Lower Back Pain and the Feet

The foot being the base and foundation for our body, many back problems can be related to the way we stand and walk. Around 40 per cent of Australians will experience some form of foot problems in their lifetime. Low back pain is a very common complaint and not many people understand how movement and alignment of the pelvis, leg, ankle and foot is intricately connected to the development of acute and chronic low back pain. Yet it can easily happen to people young and old, male and female.

There can many causes of low back pain. These may be osseous (bony), neuropathic (nerve damage) or soft tissue. Common causes can include:

Excessive Pronation

Excess pronation, or ’flat feet’, causes various rotations throughout the legs during the walking cycle. The end result of these rotations is a forward tilt of the pelvis, which in turn increases the curvature of the spine and places strain on the muscles and ligaments of the lower back.

Asymmetrical Movement of the Feet

If one foot is rolling in or out significantly further than the other, not only is there an increased curvature through the lower back, but a pelvic tilt can result. This can lead to scoliosis (a curvature of the spine), and once again places strain on the associated muscles and ligaments.

Structural / Functional short leg

One leg shorter than the other can be either structural (the bones in one leg are actually shorter than in the other leg) or functional. A functional short leg can be due to over-pronation in one foot more than in the other which rotates or twists the pelvis which becomes misaligned. When this happens, the leg is pulled up higher into the hip socket, the joints in the pelvis may be impinged, causing pain and discomfort and the leg muscle to shorten.

Incorrect Gait / Posture

Posture and gait (walking/running style) are closely related and can heavily influence other areas of the body. Even the most minor abnormalities in posture and gait can result in increased stress on the lower back and other areas of the body.

Treatment of Lower Back Pain

Podiatrists are able to diagnose any lower limb problems causing lower back pains through Footwear Assessment and Biomechanical Analysis. Podiatrists assess the suitability of footwear for your individual situation and critically analyse your posture and movements while you stand, walk and run to identify the cause of your lower back pain. Through this analysis Podiatrists are able to accurately diagnose the lower limb cause and prescribe the right treatment to alleviate your back pain.

Custom-made orthotics are the best way to treat and prevent over-pronation. They are custom-made shoe inserts which will give controlled support to the arch and hence neutralise abnormal foot pronation. Orthotics maintain the normal biomechanics and posture of the foot and leg, limiting pelvic tilt and muscular tightening of the lower back area. Heel lifts can be used to raise a structural short leg.

Stretching Exercises may be prescribed to relieve the gradual shortening of the affected muscles.

Joint Pain and Arthritis

What is Arthritis ?

Arthritis is a major cause of disability and handicap in Australia affecting people of all ages and walks of life. Arthritis is not a single condition.

Arthritis literally means inflammation of the joint.

There are over 150 kinds of arthritis, all of which affect one or more joints in the body. The most common types of arthritis are:

  • (OA) Osteoarthritis
  • (RA) Rheumatoid arthritis
  • Fibromyalgia
  • Lupus
  • Septic arthritis
  • (JIA) Juvenile idiopathic arthritis
  • Gout, which account for 90% of all arthritis cases.

One in one thousand children are diagnosed with juvenile arthritis, while it is estimated that three in every thousand children live with the condition but remained undiagnosed.

Arthritis is often misinterpreted as simply a disease which affects elderly people, when in fact 60% of those who are diagnosed with arthritis are between the ages of 15 – 60 years.

Arthritis affects 3.4 million Australians, 16.7% of the population. Of the proportion of Australians affected, 60.4% are women. 60% of all people living with arthritis are of working age.

Causes of Arthritis Can Be

Due to the fact that there are over 150 different types of arthritis, there is no one single cause or list of causes for arthritis. Often several factors contribute to an individual developing this common problem.

Types of Arthritis

Arthritis causes pain, loss of movement and sometimes swelling. This disease also can affect other parts of the body.

