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Foot function and low back pain

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Sep 29, 2007.

  1. Peter1234

    Peter1234 Active Member

    Hi Robert,

    thanks for the post. Does this mean that you will not treat LBP patients with orthotics, even if you see a 'disordered' foot function in gait?
     
  2. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Loading of the lower extremity and low back when using wedge orthotics during
    walking and stair negotiation

    Tami Janssen
    Master of Science Thesis; Iowa State University; 2013
     
  3. Dananberg

    Dananberg Active Member

    Alex,

    Sorry for the delay in responding. Just saw your post.

    Sagittal rotation of the hip joint (extension) during CLOSED KINETIC CHAIN activity such as walking requires that the heel lift off the support surface by pivoting over the metatarsal heads as the MTPJ's dorsiflex. When Functional hallux limitus is present, dorsiflexion is either limited, absent or delayed. Therefore, the timing of EFFICIENT heel lift is either limited, absent or delayed. How could the hip joint possibly extend if the heel did not lift from the ground? Therein lies your answer.

    Howard
     
  4. Dananberg

    Dananberg Active Member

    Alex,

    Sorry for the delay in responding. Just saw your post.

    The key to understanding Functional hallux limitus and its effect on hip extension is its relationship to CLOSED KINETIC CHAIN FUNCTION.

    Weight bearing makes the difference. In every muscle function study I have seen, extensors of the hip are OFF during hip extension. They work during hip flexion as a method of support (control). Therefore, hip extension during gait would appear to be non-muscular. As the swing limb kicks forward, the CoM is pulled forward. The trailing limb extends by virtue of 1) its ball and socket design and 2) the ability of the foot to act as a distal pivot, and permit the body to advance over it. As the heel raises from the ground while pivoting over the forefoot, hip extension is permitted. If Functional hallux limitus is present, then this scenario is blocked. It results in limited hip extension and accommodative flexion of the LS spine.

    Hope this helps.
    Howard
     
  5. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Foot Posture, Leg Length Discrepancy and Low Back Pain - their relationship and clinical management using foot orthoses - An overview
    Julie C. Kendall, Adam R. Bird, Michael F. Azari
    The Foot ; Available online 19 March 2014
     
  6. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Effect of Foot Hyperpronation on Lumbar Lordosis and Thoracic Kyphosis in Standing Position Using 3-Dimensional Ultrasound-Based Motion Analysis System.
    Farokhmanesh K, Shirzadian T1, Mahboubi M, Shahri MN.
    Glob J Health Sci. 2014 Jun 17;6(5):36779. doi: 10.5539/gjhs.v6n5p254.
     
  7. Peter1234

    Peter1234 Active Member

    Hi
    Does anyone have the full text version?
     
  8. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Increased unilateral foot pronation affects lower limbs and pelvic biomechanics during walking
    Renan A. Resende, Kevin J. Deluzio, Renata N. Kirkwood, Elizabeth A. Hassan, Sérgio T. Fonseca
    Gait & Posture; Articles in Press
     
  9. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The Relationship Between Foot and Pelvic Alignment
    While Standing

    Sam Khamis, Gali Dar, Chava Peretz, Ziva Yizhar
    Journal of Human Kinetics volume 46/2015, 85-97
     
  10. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Comparative Analysis of Lower Limb
    Alignments in Healthy Subjects and Subjects
    with Back Pain

    Ramin Balouchy
    Annals of Applied Sport Science, vol. 3, no. 2, pp. 33-42, Summer 2015
     
  11. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Comparison of selected muscular activity of trunk and lower extremities in young women's walking on supinated, pronated and normal foot
    Hamideh Khodaveisi, Haydar Sadeghi, Raghad Memar, Mehrdad Anbarian
    Apunts. Medicina de l'Esport; 7 January 2016
     
  12. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Gait ground reaction force characteristics of low back pain patients with pronated foot and able-bodied individuals with and without foot pronation
    Nader Farahpour et al
    Jnl Biomech; Article in Press
     
  13. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Correlation between Flexible Flat Foot and Lumbar Lordotic Angle
    FATEMA SDEEK et al
    Med. J. Cairo Univ., Vol. 84, No. 1, June: 567-572, 2016
     
  14. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Comparison of active calf muscle stretching versus ankle mobilisation
    on low back pain and lumbar flexibility in pronated foot subjects

    K. Vadivelan et al
    Int J Community Med Public Health. 2017 Jun;4(6):xxx-xxx
     
  15. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The effect of foot hyperpronation on spine alignment in standing position.
    Ghasemi MS et al
    Med J Islam Repub Iran. 2016 Dec 28;30:466. eCollection 2016.
     
