Can Custom Foot Orthotics Help Back Pain?

Shoe orthotics are custom made shoe inserts that doctors (podiatrists, chiropractors and orthopedic MDs) use to help patients suffering from foot, ankle, knee, hip, or back pain.  The concept is that, since the feet are literally the foundation of a standing human body, any problems in the foundation will translate to problems further up the body.

If you stop to consider this, it makes a lot of sense.  You don’t have to have any special training to realize the connection.  For example, if the foot rolls inwards when walking (called prontation)  it can place twisting forces in the knee and hip.  This will require more effort from the locomotor muscles, which are not only your leg muscles, but also your gluteus (buttock) muscles and psoas muscle (major hip flexor) which attaches itself to the lumbar (lower back) spine.   This happens subconsciously behind the scenes, but you will definitely notice the effects: pain in the weight bearing joints, back stiffness, reduced mobility/agilitiy, and fatigue.

Take a moment to look at the soles of your shoes (find an old, heavy-used pair in your closet).  Are they worn out a lot more on the inner edges?  If so, chances are you are over-pronating.  This is common with people who have flat feet, or “fallen arches.”  If this is the case, a pair of shoe orthotics shaped in a way to counter the rolling-in action can be prescribed.  They may be rigid or semi-rigid, depending on what the doctor thinks is more appropriate.  If the rolling in can be minimized by the shoe orthotic, then there will be less twisting forces to the knee and hip, resulting in a more efficient gait (walking motion) and less strain to the lower back.

A May 2011 study in the Journal of Manipulative Physiological Therapeutics studied the effects of custom shoe orthotics on a test group of 50 people experiencing lower  back pain.  Some were treated for 12 weeks with the orthotics, some had no treatment, and some were treated for 6 weeks.  It found that from 0-6 weeks of treatment, there was improvement in subjective scores for pain.  From weeks 6-12, improvement was maintained, but did not continue to improve.  The people who did not use orthotics continued to experience the same level of pain.

These findings suggest that there is a relationship between foot biomechanics and lower back pain, and that improvements can be effected by correcting imbalances in the foot.  However, it also suggests that more studies are needed.  What I take from it is that orthotics prescription is appropriate when indicated for treating lower back pain, but must be complemented with other types of interventions, depending on the case.  This may include exercise rehabilitation, somatic exercises, nutrition, and spinal manipulation.

If you desire to get custom made foot orthotics, you can seek out the services of a podiatrist.  Some chiropractors can prescribe orthotics as well.  Two of the main brands chiropractors use are Amfit and FootLevelers.  An off the shelf brand that I have found success with is the WalkFit orthotics.  These come with a gel cushion for the heel and acupressure massage surfaces to help with blood circulation.  If you wear sandals, which can pose a problem for traditional, doctor-prescribed orthotics, the come with sandal attachments.  Plus, they are a lot less expensive; less than $20.

To Run Barefoot or Not?

If you suffer from foot pain, knee pain, or lower back pain of unknown origin, then it might be related to your shoes:  Scientists recently held a conference in England to debate shoe running vs. barefoot running.   Over the last five years, the barefoot movement has gained a lot of recognition among runners and experts in human biomechanics.    I wrote about the merits of going barefoot last year.   The movement was apparently started by the book “Born to Run” by Christopher McDougall.  In it, he tells of time spent with members of Mexico’s indigent Tarahumara tribe, who routinely run long distances barefoot, often very fast, apparently without suffering the injuries that plague many avid runners in the developed world.

The issue is whether or not putting on a pair of running shoes implicitly causes the person to run in an unnatural way; a way that goes against nature’s design, due to a “false sense of security” offered by the thick cushioning of the shoes, especially in the heel and arch.

In a study published in the scientific journal Nature last year, Daniel Lieberman, an evolutionary biology professor at Harvard University, sought to find out how our ancestors, who ran and hunted for millions of years in bare feet or simple moccasins, coped with the impact of the foot hitting the ground.

Lieberman and colleagues from Britain and Kenya studied runners who had always run barefoot, those who had always worn shoes, and runners who had abandoned shoes.

They found that barefoot endurance runners often land on the fore-foot (the ball of the foot) before bringing down the heel, while shoe runners mostly rear-foot (heel) strike, prompted by the raised and cushioned heels of modern running shoes.

The study further discovered that barefoot runners incur less collision forces on their feet compared to shoe runners, despite the heel cushioning of the shoe, and that they use their calf muscles more efficiently.

As of this date, there isn’t a large scale study that gives definitive data on what is better for the human body, going barefoot or wearing shoes.  People are taking sides based on their beliefs, biases and experiences.  Major athletic shoe companies generally are against the barefoot running idea, for obvious reasons; but some are experimenting with “minimalist” shoes to capture this growing market.  These are shoes that offer protection to the feet but with the least amount of restriction.

My take on this:  it makes a lot of sense to walk and run barefoot.  It is a natural act, and it’s tough to argue against nature because it has its ways of cancelling out bad traits.  Our human ancestors walked and ran barefoot for millions of years, and were fine.   I believe that walking barefoot exercises the muscles and small joints of the foot and takes more of the load off the knees, hips and pelvis in doing so.  On the contrary, wearing shoes binds the feet, prevents the foot joints from doing their job of distributing the body weight and cushioning the shock, and makes the leg and back muscles work in a less efficient manner.    It is easy to see how this can result in lower back problems.  So, walk barefoot more than you currently do– not just in the house, but on pavement, hilly terrain, and the nearest park.  Then, when you feel that your feet have acclimated to the new sensations, give barefoot running a try!

 

 

 

Relieving Foot Pain from a Morton’s Neuroma

If you notice a gradually developing pain in your forefoot (just past your instep) between the tarsal bones of the 3rd and 4th toes that is worse when you press it between your thumb and index finger, you most likely have what’s called a Morton’s Neuroma.

Despite it’s name, it is not a true tumor.  It is a buildup of fibrous tissue that surrounds the sheath of one of the nerves that innervate the foot.  The nerve lies between the muscles that connect the tarsal bones and due to the fibrous buildup gets compressed within this narrow confine.  It is worse when standing and walking.

Morton’s neuromas are usually treated with orthotics (custom shoe inserts to help counter flat arches, over pronation, or other abnormalities of the foot) and cortisone injections to the painful nerve.  Sometimes surgical removal of the excess fibrous tissue is done if the condition does not resolve.

A simple remedy that can provide welcome relief, and perhaps allow the nerve to heal faster is inserting rolled up gauze or cotton between the 3rd and 4th toes.  This spreads apart the tarsal bones and creates more room for the nerve.  Sometimes simple things make for effective remedies, and this is one of them.

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