Some types of arthritis are:

Osteoarthritis, is the most prevalent form of arthritis.Osteoarthritis is a disease that affects joints in the body and is characterised by damage to the surface of the joint. The main symptoms are pain, and sometimes mild stiffness. The condition is sometimes referred to as osteoarthrosis, arthosis or degenerative joint disease. The cartilage that covers the ends of bones in the joint deteriorates, causing pain and loss of movement as the bone begins to rub against bone.

Rheumatoid arthritis, is one of the most serious and disabling types oaffecting mostly women. Rheumatoid arthritis, is an autoimmune disease in which the joint lining becomes inflamed as part of the bodys immune system activity, symptoms such as pain and swelling in the joints and stiffness in the mornings may occur.

Gout, is often said to be the most painful of all the rheumatic diseases, Although it can’t be cured, it can be successfully treated. Gout can affect men of any age. Women rarely develop it before the menopause, but may do so as they age. So, with people living longer, there are more women with gout than previously. A tendency to attacks of gout may be inherited from a parent or a grandparent.

People get gout because there is something unusual about the chemical processes that take place within the body. A substance called urate builds up as crystals in the joints, especially the big toe. Fortunately, gout almost always can be completely controlled with medication and changes in diet.

Ankylosing spondylitis, is an inflammatory condition that affects the joints of the spine. Spondylitis simply means, inflammation of the spine. As the inflammation dies down, new bone forms replacing the more flexible tendons and ligaments between the vertebrae. Eventually the individual bones of the spine may link up (fuse) resulting in stiffness of the spine. (ankylosis)

Juvenile arthritis, a general term for all types of arthritis that occur in children. Most children won’t have lasting problems from childhood arthritis. JIA doesn’t turn into rheumotoid arthritis in adulthood. And having juvenile idiopathic arthritis doesn’t mean that your child will go on to develop adult forms of arthritis.

Systemic lupus erythematosus (lupus), a serious disorder that can inflame and damage joints and other connective tissues throughout the body.

Scleroderma, a disease of the body’s connective tissue that causes a thickening and hardening of the skin.

Fibromyalgia, is a long term (chronic) condition that can cause widespread muscle pain. There aren’t usually any outward signs of fibromyalgia, but the pain and tiredness associated with this illness are very real, in which widespread pain affects the muscles and attachments to the bone. It affects mostly women.

Preventing Arthritis

As the specific causes of the different types of arthritis remains unclear, it is difficult to say what may assist in the prevention of the development of arthritis. However, listed below are a few steps which may be beneficial in reducing the effects of arthritis.

  • Maintain appropriate weight.
  • Protect joints from overuse and injuries.
  • Regularly exercise to maintain healthy bones, muscles and joints. Obviously, regular Podiatry care is of benefit too, ensuring optimal spinal/joint range of movement and flexibility.
  • Eat a healthy diet as nutrients are vital for joint health.
  • Hydrate your body. Water makes up 70 percent of the cartilage in joints and plays a major role in the lubrication and shock absorbing properties of healthy joints.

For further information, or to consult with one of our skilled Podiatrists call us on: (03) 9588 2348

Hip pain

Hip Pain & Podiatry

If you have hip pain, you may benefit from Podiatry to help control your symptoms and improve your overall functional mobility as Podiatrists take care of lower limb conditions. Your treatment program will focus on decreasing or eliminating your pain, improving your hip range of motion and strength, and restoring normal functional mobility.

Hip pain can be caused by many factors. Often, you may start feeling hip pain for no apparent reason. Sometimes recreation or sports puts repetitive strain on the hip causing pain. Because the hip is a major weight bearing joint, arthritis of the hip is a common problem. The hip is responsible for such functional activities as walking, running, rising from sitting, and climbing stairs. Pain in the hip can limit these activities.

The hip is close to the low back, and it can be difficult to determine if your hip pain is truly coming from the hip or coming from your low back. The location of your symptoms can often help solving this problem.