  16. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The effects of calcaneal posture on thoracolumbar alignment in a standing position.
    Kim SC et al
    J Phys Ther Sci. 2017 Nov;29(11):1993-1995. doi: 10.1589/jpts.29.1993
     
  17. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Association between hyper-pronated foot and the degree of severity of disability in patients with non-specific low back pain
    Arun Prasad Balasundaram et al
    Journal of Bodywork and Movement Therapies; Article in Press
     
  18. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Muscle activity and kinetics of lower limbs during walking in pronated feet individuals with and without low back pain
    Nader Farahpour et al
    Journal of Electromyography and Kinesiology; Volume 39, April 2018, Pages 35–41
     
  19. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    THE INCIDENCE OF SIGNIFICANT RELATIONSHIPS BETWEEN SELECTED PARAMETERS OF FEET AND PARAMETERS OF TRUNK IN ADOLESCENTS AGED 14-18 YEARS
    Mirosław Mrozkowiak, Mariusz Posłuszny, Marek Sokołowski, Alicja Kaiser
    JOURNAL OF EDUCATION, HEALTH AND SPORT vol 8, No 2 (2018)
     
  20. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The influence of foot hyperpronation on pelvic biomechanics during stance phase of the gait: A biomechanical simulation study.
    Yazdani F et al
    Proc Inst Mech Eng H. 2018 May 1:954411918778077.
     
  21. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Investigation of the relationship between plantar pressure distribution and lumbar multifidus muscle thickness
    C. Karartı et al
    Annals of the Rheumatic Diseases 2018;77:861
     
  22. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Effect of chronic idiopathic low back pain on the kinetic gait characteristics in different foot masks
    ShirinYazdaniaElnazDizjibFarzanehAlizadehcHamidollahHassanloueid
    Journal of Biomechanics
    Available online 22 August 2018
    t
     
  23. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    before foot pronated with patients pain back low in kinematic limb Lower
    walking during protocol training selected a after and

    .99-89):4(9;2019 Pain Anesth J
     
  24. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Foot hyperpronation alters lumbopelvic muscle function during the stance phase of gait
    FarzanehYazdania et al
    Gait & Posture Volume 74, October 2019, Pages 102-107
     
  25. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    ARE BIOMECHANICAL FEATURES OF THE FOOT AND ANKLE RELATED TO LUMBOPELVIC MOTOR CONTROL?.
    Caner KARARTI, Sevil BİLGİN, Yeliz DADALI, Buket Büyükturan, Öznur BÜYÜKTURAN, and Nilgün BEK
    Journal of the American Podiatric Medical Association In-Press.
     
  26. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    To the patient, the most important thing is how they feel while wearing the insoles. They don't care about pedantic discussions on vectors, center of motion etc etc. To the patient, they want to alleviate their pain, that is what they care about.

    I know that studies on subjective outcomes has been downgraded, and now considered, by many of my compeers, of little importance. But in this regard, I totally disagree. Our primary function is to help our patients.

    In the mid 1990s I published a paper on nearly 100 patients wearing orthotics. One year follow-ups were sent to all these patients asking them how they were doing. You can read the subjective outcomes for yourself. But the bottom line was they hurt less using the orthotics then when not using the orthotics.

    Cheers,
    Brian

    Rothbart BA, Liley P, Hansen, el al 1995. Resolving Chronic Low Back Pain. The Foot Connection. The Pain Practitioner(formerly American Journal of Pain Management) 5(3): 84-89
     
  27. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Relationship between degree of foot pronation and
    disability associated with low back pain

    Amar Prakash and Sangeeta Maurya
    International Journal of Physical Education, Sports and Health 2019; 6(5): 227-231
     
  28. Peter1234

    Peter1234 Active Member

    So should we consider looking at patients feet if they say they have back pain? There were NICE GUIDELINES suggesting we shouldn’t consider foot posture and back pain. Is that not valid anymore ?
     
