Piriformis Syndrome is a myofascial syndrome whereby the piriformis muscle (due to excessive work in trying to stabilize the hip) develops trigger points. Increased tension in this muscle can cause entrapment of the sciatic nerve and hence sciatic like symptoms. As the piriformis is an external rotator of the hip it is under constant tension when the foot internally rotates (pronation) and hence a custom orthotic that is designed to prevent over pronation is a very effective treatment for this syndrome. Massage, stretching and stabilization exercises are also advisable.