  • Pain in the groin or front of the hip. If you feel pain in the front of the hip, this may due to arthritis in the hip joint.
  • Pain in the side of the hip. Pain in the side of the hip typically indicates a problem with the muscles or structures around the hip.
  • Pain in the buttocks or back of the hip. If you feel pain in the buttock, there is a good chance this pain is coming from your low back and not your hip.

Treatment of your hip pain

Your first visit to your Podiatrist for hip pain will begin with an initial evaluation. This visit is important to ensure correct diagnosis and proper management. The examination may consist of several sections including, but not limited to:

  • Strength measurements
  • Functional mobility tests
  • Special tests – These are specific manoeuvres performed around the hip to help determine which structure may be at fault and may be causing the problem. This may include testing of the low back, foot and ankle to determine if your hip pain is really coming from your hip itself.

After the initial evaluation, your Podiatrist will be able to initiate a plan of treatment for your hip. This may include but not be limited to the following:

  • Ice
  • Rest
  • Heat
  • Orthotics to correct improper foot alignment which impacts lower limb alignment and the hip
  • Massage and trigger point therapy
  • Dry needling
  • Joint mobilization
  • Exercises to improve hip strength or mobility
  • As your hip pain improves, advanced hip strengthening can be another option to maximize hip function.

Feet and knee pain

You may not immediately think of knee pain as being related to a problem with your feet, but poor foot function can be a factor that causes pain further up the body, in joints such as the knees, hips, and lower back.

There are commonly two types of injuries which can cause knee pain:

  • Acute injuries (eg. ligament tears)
  • Overuse injuries

The most common cause of knee pain related to the feet is excessive foot flattening or rotation, which can force the knee to roll inwards in an abnormal position.

Various factors can cause overuse injuries to the knee, including poor footwear, inappropriate training programs and inadequate training surfaces (eg. bitumen or soft sand).Another major cause is abnormal alignment of the foot and lower leg.

Flat Feet 

With flat or excessively pronated feet, the result is excessive internal rotation of the lower leg at the same time that the upper leg is rotating in the opposite direction due to forces produced during walking. The knee is the area that therefore must absorb these twisting forces, and thus injuries occur.  Also, pronated feet result in a valgus, or ‘knock-knee’ position, which results in various muscles exerting their pull in incorrect directions.

High-arched feet

High arched, or excessively supinated feet, do not allow the shock absorption needed during walking.  The knee must therefore take too much force to absorb this shock, and this is when overuse injuries will occur.

Patellofemoral syndrome

With pronated feet the knees move into the ‘knock-kneed’ position. This causes the patellar tendon (which connects the muscles of the thigh to the lower leg via the knee cap/patella which acts as a pulley) to pull in the wrong direction.  The patella thus runs over areas in the knee that it is not supposed to, and eventually this will result in injury and pain. The pain is often felt with bent-knee activity, like squatting and walking upstairs.

Iliotibial band syndrome

The muscle which runs down the outside of the thigh, and which crosses the knee, is the iliotibial band. With excessive pronation, this muscle shortens over time and is therefore subject to pain and injury. Pain is felt on the outer edge of the knee joint.

Osgood shlatters disease

This commonly affects teenagers, and is an inflammation of the growth plate of the tibia (lower leg bone), which is situated just below the kneecap.


  • Orthoses – these allow the foot, leg and knee to function in the correct position, and thus forces are distributed correctly throughout the leg.
  • Exercises – strengthening and stretching of muscles around the knee to help reduce your knee pai
  • Dry Needling
  • Rest, ice, compression
  • Taping of the knee
  • Wearing appropriate footwear

If you have knee pain that you can’t seem to get rid of, consider seeing a podiatrist.

Falls prevention

Falls are an ominous yet very real part of life for people over 65 and many falls can be prevented once the causes are determined. Most elderly patients experience a decline in balance and muscle strength. The combination of this decline with visual and vestibular compromise increases the risk of falling.

