Many foot conditions eventually contribute to health concerns farther up the kinetic chain, especially the generalized condition of back pain. Therefore, it’s in the best interest of both you and your patient to be able to spot a potential low back problem before it is allowed to affect a patient’s health or lifestyle.

During standing and walking (not to mention running, in athletes) the lumbar spine and pelvis balance on the lower extremities. If leg or foot asymmetries or alignment problems are present, abnormal forces are transmitted along the closed kinetic chain, interfering with spinal function.

When excessive pronation or arch collapse is present, a torque force produces internal rotation stresses to the leg, hip, pelvis, and low back. This is where the use of foot orthotics is most effective, and can make chiropractic adjustments more effective and long-lasting.

-Alleviate musculoskeletal symptoms

-Improve musculoskeletal efficiency and sports performance

-Prevent future musculoskeletal problems

This amount of force can be the cause of persistently painful and stiff joints, especially in patients with degenerative changes in their spinal discs and joints. When made with modern viscoelastic materials, orthotics can decrease current symptoms and can help to prevent further degeneration.

The connection between orthotics and low-back pain

The foundation provided by the feet and legs must bear the weight of the entire body (and considerably more load during running and other sports). If there is insufficient or inadequate support from the pedal foundation, the spine will be exposed to abnormal stresses and strains that eventually develop into low-back pain.

Excessive stresses on the spine can be the result of abnormal foot biomechanics, poor function of the foot-ankle complex, excessive shock transmission, or leg length asymmetry. Recognizing and then responding appropriately to these factors separate the doctors of chiropractic from the spinal technicians.

When some part of the foot is not moving properly (either insufficient or excessive joint motion) the resulting forces produce negative effects all along the kinetic chain.

Foot orthotics for specific pediatric issues

Some of the situations that you may want to mention when it comes to children who could possibly benefit from foot orthotics include:

• Children who have growing pains. According to a study published in the Journal of the American Pediatric Association, a number of kids who are taken to a podiatrist with achy legs “are clinically assessed as having pronated foot posture.” They found that in-shoe devices were effective for pronated food posture and aching legs in children.
• Children with Down syndrome. A study published in NeuroRehabilitation found that children with Down syndrome benefited from foot orthotics.  In this case, the 26 subjects were all between three and six years of age and the researchers found that, for them, foot orthotics help reduce heel eversion, as well as other factors important to proper walking gait and standing foot stance.
• Children with hypotonia. Hypotonia refers to decreased muscle tone and, for children that have it, early detection and treatment is necessary to avoid walking-related issues later in life.

Conservative treatments for plantar fasciitis have included reduced activity, cryotherapy, ultrasound, taping, massage and orthotic support. While these treatments all have their merits, there are a couple of other aspects to consider.

You’ll want to look beyond the site of the symptom to see if there are some “silent partners” contributing to this dysfunction, but consider the most obvious first: the foot.

If the patient is capable of walking without an antalgic gait, look to see if there is a significant amount of foot flare during the gait cycle. Here is the rule of thumb regarding foot flare: Both feet should be pointing in the general direction the patient is walking toward.

Any significant deviation from a line directly in front of the patient involving one foot more than the other is a red flag for a biomechanical dysfunction in the kinetic chain and may be a contributing factor in the plantar fasciitis syndrome.

Foot flare is a compensation mechanism to help balance an unlevel pelvis, and there is a strong likelihood that a low medial arch is contributing to this mechanism.

If this is detected, remove the shoe and sock and observe the medial arch. In more than 80 percent of your patients, you will see some degree of excessive pronation that is most often bilateral but occasionally you may see an asymmetrical presentation.

Research has shown that measuring the navicular drop from a non-weightbearing seated position to a weightbearing standing position is a predictable indicator of excessive pronation.^1,2 This test is a reliable method to document this aspect of your patient’s foot function and has a direct correlation to the Q angle of the knee.³

Why you should scan every patients' feet

Research shows that problems in the feet can have serious repercussions throughout the kinetic chain. But how common are foot problems? By some estimates, nearly 80 percent of the population overpronates during walking and running; that’s more than three out of four adults. Excessive or overpronation has been linked to low-back pain, among many other ills that are commonly seen in the chiropractic practice.

According to the American Podiatric Association, 75 percent of Americans will experience foot health problems in their lifetime. Women on average have about four times more foot problems than men (as the cumulative effect of wearing high heels or too-small shoes).

Consider this: The average American takes about 5,120 steps a day and many take well over 10,000. Most people will walk thousands of miles over a lifetime. 

With each step, degenerative changes in the muscles, joints, and connective tissues of the feet worsen. The ligaments of the feet, especially the plantar fascia, will plastically deform; a permanent change in shape under the action of a sustained force.

And with thousands of steps at two to three-and-a-half times of one’s body weight upon heel strike, it’s not difficult to understand how this occurs. This is why all three arches of the feet must be supported during the weight-bearing gait cycle.

Clinical experience shows that foot, knee, hip, and spinal adjustments hold longer and better when the feet are stabilized. But with a compromised gait, ripple effects are felt throughout the kinetic chain.

A foot scan can quickly add insight as to what’s causing your patient’s pain. Images on the screen can compare the patient’s foot to an ideal version, revealing the level of arch deterioration, if any. The best devices will generate a comprehensive report on the patient’s foot health for further consideration.

Why aren’t your adjustments holding properly?

The pedal foundation is often the victim of unstable collapse. Pedal instability starts in the feet but causes unequal postural distortions throughout the structures above: knees, hips, pelvis, spine, and even neck (see Fig. 1).

Postural distortion is relatively easy to identify. Signs include:

• Unlevel shoulders
• A functional short leg
• Internal knee rotation
• Tilting in the pelvic structure
• Anterior cervical translation
  

Without proper support under the foot’s soft tissue, it’s highly likely the arches will collapse. And as demonstrated above, chiropractic adjustments won’t ‘hold’ properly. Orthotics help relieve musculoskeletal abnormalities and reduce symptoms by enhancing the feet’s ability to support, move, and protect the body.

The intent is to control the angle and timing of pronation, not to restrict or eliminate normal foot motion. By normalizing movement in the feet, custom orthotics encourage normal reactions along the kinetic chain.

Both systems for capturing an image of the foot have pros and cons. The orthotics that can be made from each method of foot imaging are also quite different. Understand the advantages and disadvantages of each. With either method, you’ll want to develop a good, trusting relationship with the laboratory that fabricates the orthotics.

Both systems capture a static image of the foot but the laboratories must make assumptions and determine treatment strategies. Therefore, the accuracy of the image is vitally important in both methods.

Most chiropractors appreciate the whole-body imaging that the weight- bearing procedure provides, and most patients like the more flexible and comfortable orthotics that result.

Athletes, in particular, value the shock absorption and easy tolerance of orthotics made from a weight-bearing image.