  29. Dananberg

    Dananberg Active Member

    It is the restriction of sagittal plane motion that affects gait style that is related to CLBP. In some cases, this is visible as foot pronation, but many times its not. The key factor is examine is the amount of hip extension that occurs by the termination of single support phase, and not the amount of foot pronation. The exam should focus on the changes of hip extension once treatment is applied. In the study I performed in 2001, hip extension changed from an average of 7 degrees to a post treatment average of 13 degrees in CLBP patients who demonstrated resolution of symptoms.

    Dananberg, HJ, “Gait Style and Its Relevance in the Management of Chronic Lower Back Pain”, In Proceedings, 4th Interdisciplinary World Congress of Low Back & Pelvic Pain”, Ed, Vleeming, A, Mooney. V, Gracovetsky, S, Lee, D, etal, November 8-10, 2001, pp 225-230
     
  30. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Does Plantar Pressure Distribution Influence the Lumbar Multifidus Muscle Thickness in Asymptomatic Individuals? A Preliminary Study
    Caner Kararti, et al
    :June 12, 2020
     
  31. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Iliopsoas muscle thickness and pelvic alignment in pronated and normal foot postures
    Zinat Ashnagar et al
    J Bodyw Mov Ther. 2020 Oct;24(4):20-23
     
  32. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member


    Hi David,

    I can tell you from my clinical experience spanning over 50 years now, when the appropriate proprioceptive signal is applied underneath the feet, the pelvis moves towards its anatomical neutral position. That is if the hip was in an anterversion position, it will move backwards. If the hip was in a retroversion position, it will move forwards.

    I have published several papers on the subject (you can find my publications on Researchgate). But the most compelling evidence, in my opinion, is what I have measured, comparing pre vs post stimulation postural photos.

    One can argue,per nausea, is there or is there not a correlation between the foot and the pelvis. But when one sees, over countless cases, the shift in the pelvis, to me that observable (and measurable) data is compelling.

    Just my opinion. I am sure it will take countless more studies before an accordance is reached on the subject.
     
  33. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Flat foot and spinal degeneration: Evidence from nationwide population-based cohort study
    Mei-ChiaChouabcJing-YangHuangdmYao-MinHungefgWuu-TsunPernghkReninChangiaJames Cheng-ChungWeijkl
    Journal of the Formosan Medical Association; 7 January 2021
     
  34. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    I published a paper that linked gravity drive pronation to low back pain twenty-five years ago. At the time it generated a great deal of discussion.
    • Rothbart BA, Liley P, Hansen, el al 1995. Resolving Chronic Low Back Pain. The Foot Connection. The Pain Practitioner (formerly American Journal of Pain Management) 5(3): 84-89
    But 25 years later, I am surprised that this discussion has so many hits!
     
  35. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Comparison
    Low without and with Individuals Feet Pronated in Patterns Running
    Pain Back

    A Valizadehorang, A MokhtariMalekAbadi, GH Ghane, A A Jafarnezhadgero
    Pain Anesth J .18-1):4(11;2021
     
  36. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Foot pronation affects pelvic motion during the loading response phase of gait
    Joana Ferreira Hornestam et al
    Braz J Phys Ther. 2021 May 4
     
  37. Steve Smith

    Steve Smith Welcome New Poster

    Exactly
     
  38. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    A google search on Pelvic rotation linked to foot function is replete with studies. Most couple pronation with anterior innominate rotation, the relationship I presented in a 1988 publication.

    Pelvic instability has long been known by chiropractors, and in fact, forms one of the basic tenets of their profession. We, as Podiatrists, are just catching up to them in this area of biomechanics.
     
  39. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The Prevalence and Factors Associated with Low Back Pain Among People with Flat Feet
    Adel F Almutairi et al
    Int J Gen Med. 2021 Jul 20;14:3677-3685
     
  40. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The Prevalence and Factors Associated with Low Back Pain Among People with Flat Feet
    Almutairi AF, BaniMustafa A, Bin Saidan T, Alhizam S, Salam M
    International Journal of General Medicine » Volume 14
     
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