The feet and issues pertaining to them are near and dear to my heart. I have built my practice around caring for feet and extremities for more than 17 years: I have seen hundreds of examples of how issues with the feet and arches can affect the body negatively. In fact, pain in the ankles, knees, hips, and spine often is related to the three arches of the feet. Yes. even weight problems can be aggravated and perpetuated by shortcomings in the feet. A patient of mine. "Allie." presents as a classic example. As a 55-ycar-old female patient with a height of 5" 6" and weight of 250 lb.. Allic came to me feeling despondent and fnistrated. She described chronic lower back pain that she had struggled with for years. She also lamented the weight issues that continued to plague her even after trying many different diets. To a layman, these problems may seem unrelated: I knew better. It was obvious after analyzing Allie on my 3-D digital foot scanner that she was in the severe pronation range (her score was a 170. which means her arches were dangerously flattened). Allic could barely stand up on the scanner for the two minutes it took me to scan her feet (so how could she even begin to exercise as part of her weight loss plan?). I learned a lot about Allic by just looking at her feet and correlating their problems with her locations of pain. Lct"s review a few concepts so we arc all on the same page. The foot itself docs not have just one solitary inner arch, as we have been lead to believe. Each foot actually has three arches that provide the healthy, weight-bearing, biomcchanical stability. Those three arches (the medial longitudinal, lateral longitudinal, and transverse arches) all form a triangle of stability under the feet. They form the plantarvault of the foot, which is the support foundation of the entire body. By age seven, once the arches arc formed fully, various stresses (i.e.. genetics, sports, shoe types) can create a downward force, which flattens the arches slowly over time. Weight is an important factor that cannot be overlooked. In a health} individual, standing posture finds the feet helping to distribute the weight of the body in a 50/50 ratio. Half the weight is dissipated from the ankle across to the ball of the foot. The other half is spread out from the ankle to the heel bone. This equal distribution of weight across the foot allows it to take advantage of the spring} plantar fascia on the underside of the foot. The plantar fascia is the prime stabilizer of the plantar vault of the foot and absorbs 30% of the force placed on the cal-cancus during the heel-strike phase of gait. The key phase in this scenario to focus on is midstancc. or foot flat. Here, under healthy circumstances, the foot experiences normal pronation. The force of the body is coming down on the feet, stretching the plantar fascia, depressing the arches a bit and creating inward or medial rotation of the tibia and femur bones. This allows the foot to touch and grip the ground properly. In theory, this system works, but in practicality, even for people who aren't obese, we see problems. In fact. 80 to 87% of patients exhibit overpronation with collapsing arches. This flattening of the feet creates too much medial rotation of the tibia and femur bones. In turn, the medial ankles, knees, and lateral hips arc strained. This negative biomcchanical stress torques the pelvis creating sacroiliac joint rotation and lumbar vertebral misalignments. This is why we sec so many patients who exhibit insidious onset of pain in their inner ankles, inner knees and patellae, hips, pelvis, and lower back. These painful areas arc very common in everyday practice for overweight people, but also in the "average" patient. Now lets throw in the added dimension of someone who is overweight or obese. The increased body weight puts even more strain on the three arches, plantar fascia, and the ligaments of the plantar surface of the foot. With repetitive weight-bearing activities such as standing and walking, those structures begin to buckle under the stress. The ovcrpronation scenario we described above now occurs with even more stress on the structures than normal. Ankle sprains, Achilles tendonitis/tears, shin splints, medial meniscal degeneration/arthritis, ACL tears, iliotibial band (ITB) syndrome, hip pain/arthritis, and lower back pain/arthritis are some of the major problems we see as a result. Don't forget that excessive foot pronation can affect the rest of the axial spine up to the cervical region, creating headaches and neck pain. So here is the rub: overweight and obese patients often come in to us knowing they need to exercise. They don"t realize the arch collapse in their feet is a major cause of their pain. They tell us they try to walk, get on the treadmill, or perform some other type of weight-bearing exercise. What happens? Their feet, knees, or back hurt more so they can"t exercise. It is a vicious cycle, so how can you help them break it? Try this: Appropriate physiotherapy modalities (i.e.. laser. US. EMS. etc.) to the affected areas. Adjust the feet, ankles, knees, hips, and affected spinal regions. Scan the patient and get them a pair of custom, three-arch, flexible orthotics. Use clastic sports tape to support the three arches of the feet while you wait for the custom orthotics to arrive. Elastic sports taping is extremely helpful for the painful body part as well. Taping of ankles, knees, and the low back is common for my practice. Check that patients arc wearing supportive shoes appropriate for their body weight. Prescribe home care, which may include: Creams, gels, or products for pain, swelling, inflammation, etc. Appropriate exercises (i.e.. stretches, pool exercises, walking, or other cardiovascular activities that arc not too stressful for their bodies). 7. Nutritional consultation. Whether you do it or you refer outside of your practice, patients need ideas and recommendations for how to cat and make healthier choices. Now. lets go back to Allie. I knew the pain in her knees and lower back was due to her excessively pronating feet, so we treated and adjusted her in the affected areas. Since I tad scanned her and she understood her arches were a big factor. I put clastic tape on her feet to simulate the support the orthotics would give her. She felt relief when she left my office, and was very shocked when she came back two days later to find that the adjustments and taping had worked together to help reduce her pain by 50%. She ordered the orthotics that next visit. I kept her feet taped and saw her two more times over the next week. Then the orthotics arrived and she was surprised at how comfortable they were the first time she wore them. Allic returned two weeks after getting the orthotics and said to me. "I put those orthotics in and I have never taken them off. I feel amazing. I even put them in my slippers. My knee pain and lower back pain have improved over 90%. I can walk longer and farther, and for the first time in years. I am exercising. I am walking, doing aquarobics. and want to try yoga. I also love the nutritionist you referred me to. We have changed my diet and I am eating healthier." Obesity is rampant in our society today. It unfortunately lias many facets. Our patients usually come to us after seeing the allopathic physician and trying a slew of fad diets. As chiropractors, we need to know how to recognize the relationship that feet have to the pain patients are exhibiting in the lower body and spine, and the way these problems contribute to. and perpetuate, weight problems (and vice versa). When we help break the cycle, we free patients to take control of their lives again and go on the offensive to be healthier and pain free. We help them start and build momentum. Not mam health practitioners actually understand the feet enough to make it part of a treatment plan. So go the extra step and be that practitioner. Do you have any patients like Allie in your office? I challenge you to look at them from the ground up. Dr. Kevin Wong is an expert on foot analysis, walking and standing postures and orthotics. Teaching patients and chiropractors is a passion for him, and he travels the country speaking about spinal and extremity adjusting. Dr. Wong practices full-time in Orinda, California. Contact Dr. Wong at 925-254-4040 or drkevimvong'a ginail. com.
