cause clicking, catching, or locking sensations in the hip, along with pain that worsens when the joint is rotated or stressed.
Piriformis syndrome involves the piriformis muscle, which is located deep in the buttock and runs from the sacrum to the top of the thigh bone. This muscle’s primary function is to rotate the thigh outward, but it also plays a role in hip stability. When the piriformis muscle becomes tight or goes into spasm, it can irritate or compress the nearby sciatic nerve, causing pain that radiates through the buttock and down the leg, sometimes exacerbated by internal rotation of the hip.
Gluteal tendinopathy or bursitis can also contribute to lateral hip pain that is aggravated by internal rotation. Gluteal tendinopathy refers to degeneration or inflammation of the gluteal muscle tendons (gluteus medius and minimus) on the outer hip. Greater trochanteric bursitis involves inflammation of the bursa, a fluid-filled sac cushioning tendons and bones on the outer hip. Both conditions can cause tenderness and pain over the outside of the hip, which can increase with certain movements, including internal rotation.
Early osteoarthritis, a degenerative joint disease, can also manifest as hip pain with internal rotation. This condition involves gradual wear and tear of the articular cartilage covering the ends of hip joint bones. As the cartilage thins and deteriorates, the bones may begin to rub together, leading to stiffness, reduced range of motion, and pain that often worsens with activity, including rotational movements.
Identifying the Problem
Identifying the cause of hip pain when turning the foot inward requires thorough evaluation by a healthcare professional. The diagnostic process begins with a detailed patient history, where the doctor asks about pain onset, duration, intensity, and activities that worsen discomfort. This includes inquiries about previous injuries, daily activities, and sports participation.
A physical examination follows, allowing the healthcare provider to assess the hip’s range of motion, observe gait patterns, and perform specific tests. For instance, the Flexion, Adduction, and Internal Rotation (FADIR) test helps identify hip impingement or labral tears by reproducing the painful internal rotation. The doctor also palpates the hip area to pinpoint tenderness and evaluate muscle strength and flexibility.
Imaging studies confirm diagnosis and provide detailed views of hip structures. X-rays can reveal bone abnormalities associated with FAI or signs of early osteoarthritis, such as joint space narrowing. To visualize soft tissues like the labrum, tendons, and cartilage, a Magnetic Resonance Imaging (MRI) scan, sometimes with contrast (MR arthrogram), may be ordered. These combined approaches pinpoint the underlying cause of pain.
Managing and Treating the Pain
Managing hip pain associated with internal foot rotation begins with conservative strategies to reduce discomfort and improve hip function. Rest and modifying activities that aggravate pain, particularly excessive internal rotation, are primary recommendations. This may mean temporarily avoiding certain sports or exercises to allow inflamed tissues to heal.
Physical therapy plays a significant role in rehabilitation, focusing on strengthening the muscles surrounding the hip, such as the glutes and core, to enhance joint stability. Therapists also improve hip flexibility and correct faulty movement patterns contributing to pain. Specific exercises restore normal hip mechanics and reduce stress on affected structures.
Medications manage pain and inflammation. Over-the-counter NSAIDs, such as ibuprofen, are often recommended for temporary relief. For persistent pain or significant inflammation, a healthcare provider might consider injections. Corticosteroid injections can reduce inflammation directly within the joint or surrounding tissues, while other options like platelet-rich plasma (PRP) injections may be considered for their potential to support tissue repair in certain cases.
Surgical intervention is a last resort for hip pain unresponsive to conservative treatments, especially with severe structural issues. Procedures like hip arthroscopy, a minimally invasive surgery, address conditions like FAI by reshaping bone or repairing a torn labrum. The decision for surgery is made on an individual basis, taking into account the severity of symptoms, the underlying condition, and the patient’s overall health and activity levels.
Knowing When to Seek Professional Help
Consulting a healthcare professional for hip pain, particularly when turning the foot inward, prevents further complications. If pain persists for more than a few days despite rest and home care, or progressively worsens, medical evaluation is advisable. Increasing pain intensity or frequency suggests professional assessment.
Other associated symptoms indicate a need for medical attention. These include locking, clicking, or grinding sensations within the hip joint, signaling mechanical issues like a labral tear or loose bodies. Weakness, numbness, or inability to bear weight on the affected leg are serious signs warranting prompt medical consultation.
If hip pain developed suddenly following a fall or direct injury, seek immediate medical help. Acute onset pain, especially with inability to move or bear weight, could indicate a severe injury like a fracture or significant soft tissue damage. Timely diagnosis allows appropriate management and can significantly improve outcomes.