Help your patients one foot at a time
By Kevin M. Wong, DC

When you go to your clinic each morning, do you figuratively put on a set of blinders? That is, have you become so set in your ways you may not see new opportunities to help your patients and yourself?

One opportunity is to look at how your patients walk.

Did you know that 80 percent of the population exhibit some form of excessive foot pronation? That means eight out of 10 people roll in on their feet to some degree.

This action chronically stretches the plantar fascia and foot muscles and causes the arches of the foot to collapse. Arch collapse can take a toll on different parts of the body — including ankles, knees, hips, and lower back.

The source of lower extremity and/or lower-back pain of many patients can be traced to the feet.

The key to helping these patients is to identify the involvement of the excessively pronated foot early in your treatment plan, so you can efficiently implement treatment protocols that will ease these patients’ pain and stabilize the joints of the body.

To find these problems early, use simple tests that take very little time, but clearly indicate when someone has arch problems:

• Use your eyes. Watch your patients walk just a few steps and have them stand up straight to assess their foot stability.

When you see them walk and stand with their shoes and socks off, you can observe the medial arch collapse. In the condition, the Achilles tendons bow inward as the inner arch collapses.

Bunions on the first and fifth metatarsal heads are an indication of metatarsal or transverse arch collapse.

Look to see if the toes curl and/or are deviated toward the midline of the foot.

You can also check for “five red flags.” These are five important things to look for that will help you determine if a patient needs orthotics. (See sidebar, “5 foot-problem flags.”)

• Use your hands. Chiropractors are experts at palpation, so put your skills to good use.

When you touch the patient’s feet, here are some findings to look for:

1. Tight plantar fascia that may or may not be painful;

2. Heel spurs that are large enough to be palpable;

3. Achilles tendon tightness or pain;

4. Callouses underneath any of the metatarsal heads; and

5. Bunions on metatarsals one and five.

Another way to check for arch problems in the feet is to use manual muscle testing:

1. Test bilaterally the iliopsoas, gluteus medius/minimus, and quadriceps/hamstring muscles. Note the relative strength of each.

2. Adjust bilaterally the navicular, cuboid, and metatarsal heads.

3. Retest the muscles in step one and note the increase of relative strength.

This test reveals suboptimal strength and/or imbalances in otherwise normal, healthy muscles.

• Use measurements. Another easy way to determine the need for orthotics is to use a postural stability indicator (PSI) card. You can measure and document a patient’s pronation and/or pedal imbalance with the navicular drop test.

With the patient sitting (feet on the floor, without bearing weight), find and mark the navicular prominence on each foot. Stand the card on the floor next to the medial arch of the foot and mark the card at the level of the navicular prominence mark. Then, with the patient standing in a weight-bearing position, follow the same procedure.

The PSI card measures the navicular drop on each foot. These measurements help determine the amount of pronation on each foot. If present, it will also demonstrate pedal imbalance.

• Use your skills. Now compile the information you have gathered and form a treatment plan. Below are common treatment procedures:

1. Adjust the foot bones (calcaneus, cuboid, navicular, cuneiforms, metatarsals, phalanges);

2. Prescribe custom-made, flexible orthotics that support all three arches;

3. Use taping procedures to support the three arches;

4. Prescribe exercises to strengthen the arch muscles and relax the connective tissue; and

5. Examine the patient’s footwear to make sure it is supportive.

Many of your patients have had problems with their feet for years, but you may be the first person who noticed. By using these exam and treatment procedures, you have the power to help patients understand what is happening and why.

Do not be intimidated by puzzled looks and questions about why you are looking at their feet. Most of the time, their feet don’t hurt when they come into the office.

The feet are the key to discovering the bigger picture behind patients’ problems, and you will miss it if you don’t know what to look for.

Kevin M. Wong, DC, is a 1996 summa cum laude graduate of Palmer College of Chiropractic West in San Jose, Calif. In 1997, he was named Clinician of the Year by Palmer College of Chiropractic West, where he has taught chiropractic technique. He practices in Orinda, Calif., and is a speaker for Foot Levelers seminars. He can be contacted by e-mail at drkevinwong@gmail.com.