Why you should scan every patient.
It is well-documented that in the vast majority of cases you will observe bilateral and asymmetrical foot pronation when your patient is weight-bearing. This pronation is seen as the ankles roll inward, causing all three arches of the feet (medial longitudinal arch, lateral longitudinal arch, and anterior transverse arch) to decrease their height. This causes the functional (weight-bearing) foot to be longer, wider, and flatter.
And, most importantly, nearly all foot pronation is asymmetrical. This can create a formidable challenge to having the height of the femur heads level when the patient is weight- bearing after an adjustment.
For the pelvis to be level, the patient must have a level foundation, and that starts with the feet. This is why every exam should begin with a foot scan. A good way to express this to the patient is: “We’re going to start our examination from the ground up. Please step up on the scanner.”
Foot scanners are being used with greater frequency than ever before. By providing detailed images of the feet, these devices provide a full view of your patients’ postural health. Scans can be as accurate as a quarter of the width of a human hair.
Foot imbalances that may be imperceptible to the naked eye are revealed, while subsequent educational screens provide detailed graphics and images that make it easy to explain results to patients. In fact, new scanning technology in the marketplace enables patients to scan themselves while viewing patient-education graphics and videos. Within moments, you can determine if a patient is a candidate for custom orthotics and, if so, submit the patient’s scan directly from the software.
Yet despite their growing proliferation in the profession, foot scanners remain underutilized. Many doctors only scan patients if they suspect a pedal imbalance (which is actually the case with a majority of patients), or those who complain of foot pain.
Others will scan patients during the intake process, but do not follow up to show patients how they’ve progressed.
Because an examination of the pedal foundation is so important, understand why a foot scanner should be an integral part of the chiropractic intake.
Foot problems are common
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. By age 70, the average person will have walked the equivalent of four times around the globe.
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.
More than the feet
Any structural imbalance of the body will result in compensating movements in the lower extremities and pelvis, whether it’s anatomical leg-length inequality or pes planus, in order to minimize stress to the spinal column. Over time, imbalances in the muscles will develop, eventually leading to damage of the soft tissues and bones from years of repeated microtrauma.
Excessive motion during gait will also occur when a functional imbalance is present—the collapse of one or more of the foot’s arches, for example. With excessive pronation, the entire leg spends too much time in internal rotation, placing twisting stresses on the knees, hips, and pelvis with each step. Over time, this results in excessive and prolonged stretching of the hip and pelvic support ligaments, which can cause chronic pain and dysfunction.
Problems commonly linked to lower-extremity misalignment include the following:
- Low-back pain
- Hip pain
- Medial knee pain
- Patellar dysfunction
- Plantar fasciitis
- Hallux valgus (bunions)
- Achilles tendinitis
- Corns, calluses, and hammer toes
- Navicular apophysitis
- Shin splints
- Fractures in the first and second toes
- Ankle sprains
Addressing your patient’s excess pronation prevents further deterioration of the condition and the development of new ones.
You can also look for the “five red flags” of pronation in your patients, which are: foot flare, medial knee rotation, bowed Achilles tendon, flattened or low medial longitudinal arches, and excessive wear on the posterior or lateral edge of shoes.
A digital scan of your patient’s feet, however, will accomplish this in less time with the benefit of detailed imaging and reports that explain the findings and their implications.
Asymptomatic is not problem-free
When you prepare your patient for a foot exam, you may hear a bewildered, “But doctor, my feet don’t hurt.” Explain to your patient that asymptomatic feet do not equal problem-free feet.
Subluxated joints in the lower extremities may not be painful, but they can cause biomechanical issues, neurological deficits, and other problems not necessarily related to pain. In fact, most feet that need to be adjusted and stabilized will probably never become painful.
The typical adult with excessive foot pronation does not experience notice- able foot symptoms, beyond the appearance of a longer, wider, and flatter foot. The most common adult pattern involves bilateral but asymmetrical excessive foot pronation, internal tibial, and femoral rotation, with some degree of pelvic tilting and anterior translation. Neurologically, this condition causes proprioceptive changes and muscular imbalances.
Effective chiropractic care requires adjustments, stabilization, and neuro- muscular rehabilitation. Abnormal lower-extremity biomechanics represent a primary source of structural weakness that promotes chronic forms of back pain, among many other conditions commonly seen in the chiropractic office.
Mark Charrette, DC, is a 1980 summa cum laude graduate of Palmer college. he is a frequent guest speaker at chiropractic colleges worldwide and has taught more than 1,400 seminars worldwide on extremity adjusting, biomechanics, and spinal adjusting techniques. he can be contacted at firstname.lastname@example.org.
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