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When chiropractors, osteopaths, or physiotherapists are examining a patient with acute or chronic spinal complaints, it is essential that the pelvis (foundation) and the feet (the footings of the foundation) be considered as playing a role in the complaint or associated pain. Therefore, one must explore the interrelationship between foot-ankle pronation (dropped arches) and a number of the chronic spinal complaints. Understanding the mechanisms which cause these conditions and how they affect, cause and propagate each other through their detrimental effects on the body's musculo-skeletal alignment, tone, and posture is vital.
Most, if not all, musculoskeletal complaints have more than one component that causes dysfunction and pain. However, many of these complaints can show a puzzling "chicken and egg" interrelationship where the two conditions now act to propagate each other, and it therefore becomes difficult to know exactly which complaint originated first. Excessive pronation in the feet (dropped arches or flat feet) causes postural changes in the whole body, and the following symptoms are very common with bad or poorly functioning feet:
Chronic Neck Pain Hip Pain Ankle Pain
Posture Knee Pain Heel Spurs
Lower Back Pain Shin Splints TMJ
Excessive pronation, as it is known, acts to internally rotate the upper and lower leg. (See Diagram 1) This internal rotation causes increased stress on the knee and hip joints along with a forward tilt on the pelvis on the side of the dropped arch. Typically, we would think this would now represent the short leg, however, because of the mechanics with the ilium, it is now the LONGER leg, not the short leg. This results in a functionally long leg on the more dropped arch. As a result, our body weight shifts forward placing excess pressure on your foot muscles, making this even harder to correct. This constant abnormal pressure on the foot muscle results in wider, flatter and fatter feet causing the body's musculoskeletal system to breakdown. The force which tilts the pelvis forward also tips your sacrum and tail bone backwards and up so now your rear sticks out.
Diagram 1: Pelvic Tilt With Foot Pronation
This combination of events results in the triad of dysfunction:
i) mechanically disadvantaged abdominal muscles become dysfunctional and weak because they get lengthened and stretched as the pelvis tilts forward. Over time, the abdominals continue to lose their tone which allows for an increased lumbar curve and further forward tilting of the pelvis.
ii) the shortened spinal muscles of the back along with the shortened hip flexors muscles in the front (psoas and iliacus) increase the lumbar curve and forward pelvic tilt. Often times the lateral femoral cutaneous nerve is entrapped associated numbness in the front of the thigh muscle results.
iii) the increased lumbar curve jambs the lower lumbar facet joints and thereby places them under increased mechanical stress. The increased low back curve then forces the upper back curve increase in the opposite direction, the shoulders round forward, and the neck pokes out. These postural changes make you shorter and place the spine and musculo-skeletal system at higher risk for other injuries and complaints.
The spinal joints get jammed together and this irritates the nerves. Muscle spasms result because these muscles have been shortened and therefore tend to spasm more frequently. Any leg pain experienced in this situation may not be true sciatica but referred pain from the irritated lumbar joint(s), commonly felt in the posterior, lateral thigh or groin areas. True sciatica develops when the forward pelvic tilt causes entrapment of the sciatic nerve by the super tight piriformis muscle resulting in pain going down the back of the leg.
Headaches, TMJ, neck and upper thoracic pain are also possible due to the compensatory rounding of the shoulders and forward positioned head. This head position (See Diag. 3) places the neck and upper back under considerable postural stress which then presents as a dysfunctional spinal complaint.
Diagram 2: Posture Distortion
It is therefore necessary to consider foot dysfunction with any musculoskeletal complaint. By treating the feet, if involved, the patient does not walk themselves back into their problem so to speak. This is probably the biggest complaint against chiropractors by patients, “I have to go back over and over again, and I do not hold my adjustment.” Addressing the feet may be a huge factor in maintaining your alignment and decreasing your costs.
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Rarely is it as simple as just orthotics. Don’t get me wrong, orthotics can be extremely important. However, using applied kinesiology to find and strengthen weak and dysfunctional muscles is the key component. This followed by orthotics, and the correct rehabilitation at home, gives you, the patient, the best long-term solution to your complaint.
A simple functional foot test you can do at home is to stand with your feet shoulder width apart and have someone try to lift your big toe off the ground. The secret here is to relax. Do not help them lift the big toe and by the same token, do not stop them. The big toe should come off the ground as in the supinated arch picture in diagram 3. Your lower leg should rotate out along with your knee cap as the big toe is lifted up. If your big toe feels stuck or glued to the ground or does not come off the ground very easily, then feet are a big part of your spinal health problem(s).
Remember that a lot of people have feet problems and don’t know it. Whether back pain, neck pain, knee pain, or jaw pain is your issue, don’t forget to have your feet checked. Utilizing applied kinesiology to get your muscles working correctly is essential from the ground up.
Diagram 3: Toe Test