The feet have a story to tell for every patient, and orthotics for feet are making chiropractors’ jobs easier
The average patient who seeks care from a chiropractor has little knowledge of how their body actually works. They are accustomed to taking a pill, getting a shot, getting surgery, or being referred immediately out for physiotherapy, with little knowledge of what orthotics for feet can accomplish.
Patients often come to our offices out of frustration and desperation and their musculoskeletal knowledge is very lacking. As chiropractors, identifying the cause of the biomechanical issues often provides a greater depth of understanding of the patient’s condition and improved success of their treatment plan.
Orthotics for feet: the light bulb moment
In my first month of practice, I learned that my low-grade, chronic, right sacroiliac and medial knee pain disappeared after a pair of three-arch, flexible, custom-made foot orthotics were placed in my shoes. A bright light bulb went off in my head.
Further research indicated that the majority of musculoskeletal pain that patients present with has a significant link to the feet and the arches. That began my 24-plus-year crusade to teach every chiropractor, patient, and anyone who would listen, about the feet and the strong relationship they have to overall body health.
‘What should I be looking for?’
The feet are the foundation of our human “house.” Everything that affects the feet will be reflected upward to the rest of the joints.
Picture, in your mind, a house with a cracked foundation and a cracked chimney. The instability of that house comes from the ground up, just as it does in our bodies. The feet support the weight of the entire body so how efficiently they do this will then dictate biomechanical health or stress to the ankles, knees, hips, pelvis, spine, shoulders and jaw/skull. In essence, the more unstable our feet are (cracks in our human foundation), the more likely we are to see cracks (instabilities, stress, pain, injury) to the structures above.
We will focus on flat, over-pronated feet because in my experience, they are typically are seen in up to 87% of my patients. Patients with excessively supinated feet and healthy arch support make up the remaining 13% and are less commonly seen in my practice.
One of the biggest fallacies our patients have in their minds is that we have only one arch under the inside of each foot. In fact, we have three functional arches that form the plantar vault or underside of each foot.
When the three arches are well supported, we are none the wiser. Weight-bearing posture is healthy, supported, and more stress-free. What patients don’t realize is that by age seven, the arches are fully formed. They will not get any more support after that no matter how much bigger our feet get.
This is the age where foot arch issues begin, and we can start seeing them flatten (overpronate). Many of the reasons for this excessive pronating are based on genetics, sports, shoes, gravity, injuries, and some other factors. Some patients show this very early and others later in life. But it is something very important to observe as it literally gives you a roadmap for stress and subluxation patterns in the patient’s body. Look at the picture of the “Crooked Man” below.
Going up the kinetic chain
You can observe in this picture what happens in an individual who is overpronating more in their left foot. Start from the left foot and follow the diagram upward. See how the left foot rolls inward as the arches have fallen? The tibia, patella and femur bones either rotate or move medially as compensation for the arch collapse.
Notice how the pelvis tips and rotates, creating some mild lumbar scoliosis. Moving upward, you can see the effect on the shoulders, neck and head. Flattened arches create a cascade of negative biomechanics from the ground up. You can see why people can have pain in all the joints just based on seeing this picture. Imagine that the earlier someone starts showing excessive pronation signs, the more years they can have for their body to become damaged and painful.
There are five easy ways to spot excessive foot pronation. Keep in mind that all five of these are consequences of flattening or flattened arches. Excessive foot pronation is bilateral and asymmetric (one foot is worse than the other).
- Foot flare during gait: As the arches of the foot keep flattening, the feet flare. You can often spot one foot being more pronated than the other due to the foot flare. Often, it’s worse on one side vs. the other.
- Internal knee rotation: This is due to the excessive internal rotation of the tibia/femur and their subsequent increased pull on the patella in a medial direction.
- Bowing Achilles tendons: As the arches fall, the foot flattens out and the Achilles tendons bow medially. This is one of the easiest and most obvious things to observe.
- Flat feet: The medial arches (which are the last ones to fall) are visibly dropped or flattened.
- Lateral heel wear (excessive): Since the patient is overpronating in the foot flat portion of the gait cycle, they over supinate on heel strike. This causes too much lateral heel wear. You will notice in runners and heavy walkers/hikers that they tell you about having to replace their shoes every 4-6 months. This will change once proper foot alignment is restored.
One of the easiest ways to observe all five of these red flags at once is having the patient stand on a 3D, digital, laser foot scanner. I suggest you scan every patient and make it a part of your new-patient protocol. This way you catch everyone’s degree of pronation whether they are mild or severe.
When we just “eyeball” the foot arches, our eyes can miss details and characteristics about the feet that the scanner will pick up. A full-color readout on the display, along with an email sent directly to the patient, provides information on the three arches and the biomechanical effects on the patient’s body.
Scanning tech and 3-arch support for patients
I have used scanning technology since 2002 and it’s become more accurate and high-tech since then. This information is not only useful for helping to educate the patient about foot biomechanics but also helps them understand why they need their custom orthotics.
Orthotics for feet will effectively and uniquely support the three arches of each foot and greatly reduce and improve the biomechanical stresses seen in the “Crooked Man” diagram you saw earlier.
Some important points about custom, 3-arch, flexible orthotics:
- Patients need to wear them whenever they are weight-bearing. No matter where the patient is (home, work, exercising, etc.), whenever they are on their feet, they need to be wearing their orthotics. Many people don’t wear them in their house, but floor surfaces like tile, hardwood, etc. are very hard on the feet and body.
- Shoe styles require different types of custom orthotics. For optimal stabilization, make sure your patient has the right orthotic for all their footwear, from work and dress shoes to athletic shoes for various sports.
- Check the patient’s shoes to make sure they are supportive and in good shape. Worn-down or poor-quality shoes are not healthy for the foot and will not allow the orthotics to work as well.
To this day, I still observe that most health care practitioners ignore the feet or give them a cursory look-over. It’s not hard to learn and understand the basics of foot analysis and the prevalence of excessive pronation. The fact that 99% of the population has some degree of overpronation hopefully reinforces and motivates you to be checking the feet in every patient.
KEVIN M. WONG, DC is a graduate of the University of California-Davis and a 1996 graduate of Palmer College of Chiropractic West. He has been in practice for over 24 years and is the owner of Orinda Chiropractic & Laser Center in Orinda, Calif. As a member of Foot Levelers Speakers Bureau since 2004, he travels the country speaking on extremity and spinal adjusting. See upcoming continuing education seminars with Foot Levelers Speakers at footlevelers.com/continuing-education-seminars.