How does your foot position cause back pain?

Introduction

Estimates from the Australian Bureau of Statistics 2014–15 National Health Survey show about 3.7 million Australians (16% of the population) have back problems. It is estimated that 70–90% of people will suffer from lower back pain in some form at some point in their lives

When it comes with lower back pain there is not just one contributing factor, but a multiple of different factors. Some back pain is idiopathic, other can be directly linked to tight muscles and an anteriorly or obscured pelvic structure, amongst ‘bad’ foot posture. 

Your podiatrist can examine your lower extremity, assessing the static position of the bones of the feet and more importantly the dynamic position of the feet during gait.  If there is too much or too little motion, you may experience the onset of lower back pain. 

Anatomy 

The leg bones are connected to the pelvis.  The foot and ankle complex attach to the distal end of the tibia and fibula (shin bones).  The talus is situated in the mortise or area created by the ends of the tibia and fibula.  The talus sits on top of the calcaneus or heel bone forming the “rear-foot” portion of the complex.  The rear-foot is attached to the mid-foot and the mid-foot is attached to the forefoot of the complex. 

Any excess or lack of motion in the foot can have an effect on the entire leg and eventually the lower back.  The proper amount of motion is required to absorb shock when the foot hits the ground and the body weight is transferred onto the weight-bearing limb position of your feet assessed in a static and dynamic state.  

Patho-physiology

Too much pronation (flat footed appearance) can cause low back pain due to excess motion of the lower extremity bones. Here is what happens: the talus “drops” and causes the tibia to internally rotate.  The femur follows and eventually causes the pelvis to rotate excessively.  Once the pelvis moves too much, the lumbar spine is compromised leading to an onset of pain.  This excess motion is more pronounced when you perform an activity that includes a high impact landing like running or jumping.

In contrast your podiatrist may determine that the feet have too little motion (pes cavus or high arches) in either static or dynamic positions. In this case, you will most likely have an onset of low back pain due to the lack of shock absorption.  This can lead to impact type injuries.

Treatment

The lumbar spine evaluation must include a “screening” of the lower extremities to include the feet.  The choice of treatment in many cases is to place an orthotic or shoe insert into the patients’ shoes.  A firm or semi-rigid orthotic is commonly used to add support to a foot that over-pronates and a cushioning type orthotic is used when the person’s feet do not have enough motion to produce a shock absorbing result.