feet and low back pain- by Dr Anel Kapur

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​Most people are puzzled when a podiatrist draws a link between these two seemingly unrelated structures however the reality is, they very well could be impacting on one another. In fact, about 25% of all the bones in the body is found in the feet and a misalignment in these structures can easily be responsible for problems further up the body. I often equate the feet to being like shock absorbers in a car. They act to disperse forces from the road equally to enable a smooth drive. If the shocks are worn, damaged or not working optimally, the ride would be bumpy and steering would become difficult. Along these lines, podiatrists expertly assess the biomechanical functioning of the feet and isolate potential problems in alignment or function which may be contributing to symptoms in areas other than the feet. This thorough examination may involve further referral to specialists such as chiropractors and physiotherapists for further assessment of the back pain but it serves as a good stepping stone for people to understand how vital feet are to the functioning of the body and more importantly the benefits of taking care of one's feet.

A number of studies have shown that the impact lower back pain has on the healthcare sector has been gradually on the rise in Australia with figures in 2001 showing $9.17 billion dollars being spent on treatments. One of the issues research brings up is the problem of misdiagnosis. A similar study also showed that amongst a group of 97,279 soldiers tested, those who had flat feet were twice as likely to report lower back pain. In fact when you think about it, during an average day walking, the total forces experienced on your feet can equal to hundreds of tons.

Whilst there are many factors that may contribute to the development of lower back pain, when you consider the influence of feet, a number of common factors are seen as culprits. Whilst this is not an exhaustive list, it is for podiatrists a warning sign that patients may be heading down the road of pain and discomfort.

1. Flat feet (pronated feet)/low foot arches.

This is a common problem that people presents with to the podiatrist. Whilst not all feet with low arches may be problematic or cause issues, it is the effect that flatter feet have on the alignment of the body that may predispose a patient to back pain. Feet that roll in excessively may cause a person knees to internally rotate which might in turn affect the pelvic alignment which can cause tightness of the lower back muscles. The image below best illustrates the effect of pronated feet.







What can be done?
A biomechanical assessment of the foot alignment and function can help determine the level of intervention needed. By identifying exactly what part of the foot alignment is associated with the described symptoms a podiatrist can work to correct the alignment of the feet and reduce the back pain. Some common interventions that may be applied for flat feet may include: custom or off the shelf orthotics, specialist footwear advice, sports taping and padding of the feet and current footwear. These will all aim to position the feet in a ‘neutral’ position whereby excessive pronation is controlled. Whilst flat feet may never be ‘fixed’, the consequences that they carry on the body most certainly can be reduced and reversed to ensure a patient's life is not interrupted by pan.

2) Poor footwear choices
Footwear plays an important part in the functioning of feet. Choose unsupportive shoes when you need support, and your feet will suffer the consequences. Whether for fashion, work requirements or affordability, people often opt to wear shoes that may be doing them more harm than good. Much like the effect of foot posture, poorly fitted or unsupportive shoes can enable excessive motion of the foot during weight bearing which may mean instability that can lead to injury. With people spending hours on their feet every day, improper or worn out shoes can affect the natural gait cycle. Overly flat shoes (‘flats’) generally offer no support, this may lead to insufficient shock absorption through the joints of the feet and may result in jarring of the spine or tightening of the lower back muscles.

How can a Podiatrist help?
A podiatrist can offer specialist advice on your current footwear and will be able to tell you whether they are appropriate for your foot type or not. I have in the past had to convince patients to let go of their beloved NIKE’s or ballet flats much to their dismay. However the same people who have followed advice have also thanked me weeks later for the advice often telling me that ‘their feet have never felt better’. Unfortunately there is no single ‘magic type of shoe’ for every foot as everyone's feet are unique. This highlights the importance of having your feet assessed to obtain specific advice. There are three general characteristics that can be used as a guide for purchasing new footwear:

• A firm and supportive heel counter.
• Supportive and cushioning midsole.
• Minimal flex through the front of the shoe.

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3) Tightness in the calf muscles
Whilst many muscles may be directly involved in lower back pain symptoms, where the feet are concerned the calf muscles are undeniably linked to the onset of these symptoms. The calf muscles are made up of 2 separate muscles which form the achilles tendon. They function to place the foot in a plantar-grade (downwards) position which is important when walking to push off the ground with your toes. Calf tightness can be caused by a number of factors including:

• Genetics
• Long periods of walking, standing or training.
• Wearing high heels or firm sole shoes.
• Excessive pronation or supination of the feet.

Having tight calf muscles reduced your ankle range of motion and makes it harder for your ankle to flex the necessary amount needed for proper gait. This would in turn cause your body’s center of mass to shift forwards. This would in turn trigger the lower back muscles which will try to reduce the forwards shift of the center of mass. Over the long term, this can lead to ongoing lower back pain symptoms.

How can calf tightness be reduced?
Whenever I see patients who present to the clinic with tight calves, I offer a number of treatment methods to help alleviate the tightness. Often the tightness is due to simple soft tissue contracture other times it is in consequence of foot alignment. Foot alignment problems can be corrected using an orthotic but outside of that:Massage

• Massaging the calves (either professionally or at home) regularly can help reduce tension in the muscle fibers and in turn the pressure on the ankle joint.

Stretches
Towel/band/belt stretch

• Whilst sitting, position any of the above underneath the ball of the foot and gently pull the sides up towards you, gradually bringing the toes towards you. You should feel a gentle stretch through the calf muscles.
• Hold for 30 second. Repeat twice. Once daily 

Wall stretch

• Standing in front of a wall, place your hands on the walls surface and move one foot towards the wall such that the toes are in contact with it. Position the other foot behind you keeping the trailing leg straight. Slowly bend the front leg towards the wall so that you feel a slight stretch through the fibres of the trailing leg.
• Hold for 30 seconds and swap legs. Repeat 3 times. Once daily.

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​Whilst there is no one single ‘best approach’ for alleviating symptoms caused by problematic feet, seeing a podiatrist can be the first step to achieving your goals and a pain-free day to day life.

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Dr Anel Kapur delievers an outstanding clinical podiatric care to all clients. He has earnt himself an exceptional reputation among his clients for his attention to detail, gentle approach and depth of knowledge.
Dr Anel Kapur is available for appointments Monday and Saturday.
Bookings are available online or contact receptions on 9542 3330 

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