A Healthy Back Starts With Your Feet

Contrary to popular belief, many people with foot problems do not have any pain in their
feet. Instead, the area of pain is transferred up the body, to the knees, hips, lower back, or
even neck. An example of this is one whose feet roll inward, which causes their pelvis to jut
forward. This, in turn, causes the upper back to “hump” and the head to move forward, all in
an attempt to keep the body balanced. In fact, 80% of people over forty years of age
experience bodily distortions directly resulting from supinated (rolled out) or pronated
(rolled in) feet. The most common symptom of this problem is not pain, but rather, a
general feeling of fatigue.

Your feet must be flexible enough to adapt to changes in the terrain, yet rigid enough to
provide solid propulsion when walking. Problems arise when there is too little or too much
mobility in the foot and ankle. Visual signs that the foot and ankle are causing problems
include: bowing in of the Achilles tendon, lateral heel wear on shoes, patellar (kneecap)
malpositioning, weak psoas (hip flexor) muscle, and anterior pelvic tilt.

Orthotics can help stabilize your feet and ankles, thereby alleviating the associated pains.
Orthotics have been shown to help the following conditions: excessive pronation, arch pain,
bunions, plantar fasciitis, heel spurs, Morton’s neuromas, shin splints, Achilles and patellar
tendonitis, patellofemoral syndrome, iliotibial band syndrome, hip bursitis, hamstring strains
and spasms, stress fractures, ankle sprains, chondromalacia patella, knee collateral ligament
injury, vertebral subluxations, lower back pain, leg length inequality, sciatica, spinal
instability, lumbosacral strain, lumbosacral facet joint jamming, L4/L5/S1 disc degeneration,
temporomandibular joint (TMJ) dysfunction, cervical muscle spasm, and pelvic rotation.

Besides orthotics, wearing properly fitted shoes is very important for foot health. This is
especially important for women, as they are four times more likely to have foot problems
due to the type of shoes they wear. Shoes have been shown to be the principle cause of
forefoot disorders in women, and 88% of women wear shoes that are too small for their
feet. Proper footwear for the proper activity reduces fatigue because the bone alignment is
correct.

When buying shoes, pay attention to the width and arches of the shoe as well as the length.
Each type of shoe has a particular arch to support the movements the foot needs for that
activity. Alternate shoes daily and with each activity. All fitting should be done weight
bearing. You should have your feet measured by a qualified professional occasionally, as our
foot size tends to change with age. When standing in a shoe, there should be three-eighths
to one-half inch space from the longest toe (which is not necessarily the big toe) to the front
of the shoe. The toe box must be wide, high, and long enough to allow for toe movement. If
it is too narrow, the toes will be crowded and calluses will form. If it is too short, the shoe
will cause nail problems and jammed toes. Any shoe that does not have laces is too tight; as
it needs to be so to prevent the shoe from falling off, so avoid these if at all possible. If,
after some time of wear, your shoes show a “pushed over” vamp (the lace area), it is
probable that you have biomechanical foot problems.

If you have back pain and answer “yes” to any of the following questions, your pain may be
related to problems in your feet:

1. Do you stand or walk on hard surfaces more than four hours per day?
2. Do you regularly participate in a physical sport?

3. Are you forty years of age or older?

4. Have you had a previous knee, back or neck injury?

5. Do your shoes wear unevenly?

6. Do you have joint pain while standing, walking, or running?

7. Is one of your legs shorter than the other?

8. Do you have “knock knees” or “bow legs”?

9. Do you have any obvious foot problems, such as bunions, corns, or flat feet?

10. Do your feet toe out when you are walking?

Whether a foot tends to pronate or supinate, these chronic, repetitive forces are transmitted
along the kinetic chain to the knees, hips, back, and neck. To stabilize the feet, well-fitted
shoes and custom-made orthotics are necessary. By providing proper support for each phase
gait, these will ensure balanced function throughout the musculoskeletal system.

References:Austin, William M, DC, CCSP, CCRD. “Repetitive Microtraumas and Chronic Low
Back Pain.” Practical Research Studies, Vol. 15, No. 3, 2003. Charette, Mark N, DC. “Every
Shoe Has a Story to Tell.” Orthopedic Notes, 2003. Danchik, John J, DC, FICC, CCSP.
“Posture Starts From the Ground Up.” Orthopedic Notes, 2003. Greenawalt, Kent S. “Serial
Distortion: It’s Effect on the Patient.” Orthopedic Notes. Hyland, John K., DC, DACBR,
DABCO, CSCS. “Foot Flexibility and Hypermobility.” Practical Research Studies, Vol. 17, No.
2, 2004. “Tips on Foot Care from Faculty Doctors at Northwestern Health Sciences
University.” Northwestern Natural Health News Service, 2003.

Dr. Heller is a chiropractor and certified strength and conditioning specialist (CSCS),
practicing in Wauwatosa, Wisconsin. She has extensive experience teaching fitness classes,
including aquatics, to all age groups and abilities. Dr. Heller currently teaches classes and
trains clients at Highland Elite Fitness and Racquet Club in Brookfield, Wisconsin.