Back pain will affect up to 80% of the people in this country at some
point during their life. In fact, back pain is the second most common
reason people seek medical care.1
Foot function can play a role in some cases of back pain. In fact, in a 1999 study of patients with low back pain, gait abnormalities were detected in all patients. Eighty four percent of the patients studied experienced improvement with the use of custom foot orthotics. All of the study participants had not responded to standard treatments which had included spinal manipulation, physical therapy, therapeutic injections and/or surgery.2
At the Foot & Ankle Center, Drs Hale and Huppin have a very specific approach to back pain treatment. In general, we use the following protocol;
1. Evaluate whether foot pain is a probable contributor to back pain. We do this through a history, physical exam, biomechanical exam and gait evaluation. In some cases we can determine in the office whether or not your lower extremity function is likely contributing to your back pain. In other cases we do testing of the effects of changing foot function using taping and temporary orthotics. Once done, we will let you know if we feel that your foot function is contributing to back pain. If we do not feel that your feet are contributing to your back pain we will refer you to an appropriate back specialist. If it does appear that foot function might be playing a role in your back pain, however, then we move on to step 2.
2. Step 2 is to correct abnormal lower extremity biomechanical function that may be playing a role in your postural pain. Often this will be through the use of custom foot orthotics. In most cases of foot function related back pain, our goal with orthotics is to decrease excessive pronation (flat-footedness) and / or to achieve symmetry between the right and left foot (ensure that the left and right feet are functioning in the same way and at the same speed).
3. Step 3 is to modify the orthotics. In treating back pain, it is imperative that we not only limit excessive motion, but also try to achieve symmetry between the left and right feet. To achieve this we may add lifts, cushions, pads or cut-outs to the orthoses. 90% of the time, we will be able to determine the appropriate orthotic prescription and necessary modifications via our in-office biomechanical evaluation and gait analysis.
4. For the approximately 5% of patients with more complicated biomechanical problems, we may refer you for ADVANCED TECHNOLOGY GAIT AND ORTHOTIC ANALYSIS (ATGOA). Located in Seattle at a Human Performance Lab, we will refer you for a series of evaluations designed to achieve determine more subtle orthotic modifications might be necessary to relieve your symptoms. The primary test we run for patients with back pain is F-scan computerized in-shoe gait analysis.
5. Having one leg shorter than the other can also cause back pain and evaluation of limb length discrepancies is part of our back pain work-up.4-11 We will measure limb length in the office and you may also be referred for a sophisticated x-ray evaluation of limb length called a scanogram. In addition, F-Scan computerized gait analysis and Dartfish video gait analysis can give insight into limb length issues.
1. Carey TS, Evans A, Hadler N, et al. Care-seeking among individuals with chronic low back pain. Spine 1995;20(3):312-317.
2. Dannenberg, Guiliano. 1999. Chronic low-back pain and its response to custom-made foot orthoses. Journal of the American Podiatric Medical Association.
3. Botte RR. An interpretation of the pronation syndrome and foot types of patients with low back pain. J Am Podiatry Assoc 1981;71(5):243-253.
4. Beal MC. A review of the short-leg problem. J Am Osteopath Assoc 1950;50:109-121.
5. Giles LGF, Taylor JR. Low back pain associated with leg length inequality. Spine 1981;6(5):510-521.
6. Rush WA, Steiner, HA. A study of lower extremity length inequality. Am J Roentgenol 1946;56:616-623.
7. Fann AV. Pelvic obliquity in patients with and without chronic low back pain. Arch Phys Med Rehabil 2000;81.
8. Gofton JP. Persistent low back pain and leg length disparity. J Rheumatol 1985;12(4):747-750.
9. Blake RL, Ferguson H. Limb length discrepancies. J Am Podiatry Assoc 1992;82(1):33-38.
10. Okun SJ, Morgan JW, Burns MJ. Limb length discrepancy: a new method of measurement and its clinical significance. J Am Podiatry Assoc 1982;72(12):595-599.
11. Giles LGF, Taylor JR. Lumbar spine structural changes associated with leg length inequality. Spine 1982;7(2):159-162.
12. Fann AV, Lee R, Verbois GM. The reliability of postural x-rays: a new study. Arch Phys Med Rehabil 1999;80(4):458-61
13. Woerman AL, Binder-MacLeod SA. Leg length discrepancy assessment: Accuracy and precision in five clinical methods of evaluation. J Orthop Sports Phys Ther 1984;5:230-239.
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Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
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