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:
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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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.
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.
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.
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.
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.
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
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.
When you think about your back pain, do you consider the health of your feet? Maybe not. We read this blog on the Canadian Chiropractic Association and thought we would share it with you!
Your feet serve as the foundation for your entire body as it moves. Dysfunction in your feet can manifest as pain in other areas of your body like your back. Did you know that studies have linked flat feet, excessive pronation, ankle instability, and ankle joint dysfunction to low back pain? Faulty foot biomechanics, like the ones we just pointed out, can have a negative impact on all supporting joints above the foot/ankle complex, including the low-back region.
For some people, even those with faulty foot biomechanics, they may not experience symptoms like others do. But for those at risk, read about how your feet may be linked to the pain in your back:
Flat Feet: Flat feet can increase risk of back pain due to flattening and rigidity of the arch. For people who have flatter arches, the feet may not adequately correct how the forces disperse on landing. This can result in forces being translated up to other structures, like the back, causing pain and discomfort1. Foot orthotics can help correct flat feet (pes planus).
Leg Length discrepancy: This is literally a difference in leg length between one and the other. Leg length discrepancy can be structural or functional. To accommodate the difference, the body will adapt and in some cases may result in a functional scoliosis. Also, to compensate, muscles and other soft tissues may be affected which can cause pain and discomfort1.
Excessive Pronation: Over-pronation occurs when the foot and ankle joint collapse in the centre from bearing weight. The foot absorbs axial rotation of the leg during gait and then prepares the body to react against contact with the floor2. Foot orthotics can help improve pronation.
Ankle Instability: Ankle instability can be due to an injury, or due to irregular neuromuscular control of the ankle. Studies have shown a correlation between moderate to severe ankle instability and the risk of low back pain3.
So if you are experiencing back pain, consider the role that other structures may play. How your feet function as you move, work, and participate in activities you love can impact the rest of your body.
1O'Leary C, Cahill C, Robinson A, Barnes M, Hong J. A systematic review: The effects of podiatrical deviations on nonspecific chronic low back pain. Journal Of Back & Musculoskeletal Rehabilitation [serial online]. April 2013;26(2):117-123 7p
2Rothbart B, Estabrook L. Excessive pronation: A major biomechanical determinant in the development of chondromalacia and pelvic lists. J Man Phys Ther. 1988; 11(5): 373-379.
3Marshall PW, McKee AD, Murphy BA. Impaired trunk and ankle stability in subjects with functional ankle instability. Med Sci Sports Exer. 2009; 41(8): 1549-57.
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.
Perhaps, you have something called plantar fasciitis…..
What is Plantar Fasciitis?
Commonly (but not exclusively) found in runners, plantar fasciitis (more currently referred to as plantar fasciosis, plantar fasciopathy, or heel foot pain) is a common cause of back heel pain. The most commonly known syndrome is sharp pain at the bottom of the heel with the first few steps out of bed. Pain can also occur with prolonged walking, running, or standing. The cause of this condition is a build up of tension in the tissues under the feet (the plantar fascia) which tugs on the inferior aspect of the heel bone causing pain. Sometimes this constant tug of the heel bone creates a heel spur at the back of the foot.
What symptoms may I experience?
-Symptoms include heel pain, under the heel and usually on the inside, at the origin of the attachment of the fascia.
-Pain when pressing on the inside of the heel and sometimes along the arch (see plantar fasciitis diagnosis).
-Pain is usually worse first thing in the morning as the fascia tightens up overnight. After a few minutes it eases as the foot gets warmed up
-As the condition becomes more severe the pain can get worse throughout the day if activity continues.
-Stretching the plantar fascia may be painful.
-Sometimes there may also be pain along the outside border of the heel. This may occur due to the offloading the painful side of the heel by walking on the outside border of the foot. It may also be associated with the high impact of landing on the outside of the heel if you have high arched feet.
Sourced from http://www.sportsinjuryclinic.net/sport-injuries/foot-heel-pain/plantar-fasciitis
What treatment options are available to me?
Several treatment options can help relieve tension in the tissues including soft tissue therapy, interferential current, cold therapy, graston, ultrasound and custom made orthotics (for shock-absorption). To learn more about how these techniques may help you, please feel free to contact us.