Knee pain? Lower back pain? Rotator cuff problems?

What do these painful conditions have in common? 

The feet are comprised of 26 bones, and over 30 joints. In addition, there are approximately 20 muscles that work together to give the foot its unique shape, and create the movement necessary for proper ambulation. If you’ve ever watched someone who has had their arms/hands amputated, you will see that their feet are able to perform almost any function that their hands used to perform!

The functional relationships of the bones, muscles, tendons and ligaments are necessary to provide shock absorption, set the stage for postural alignment when standing, and to provide a functional lever for propulsion when walking, running or jumping. As the first point of contact with the ground when walking, the foot will absorb up to 1.5 times your bodyweight at the heel each and every time you put your foot down. When you start to pick up the pace, the load on each foot increases to 3-4 times your bodyweight while jogging or running!

In addition to the biomechanical needs for proper foot alignment, important nerve information comes from the joints of the feet, serving to keep the body informed as to what is happening at the level of the ground. This information is crucial with respect to the postural muscles in your back and your neck, as they require this information to properly maintain your balance. This is one of the main reasons why weakness in the feet can contribute to chronic lower back pain. When the joints of the feet are out of their proper position, which can even happen with normal everyday wear and tear, the information that comes from the joints of the feet is altered, and the body’s ability to function and respond to normal postural demands is compromised. Imagine what affect this may have when you decide to add 200-300 pounds across your shoulders and do some deep squats! Or, what about when you decide to take a long run on the forest trails or go for a hike on the local mountain?

In my clinic, I see many patients with problems in their knees, hips, or spine which are directly caused by, or worsened by, improper foot biomechanics. One of the most common foot faults is over-pronation, or inward rotation of the foot and ankle. This can be caused by failing arches in the foot, but it can also be caused by a rotated pelvis, or an unstable ankle joint. When standing, a person should be able to comfortably slide the tips of their fingers under the inside part of your foot (the longitudinal arch). In addition, the Achilles tendon should appear to be perfectly vertical, in line with your heel and lower leg. If the arch of the foot has flattened, or the Achilles tendon appears to be curved inward, you are likely an over-pronator, and this could be contributing to a multitude of other painful syndromes in your body.

Most common syndromes related to problematic feet.

When a person over-pronates, the subsequent flattening of the arch of the foot will place an excessive amount of strain on the tendons and soft tissues that support the longitudinal arch. As a result, this person is more likely to experience plantar fasciitis, or an inflammation of the soft tissue on the bottom of the foot. This is particularly painful in the morning when first stepping out of bed, and is aggravated by prolonged standing or walking. Another common complaint from those people with fallen arches is shin splints – a painful irritation of the insertion points for the muscles attached to the tendons that support the arch. Pain is felt along either side of the bone of the lower leg (the tibia), and is aggravated by any prolonged weight-bearing activity, especially running.

With over-pronation, the inward rotation of the ankle joint also contributes to an inward rotation of the lower leg (the tibia). This movement will place an abnormal rotational stress on the knee. If it is significant enough to cause misalignment of the knee, muscular compensation patterns above the knee will appear as the body attempts to correct for this faulty rotational pattern. One of the most common syndromes resulting from stress of this kind is the ITB syndrome – or iliotibial band syndrome. This is a painful syndrome that is felt on the outside part of the knee, and can sometimes be felt all along the outside part of the thigh as well. Over-training or excessive running up and down hills is often the primary cause of this problem. Finally, lower back pain is very often related to poor foot biomechanics, and it can be elicited from the direct stress of tibial rotation making it’s way up the kinetic chain, or indirectly from faulty proprioceptive information coming from foot joints that are not feeding the postural system with the right information.

Other common foot problems may include stress fractures of foot bones, ligament sprains of the ankle, and abnormal wear and tear of the joints of the feet (osteoarthritis).

The Solution:

For any acute injuries, rest, ice, compression and elevation is always recommended. This will serve to limit the inflammatory response, reduce swelling and minimize pain. Exercise modification is also suggested to reduce the chance of re-injuring the area before it has had a chance to heal properly.

For more chronic problems, the most common therapeutic solution is custom orthotic shoe inserts. These devices are designed to support the natural curve of your arch when the ankle is in a neutral biomechanical position, and also to allow for proper motion when walking or running. As a result, your alignment is optimized, and the stress and strain from musculoskeletal compensation patterns is minimized.

Then, once your arch is supported and your alignment improved at the ground level, the next step is to ensure that this alignment will be supported along the entire kinetic chain. At Back2Health Chiropractic Clinic, we do this by testing the legs for neuromuscular imbalance. Length/strength testing should be done at least up to the pelvis, as rotated pelvic bones place an uneven load on the feet, often creating the appearance of a flattened arch when the foot is not actually the problem. Once areas of weakness/tightness are identified, we apply an innovative new treatment system called Trigenics® to those areas. Incorporating functional neurology, biofeedback and acupuncture philosophy, the Trigenics® practitioner works with the patient to restore the normal resting tone in the muscles treated. The result is increased strength, accelerated healing and rehabilitation, and less pain. (visit www.trigenics.ca for more information)

Finally, although alignment is one of the most important elements to ensure a properly functioning musculoskeletal system, it is not the only one. Correct movement patterns also depend upon the proper movement of the joints. Restrictions in any of the joints of the legs will have an impact on flexibility, which in turn will limit function. Chiropractors are specialists in joint manipulation. With incredible precision, doctors of chiropractic are able to improve joint motion with a quick and gentle thrust. The resulting decompression of the joint creates an immediate sense of ease in the joint, as it moves with less pain and restriction. Because the joints also have a rich supply of those proprioceptive nerve endings, joint mobilization also helps to restore neurological integrity in the body.

So, the bottom line is to look after your feet. When most of us think of building our bodies to be strong and powerful, or sleek and flexible, few of us consider the importance of the structure and stability of our feet in achieving these goals – however feet provide the foundation for your entire body. Any problems that you are currently having with your body may, in part, be exacerbated by instability in your feet. Have them assessed the next time you see your physical therapist, chiropractor or doctor.

Remember: as the twig is bent, so grows the tree.