Our body is a complex and fascinating structure of connected and largely interdependent parts. In a past blog, we discussed how your feet can contribute to back pain and other musculoskeletal (MSK) conditions. The altered gait and biomechanics can create additional stress on joints, muscles, bones, and the nervous system, putting you at risk of injury.
Here are some examples of biomechanical foot dysfunctions, and how they can lead to back pain1,2,3,4,5:
- Injuries
A series of studies suggest that back pain may result, in part, from repetitive abnormal function of the feet, causing you to alter your posture to compensate for the foot pain—ultimately creating an environment primed for low back pain. The studies also suggest that someone with a previous history of injuries is more likely to reinjure themselves. This is due in part to repeating the same dysfunctional movements over time, consequently altering one’s gait—often without being addressed.
- Range of Motion
Motions of the hip, knee, ankle and foot joints flex in the opposite direction from the joint directly above or below it. Should one of these hinges be restricted or limited, the loss of motion in one joint negatively impact the others (higher up the leg or in the spine, for example) and this may result in pain or dysfunction.
- Leg Length Discrepancies
A difference in leg length that is greater than 5 millimeters can contribute to low back pain. If the leg length difference is greater than 9 mm there is a significantly greater likelihood of having an episode of low back pain. Leg length discrepancies can be structural or functional. Depending on the discrepancy, measures can be taken to help address these and alleviate symptoms or dysfunctions.
- Body Weight Imbalances
There can be subtle structural differences in your body. These can be related to natural asymmetry or an injury, and either could potentially have a dramatic impact on the rest of your body. The parts of your body are all connected in a kinetic chain, and if there is a significant imbalance in your weight, the imbalanced force can end up making its way to your lower back (or another part of your body) causing MSK-related issues down the line. Any host of issues stemming from the foot has the potential to work all the way up to the hips, which is just a short chain link away from your low back, potentially causing you back pain.
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References
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Wilson J, Ferris E, Heckler A, Maitland L, Taylor C (2005). A structured review of the role of gluteus maximus in rehabilitation. New Zealand Journal of Physiotherapy 33(3) 95-100.
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Dananberg HJ. The Effect of Gait on Chronic Musculoskeletal pain. Manual for The Langer Foundation for Biomechanics and Sports Medicine Research, 1992 pp.16-22.
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Dananberg HJ. Gait style and its relevance in the management of chronic lower back pain. In: Vleeming A, Mooney V, Gracovetsky S, Lee D, et al. (eds): Proceedings, 4th Interdisciplinary World Congress of Low Back & Pelvic Pain, Montreal, Canada, November 8-10, 2001, pp. 225-230.
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Dananberg HJ, Guiliano M. Gait mechanics and their relationship to lower back pain. In: Vleeming A, Mooney V, Tilscher H, Dorman T, Snijders C. (eds): Proceeding of 3rd Interdisciplinary World Congress on Low Back and Pelvic Pain. European Conference Organizers, Rotterdam, Holland, November 1998.
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Dananberg HJ. Gait style and function of the SIJ. In: Vleeming A., Mooney V, Snijders C, Dorman T (eds): Movement, Stability, and Lower Back Pain. Churchill Livingstone, New York, 1998, pp. 253-267.
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Understanding Orthotics
Your feet play an important role in your overall health—they serve as a strong base to your body when you’re standing and walking. However, at times, your feet and body may benefit from extra support by wearing custom orthotics. An orthosis is an externally applied device that is designed and fitted to the body that can help1:
- Control biomechanical alignment
- Correct or accommodate deformity
- Protect and support an injury
- Assist in rehabilitation
- Reduce pain
- Increase mobility
There are varieties of prefabricated and custom-made orthoses that can help manage a number of MSK problems. Commonly, we understand that orthotics can provide arch support and realign the structures of the foot and leg, as well as prevent muscle and tendon fatigue. Orthotics may also be used to correct structural deformities2.
Chiropractors are trained to assess if and when custom orthotics may benefit a patient. As part of the assessment, a chiropractor’s evaluation may include observation, gait analysis, functional analysis and neurological and orthopedic testing among others. This will help the chiropractor determine if custom orthotics are appropriate for a patient. In some cases, off-the-shelf orthotics may be best suited to meet the needs and goals of the patient. However, in cases where structural deformities exist and correction may be required, chiropractors will typically refer to a colleague, like a podiatrist, to co-manage the condition.
