In his text Orthopedic Physical Assessment, Magee1 states, “At least 80 percent of the general population has foot problems.” He goes on to say that “these problems can often be corrected by proper assessment, treatment, and above all, care of the feet.”
The 80 percent statistic is interesting as it is a familiar number to doctors of chiropractic. For decades, many studies and texts have stated that 80 percent of the general population will experience back pain at some point during their lifetime.2 It must be stated here that both statistics are for problems in general and the stats are not broken down by diagnoses.
Is there a link between the two regions and their dysfunctions? The opinion here is yes, especially when the common problem of excessive foot pronation is considered. Hunter, Dolan, and Davis cite a 1981 study by Botte that suggests a strong relationship between excessive pronation and lower back pain. Pain was thought to be secondary to excessive pronation causing displacement of the sacroiliac joint.3
An in-house study by Foot Levelers Inc. found that 77 percent of chiropractic patients had mild to moderate over pronation.4 Considering the primary condition treated by chiropractors is lower back pain, a strong correlation between the feet and spinal pelvic conditions is suggested.
While Botte’s study linked the over pronation of the foot to sacroiliac displacement, it did not discuss the structures and joints between the foot and sacroiliac joint. Pronation affects multiple structures between the two regions.
Excessive pronation of the foot may result in any or all of the following; asymmetrical shoe wear, medial bowing of the Achilles tendon (Helbing’s Sign), increased foot flare (Increased Fick Angle and/or Too Many Toes Sign), Drop of the Navicular bone in the medial arch of the foot, increased Q-Angle of the knee, and anterior rotation of the pelvis and pelvic obliquity. Anterior pelvic rotation and obliquity are consistent with sacroiliac displacement.
Most chiropractic adjusting techniques begin their analysis of the human kinetic chain at the level of the pelvis.5,6 The analysis in some techniques is not only used to determine where to adjust, but to determine the need for and size of a heel lift.
The heel lifts when used are placed without consideration given to measuring for functional or structural short legs in the lower extremity. Consideration of other lower extremity factors is also absent in most cases.
Despite the emphasis from some factions in the chiropractic field for over five decades,7 extremity evaluation and treatment has only been a part of most chiropractic college curriculums for the last decades.
Prior to this, extremity evaluation and treatment was relegated to an elective course. This detail left generations of chiropractors without the skills necessary to consider, evaluate, and treat extremity problems. The deficiency was only addressed through elective and postgraduate courses.
The information above directs doctors of chiropractic to the need to assess the human kinetic chain from the bottom up. At some point during the examination process, the feet, knees, and hips should be assessed to identify any factors that may be affecting a patient with spinal-pelvic complaints, as well as any complaints in the lower extremities.
An initial assessment of the feet can begin with the scanning of the patient’s feet with a scanner such as the Associate Platinum digital scanner sold by Foot Levelers. The scanner can be used in the quick scan mode to assess the patient at the beginning of the patient evaluation.
Since the results obtained can be interpreted later, the scan can be performed by a staff member along with other vital signs prior to the doctor entering the examination room. After the doctor’s history and physical assessment of the patient, the doctor can review the scan for signs of foot problems (primarily pronation) that can relate to foot and/or spinal-pelvic problems.
It should be emphasized that the scanner results must be correlated with history and physical findings prior to diagnosis and treatment. Once pronation, other foot problems, or spinal-pelvic problems are identified, the scanner results can be utilized to determine the need for adjustment of the lower extremities, orthotic support, and rehabilitative protocols.
The kinetic chain and the maladies of the lower extremities, pelvis, and spine must be adjusted, supported and rehabilitated in order to achieve optimum results.7
As it becomes increasingly evident that assessment and treatment of the kinetic chain must begin at the ground, chiropractic evaluations must evolve to meet this need. Only then can the profession move toward fulfilling the wellness doctrine stressed in recent years.
1Magee DJ. Orthopedic Physical Assessment (5th ed.). St. Louis: Saunders/Elsevier, 2008.
2Souza TA. Differential Diagnosis and Management for the Chiropractor, Protocols and Algorithms (3rd ed.). Boston: Jones and Bartlett, 2005.
3Hunter S, Dolan MG, Davis JM. Foot Orthotics in Therapy and Sport. Champaign, IL: Human Kinetics, 1995.
4Peterson JD (Ed.). Palmer College of Chiropractic Adjusting Technique Manual. Davenport, IA: Palmer College of Chiropractic, 2003.
5Cooperstein R, Gleberzon BI. Technique Systems in Chiropractic. London: Churchill Livingston, 2004.
6Hyland JK. Spinal Pelvic Stabilization, A Practical Approach to Orthotic Application. Roanoke, VA: Foot Levelers Inc., 2002.