Whether you have thought about it or not, the body is interconnected. Often, back pains stem from a pathology in the foot, as it relates to a person’s gait (the way they walk), and their arch profile. Alternatively, some back issues can end up causing pain in the feet.
Persons can be placed in orthotics for a variety of foot problems, where the orthotic is intended to modify the patient’s gait. Upon review, many patients indicate that not only are their feet feeling better, but they have noticed that their back issues and posture have improved too.
Foot Function and the Lower Back
On average, a person will walk anywhere from 2,500 to upwards of 15,000 steps per day. There is the ‘fitbit’ and other such devices to measure that now. If there is a malfunction occurring in either or both feet, over time it will cause a stress point somewhere along the kinetic chain. A term that is used quite frequently these days in musculo-skeletal pain, is ‘repetitive stress’. It’s where the accumulation of small stress leads to a major pain; in this case, the lower back. This repetitive stress which plays out day after day, week after week, year after year, may eventually lead to the breakdown of joints. It would then lead to: arthritis, a breakdown of muscle, leading to muscle fatigue, and ligament issues.
Generally speaking, there are two instances where a foot imbalance may lead to back pain. Prolonged periods of standing, and after walking a fair distance. This pain may occur as a result of abnormal foot function, even though there is no actual foot pain. If you are suffering from chronic back pain, and treatment directed at the back has not helped, then the next logical step would be to look at your feet as the source of your back pain.
If there has never been a direct trauma to the lower back, and your complaints of lower back pain seem to come out of nowhere, this would be a good indication to at least look at your feet as a source of your pain.
One of the purposes of the foot, is to absorb shock when the heel comes down. Normal heel strike in most individuals is on the outer side of the heel, so that is where you will notice excess heel wear on your shoes. If there is limited motion, or no motion in the ankle joint, shock will not be adequately absorbed by the foot. This excess shock then goes up the leg, all the way up to the lower back. A lot of this shock may be absorbed in part by the ankle, knee, and hip joints. But if any of the excess shock reaches the lower back, over time it may cause issues within the back itself.
So, lack of shock absorption, is one issue that may adversely affect the lower back. The next is a limb length discrepancy, where one leg is shorter than the other. Most people exhibit some degree of limb length discrepancy, but in very general terms, any discrepancy less than a half inch, is not considered pathological.
In situations where there is an abnormal discrepancy, it may impact the lower back. A flexion deformity of the lower back, let’s say from poor posture like not sitting up straight, causes the vertebrae to not line up properly. If additionally there is a limb length discrepancy, the difference in the limb length can then cause further exacerbation of the poor alignment, on one side of the vertebrae. There are a few conditions within the foot itself that will alter one’s gait, just enough to create repetitive stress, which in most cases will lead to a foot problem. In a certain percentage of cases, it will also lead to back pain.
Foot Problems that can Affect Gait
Some of these include:
- Hallux limitus – This is the inability of the big toe joint, to allow the big toe to bend upwards. It’s the bending upwards of the big toe, that allows us to propel our foot off the ground, and move it forward to the next step. If there is a “hitch” in the ability to propel the foot forward, this may manifest itself as lower back pain.
- Arthritic changes – In the mid portion of the foot, it’s another problematic area. In the mid-stance part of the gait cycle, where the foot is supposed to be flat on the ground, any problems in the mid-foot may cause another “hitch” in an otherwise smooth gait cycle, thus leading to pain in the lower back.
- Lack of ankle dorsiflexion –The foot bending upward, relative to the leg at the end point of mid-stance, will also have the potential to cause back issues.
Usually, I will see a patient for a specific foot complaint, possibly one of the aforementioned foot problems. In an effort to address the foot issue, I may prescribe an orthotic (arch support). If it is effective for the foot problem, then it would stand to reason that the same orthotic will have a positive effect on the lower back. It is not to say that an orthotic will cure a lower back problem. However, if it can be determined that part of the back pain is coming from a foot malfunction, then an orthotic will be very helpful.
As mentioned earlier, if your back pain is most noticeable after long periods of standing, or if it seems to worsen after you have been doing a lot of walking, then it is important you get your feet evaluated; have a biomechanical assessment done.
Your feet mirror your general health . . . cherish them!