Chiropractors consider the body as a whole. For example, when assessing knee pain they will also look at the function of the back, hip, ankle and foot. Interestingly, patients who benefit the most from orthotics may not present with only foot pain, but rather pain in the ankle, knee, hip or low back, and a comprehensive look at all these biomechanics are reflected in chiropractic training3.
The underlying problem doesn’t always stem from the source of pain—a foot dysfunction (e.g., over pronation) can cause pain in other parts of the body. The value of chiropractic training in the field of orthotics, when considering all therapeutic options, involves assessing the entire lower kinetic chain for patients presenting with non-foot pain.
Sourced from the CCA
References
1 The Australian Orthotic Prosthetic Association, “About Orthoses and Prostheses,” https://www.aopa.org.au/careers/what-are-orthoses-and-prostheses.
2 Sun Life Financial, “Understanding Orthotics and Orthopedic Shoes,” https://www.uoguelph.ca/hr/system/files/Understanding%20orthotics%20and%20orthopaedic%20shoes.pdf.
3 Sun Life Financial, “Understanding Orthotics and Orthopedic Shoes,” https://www.uoguelph.ca/hr/system/files/Understanding%20orthotics%20and%20orthopaedic%20shoes.pdf.
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THE FUNCTION OF A RUNNING SHOE
The function of a running shoe is to protect the foot from the stress of running, while permitting you to achieve your maximum potential. Selecting the right shoe for your foot can be confusing without the proper knowledge.
People with low arches, called pronators, will need a shoe that provides stability. A shoe with good cushioning is important for people with high arches, called supinators.
There are three main features that you need to consider when selecting a running shoe: shape, construction, and midsole.
Shape
To determine the shape of the shoe, look at the sole. Draw a straight line from the middle of the heel to the top of the shoe. In a curve-shaped shoe, most comfortable for supinators, the line will pass through the outer half of the toes. A straight-shaped shoe will have a line that passes through the middle of the toes. These shoes are built to give pronators added stability.
Construction
Take out the insole and look at what type of stitching is used on the bottom. In board construction shoes, built specifically for pronators, the bottom of the shoe will not have any visible stitching. Combination shoes, appropriate for mild pronators or supinators, will have stitching that begins halfway. On slip-constructed shoes, you will see stitching running the entire length of the shoe providing the flexibility supinators need.
Midsole
Most of the cushioning and stability of a running shoe is determined by the midsole. A dual-density midsole provides shock absorption as well as some stability, perfect for pronators. Single density midsoles offer good cushioning but are not great at providing stability, making them better for supinators.
Keep in mind that a chiropractor can help you prevent running-related problems by assessing your gait, as well as the mobility of the joints in your feet, legs, pelvis and spine.
Provided by Dr. Luciano Di Loreto, HBSc., D.C. & Associates
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Kick Up Your Heels!
Not only can those brand new high-heeled shoes cause pain in your feet (plantar fasciitis), they can cause low back pain as well. In fact, poor footwear can cause difficulties in the feet, knees, hips, low back and all the way up the spine. Generally, the best shoes for your body are relatively flat and provide adequate support.
Try these tips to reduce the pain on those high-heels days.
Shopping for shoes
Shop in the afternoon or evening, as your feet tend to accumulate fluid and swell throughout the day.
Choosing a shoe
- Choose a heel height that you can walk in gracefully. The effect of a high heel is easily negated by a clumsy walk.
- Try to choose a shoe with a heel height of no more than 2 inches. It’s a good compromise height that will still create the arched posture associated with high heels without sending you tipping out of them.
- Avoid buying shoes with a recessed heel, as it is one of the most unstable heel styles.
- Avoid shoes with many thin straps; these can dig into your skin causing pain and swelling.
- Ensure that the shoes have good support for the arches of your feet.
Give your feet a fighting chance
- Place a cushioning pad into the front of the shoe to pad the balls of your feet. This will also help keep your toes from getting wedged into the front of the shoe.
- Take a break from your heels now and then. Slip off your shoes discretely and stretch some of the tensed muscles. Wiggle your toes and make circles with your ankles to help increase circulation.
- Finally, after a long day or evening on your feet, give them a break. Wear a low, comfortable shoe the next day to rest your muscles. Soak your feet in warm water or give them a nice massage.
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