How your low back pain is linked to your flat foot

What back pain treatment options do you have when you are hurting?

Your foot contributes to your back pain…the distance between them is quite far…really?

Yes, there is a possibility.

Considering the structural interdependence of the human body, it is not too far-fetched to think of the foot as one of the contributing factors to lower back pain.

In this article, we will discuss how the infamous pes planus (aka flat foot) may have a correlation to the curvature of the spine thus contributing to ongoing symptoms in the lower back, and back pain treatment options.

What is the foot arch?

There are three arches in the foot: the more famous one is the medial arch (on the inside of the foot). The arches are designed similarly to a spring for shock absorption during walking and other weight-bearing activities. Structurally, these arches are formed by bones in the foot and supported by the ligaments and muscles. These arches are also not rigidly held in place and are designed to collapse and reform when we stand, walk and do exercises.

When the arch is constantly held in a collapsed position, it is term as Pes planus or flat foot.

What is Pronation? And the link to the lower back.

The movement when the foot arch collapse is called pronation. Again, pronation occurs naturally when we walk, run and jump. Each time the foot pronates which helps to absorb shock and impact from the ground.

This pronation is not isolated just to the foot. Whenever the foot pronates, it creates a series of concurrent inward rotation of the shin bone, thigh bone.

This movement carries on to the spine and pelvis, causing the lower back to arch backwards called lordosis. This increase backwards arching movement of the spine has been found to increase the prevalence of low back pain. This is due to the increase in the shearing strain or stress in the lumbo-pelvic region from the anterior shift of the center of gravity.

People with increased lordosis were found to have delayed activation of the local muscular stabilisers of the spine. Anatomically, these muscles functions as our in-build lumbar corset that provides dynamic stability to our spine with our various activities. A delayed activation would mean less effective stabilization of the spine at the lumbopelvic region which may contribute to spinal symptoms.

Muscle weakness and imbalance will affect the lumbo-pelvic stability, especially with dynamic tasks causing increase in pelvic rotations, thereby further increasing one’s risk to developing low back pain. Not forgetting that these local stabilizers are postural muscles, their engagement needs to be sustained though our movements and having endurance strength is more important.

Let us direct our attention back to the feet…

The feet are the foundation of human posture and affect may affect or daily functions and athletic tasks. Excessive foot motion leads to inefficient shock absorption thus the need for other areas of the body to compensate for the dissipation of the ground reaction forces along the kinetic chain; potentially increasing the load in the lower back. With time and repetitive stress, pain may onset gradually or reoccur intermittently dependent on one’s physical demands.

Pes planus may also increase the predisposition of foot and ankle injuries such as plantar fasciitis and tibialis posterior tendinopathy. Compensations from avoiding pain upon injury may also alter the biomechanics of walking. This may lead to less effective force distribution through the joints along the kinetic chain thereby contributing to low back pain with physical activities (ie. walking) or carrying loads (ie. carrying groceries).

What can I do?

Wearing orthotics in your shoes, maybe…

No doubt the orthotics will be able to support the arches; they merely try to recreate what your foot musculature is designed to do. It does not correct the stance or provide ankle stabilization nor allow the muscles and joints to work through their full range of motion. It is not just about altering and maintaining the foot posture, but rather, addressing the underlying dysfunctional pattern by training its control and awareness at the foot and ankle to create stability during dynamic tasks.

A visit to the physiotherapist would therefore be helpful to provide guidance in retraining the arch through various exercises that aim to increase awareness of the foot position, biomechanics of multiple tasks as well as strength and extensibility of the muscles along the kinetic chain.

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Dr Sharon Wang

Principal Physiotherapist

Dr Sharon Wang, writes from her heart and her personality shines through during her physiotherapy session with her patients. This exercise enthusiast loves a good workout, and you can catch her doing her Yoga to dance routine any day.
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