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.

When to prescribe pediatric foot orthotics

There are several are things parents can look for to decide if child could benefit from foot orthotics. Some to consider include:

• If the child continuously trips or falls
• The soles of their shoes show uneven wear
• A child who doesn’t want to walk on his or her own more that those their age.
• Unusual foot position while the child is walking,
• Skin abnormalities on the child’s feet.

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.

Shin splints is a painful condition characterized by inflammation of the tendons, muscles and bone tissue around your shinbone.

It may occur for any numbers of reasons, too. Often emanating from the soleus muscle, shin splints are extremely sensitive to the touch. According to a report by the Center for Enhanced Podiatric Function, foot orthotics may relieve pain and even prove a viable option to surgery.

If a patient is prone to shin splints, you may want recommend orthotics to prevent future re-occurrence in certain situations. Orthotics are custom-fitted inserts for footwear. Depending on the condition, precise measurements of the foot, leg, and gait may be needed. Orthotics are made from a variety of materials such as plastic and leather and function biomechanically with the foot.

It would be a good idea to try orthotics if the patient has problems with foot pronation; misalignment of the foot and leg; a very high arch in the foot; or a stress fracture of the tibia due to repetitive motion. Patients should also wear supportive shoes with good cushioning moving forward if they deny orthotics.

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Gait analysis ensures optimum aid from foot orthotics. Many foot orthotics are available on the market to consumers right off the shelf without a doctor. Some drug stores have even included a foot-mapping machine to complement their products for sale. However, people suffering from more severe or specific issues will need to consider custom foot orthotics, which are selected and shaped based on thorough gait analysis. 

From walking to running, gait describes the way a patient moves on his or her feet. Individuals may have a very pronounced swinging of the hips, knees that bow outward, or even feet that roll inward. A gait analysis aims to reveal a patient’s biomechanical patterns related to foot movement, searching for any dysfunctions that may lead to pain or other conditions and issues.

Each gait analysis can include observations with the naked eye, as well as recorded footage of the patient on a treadmill. Such data can then be analyzed to identify any biomechanical factors that affect the person’s gait that cause pain, discomfort, or chronic condition.

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.

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Evaluation of functional leg-length discrepancy

Leg-length discrepancy (LLD) may affect as much as 60 to 90 percent of the population, which should be of great concern to chiropractors. Whether functional or anatomical, the condition has profound effects on the body’s functional integrity and the biomechanics of the lower lumbar spine and sacroiliac joints.

Symptoms associated with LLD are diverse, but the most common is backache. Other symptoms include arthritis of the knee, psoasitis, arthritis of the hip, patellar tendinitis, patellofemoral pain syndrome, plantar fasciitis, medial tibial stress syndrome and metatarsalgia, iliotibial band syndrome with lateral knee pain, trochanteric bursitis, sacroiliac discomfort, Achilles tendinitis, and cuboid syndrome.

Whenever you check a patient on the treatment table, whether prone or supine, errors of positioning are introduced and LLD is difficult to determine. Measurements of leg length obtained in a non-weight-bearing position tend to be unreliable.

Many variables (such as subluxations in the pelvis and spine, and muscle imbalances) affect the alignment and relative positioning of the legs and feet when a patient is lying on a treatment or exam table. In a relaxed, upright posture, these confounding factors are no longer an issue. Then accurate clinical and radiographic determinations are possible and chiropractic care can proceed.

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.

The location of women in the U.S. also has an impact on their shoe choice and dictates the average heel height.

According to a shopping website study, Puerto Rico, Florida, and Nevada women have an affinity toward stilettos or higher-heel heights^. In addition, they tend to wear shoes that are too small for their feet; a survey on women’s shoes found that women commonly wear shoes that are smaller than needed, and that nearly 75 percent of those surveyed were found to have one or more foot deformities.

It has also been noted that as the shoe heel is higher, the wearer perceives the foot to be shortened, and this leads to the choice of a smaller shoe size. The literature does support this theory, and also that the shorter the shoe heel, the longer the foot is perceived.

The higher the heel height, the greater the pressure on the metatarsal region and medial forefoot and impact during foot strike during gait, which can be enhanced if the individual experiences pronation with normal gait. This is in addition to the anatomical shortening of the Achilles tendon due to chronic wear of excessively high heels and improper biomechanics of the foot.

As heel height increases, it is common on a postural analysis to note that the knees tend to become hyperextended and this results in an associated hyperlordosis of the lumbar spine. As the lordosis increases, the pelvis should be analyzed for anterior pelvic tilt. It has also been noted that younger females tend to have greater impact on the lumbar lordosis from heels than older females.

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