The spine cannot be the lone source of issues for chiropractic patients — foot arch support can play a large part
Through much of our schooling, we learn what it truly is to be a chiropractor. We recall the famous story when in 1895, D.D. Palmer adjusted the fourth dorsal on a prone-facing Harvey Lillard. This adjustment returned Mr. Lillard’s hearing to him and gave birth to our profession. The spine is what we start learning about early in our curriculum and its importance becomes ingrained in us. We understand and appreciate how critical it is for patients’ spines to be in alignment neurologically, physically and emotionally. It’s what we all believe — but how much of an issue is foot arch support?
Seeing beyond the spine
The issue arises when our eyes see only the spine as contention for patients’ symptoms. Often, the time spent learning about the extremities, especially the feet, is considerably less than our time learning about the spine. It really depends on how each of you not only learned the material, but if you used it in student clinic and right when you got out into practice.
A majority of health care, especially in the United States, is symptom-based. The practitioner focuses on where the patient points to the pain. While this idea may be accurate in some of the cases, many times it is incorrect. Instead of chasing symptoms, chiropractors understand the big idea: Our body is a dynamic biomechanical organism, and body parts are interrelated.
Nowhere is this more evident than your own two feet and foot arch support. The feet are the foundation of our entire body and it is easy to forget how critical their role is to normal, daily life. What is interesting is that only when the feet become painful or “ugly” (bunions, hammer toes, hallux valgus) do patients begin to pay attention.
Plantar fasciitis, neuromas, metatarsalgia, heel spurs, Achilles tendonitis, shin splints, knee pain, lower-back pain, hip pain and knee pain are just a few examples of what occurs when feet are problematic. Let me explain how looking outside the painful area will help you discover the source of the real problem. If you think the feet aren’t important, think again!
Consider the feet
The feet are one of the most overlooked parts of the body, especially for chiropractors. Aside from clinical anatomy and a class on lower extremity, some of us don’t have a lot of exposure to the feet. Each foot has 26 bones (52 total) and when you consider the body has 206 bones, 25% of your bones are in your feet. Recall that the feet have three arches (not just one) supporting them underneath.
The feet have 3 main functions:
1. Weight Transmission
When we are standing up, the weight from our body moves through our femur and tibia bones and places pressure initially on the dome of the talus bone. Ideally, weight will then be distributed across the feet so that the distribution equals 50% on the hindfoot and 50% on the midfoot/forefoot.
Also understand that healthy weight bearing involves some collapse of our arches into normal, healthy foot pronation. This allows our feet to grip the ground properly for optimal contact.
2. Balance Posture
Posture is a balanced position meant to keep you stable and prevent falling or swaying while weight bearing. Balancing and maintaining normal posture involves contraction of the approplantar fascia and spring ligaments underneath the feet to give the arches proper support. Secondarily, the gastrocnemius, soleus and plantaris muscles help. These connective tissues help distribute weight properly to balance things out.
3. Assist Ambulation and Gait: Moving from one place to another
Ambulation includes walking, running, jumping, etc. Various forces will influence motion on the body that can be forward, backward or in a lateral direction. Specifically looking at the walking, or gait cycle, we observe some key functions of the feet.
On average, a shockwave of five Gs hits the calcaneus bone during heel strike. This wave moves through the lower extremity, the spine and up to the head/TMJ, becoming .5Gs in 10 milliseconds.¹ The ankle inverts and the foot supinates during this stage and 30% of this initial ground shock is absorbed.
During foot flat, the foot pronates at the subtalar joint. The tibia/femur bones internally rotate so the foot can contact the ground properly, completing normal pronation. In the toe-off phase, the feet go back to supinating as the toes dorsiflex. Then the foot stiffens back up and begins its journey through the swing phase.
Throughout the walking cycle, plantarflexion, dorsiflexion, pronation (internal rotation) and supination (external rotation) must all occur. Additionally, the big toe movements of flexion, extension, adduction and abduction are also utilized so that weight is properly distributed, and the foot is anchored and then propelled in the right direction.
Aside from the three main functions, the feet have a larger role in overall biomechanics and stability for the body via foot arch support. We have been discussing how the feet help support normal, healthy weight-bearing individuals. Let’s throw into the mix that over 85% of my patients who present for care are over-pronating. In other words, their feet are flattening out to some degree. That equates to 8-9 out of 10 patients who walk into your clinic pronating.
Think about this for a second: If over 85% of your patients are exhibiting mild, moderate or severe foot flattening or arch collapse, do you think that can affect the rest of their body? Of course! And it is something that is happening to your patients whether you are looking for it or not.
Flat feet and a cascade of stress
When the feet are flatter, they lose their ability to absorb the 30% of initial ground shock, so that is more stress going up the axial kinematic chain. The static postural observations exhibited from overpronation include: bilateral, asymmetrical foot pronation; anterior pelvic translation; thoracic kyphosis and forward head carriage.
Biomechanically, the collapsed arches set up a cascade of stress that puts stress in the medial ankle. Following the pattern upward, we notice too much medial rotation of the tibia and femur. The patella moves medially and the inner knee becomes stressed. The pelvis tilts toward the side of the worse foot pronation, and the excessive inward rotation of the femur bone pulls the femur head laterally. There is resultant lateral curvature of the lumbar spine, affecting the thoracic region and ribs. The shoulders tilt as a response, and further stress is placed on the neck.
The feet are an incredible source of clinical information and they are effective indicators for healthy and unhealthy standing, walking and movement patterns.
Kevin Wong, DC, earned a BS in exercise physiology from the University of California-Davis and his DC degree from Palmer Chiropractic College West. He practices in Orinda, Calif., and serves the Lamorinda, Berkeley, Walnut Creek and many other East San Francisco Bay Area communities. He is an expert on foot analysis, walking and standing postures, and orthotics representing Foot Levelers. He lectures nationwide on spinal and extremity adjusting.