The risk of falls and associated complications rise steadily with age and can be a marker of increasing frailty. Frailty is not clearly defined but is widely accepted to include a combination of weight loss, fatigue, reduced grip strength, diminished physical activity or slowed gait associated with increased risk of falls, hospitalisation, loss of mobility and independence, increasing disability and death.(1)

The Australian Bureau of Statistics has found that the number of elderly people who die each year from falls has quadrupled over the past decade. 1530 people over the age of 75 died from falls in 2011, compared to 365 in 2002. Falls are also the leading cause of injury-related hospitalisation in persons aged 65 years and over in Australia. In 2011–12, 96,385 people aged 65 and over were hospitalised for a fall-related injury. The increasing rate of fall-related hospital admissions reflects Australia’s ageing population. The number of fall-related hospitalisations for older people has increased 2.3% per year between 1999–00 and 2010–11. A randomised trial to assess the effectiveness of a multifaceted podiatry intervention in improving balance and preventing falls found, a podiatry referraland multifactorial intervention approach is recommended.(2)

Foot problems are a main cause of falls in the elderly can be prevented through proper care and consultation with a Podiatrist.

Foot problems than can contribute to a fall include:

  • Difficulty walking
  • Arthritis
  • Foot pain
  • Decrease in muscle strength
  • Toe deformity
  • Decreased range of motion in the joints of the foot
  • Gait impairment
  • Inappropriate footwear

Podiatrists have an important role to in play in reducing the risk of falls by means of:

  • Identifying and correcting underlying biomechanical and gait abnormalities
  • Assessing and treating foot pain
  • Prescribing exercise programs
    • Exercises targeting gait, balance, functional tasks, strength, flexibility and endurance
    • Home-based exercise programs containing some form of balance and strength training are the most important intervention strategy to effectively decrease falls.
    • Maintenance of general foot health care
    • Patient education including;
      • Falls prevention booklet
      • Footwear advice/provision
      • Nail care
      • Prescription of foot orthoses
      • Mobility assistance including assessment & prescription of mobility aides if needed

Fall prevention is possible through proper care of your feet and regular consultation with a Podiatrist who will assess your risk of a fall and treat any conditions in your feet to reduce your overall risk.


  1. World Health Organisation. WHO Global Report on Falls Prevention in Older Age. Geneva: World Health Organisation; 2007. http://www.who.int/ageing/publications/Falls_prevention7March.pdf?
  2. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56.
  3. Spink MJ, Menz HB, Fotoohabadi MR, Wee E, Landorf KB, Hill KD, Lord SR. Effectiveness of a multifaceted podiatry intervention to prevent falls in older people: randomised controlled trial. BMJ 2011;342:d3411.


Arthritis affecting joints in the feet can have far-reaching effects on other parts of the body; your ligaments, tendons and muscles are forced to work harder to maintain stability. This can cause overuse injuries including ankle sprains, torn ligaments and a greater risk of falls.

Because each foot contains 33 joints and bears a tremendous amount of weight and pressure, feet may be more susceptible to arthritis than other part of the body. When arthritis affects the feet, it makes standing and movement very uncomfortable.

Another key concern for arthritis sufferers is chronic pain, which has huge effects on overall health. Severe pain not only limits movement, but also disturbs sleep and can lead to problems with mental health and overall well-being.

While arthritis may occur in any part of the foot, certain forms of arthritis have a tendency to affect specific parts. For example, rheumatoid arthritis commonly affects the smaller joints of the foot while osteoarthritis tends to involve the big toe or the ankle.

The signs and symptoms of arthritis of the foot vary, depending on which joint is affected.

Foot care can relieve pain, maintain function and improve quality of life using safe, cost-effective treatments. An annual foot review is recommended for patients at risk of developing serious complications. Podiatrists work with your GP to provide education and information to help you manage the condition, improve pain and prevent further damage to your joints.

People who suffer with Arthritis are often concerned that by being physically active they will cause pain or increased damage to their joints, when in fact gentle physical activity can reduce some of the symptoms of Arthritis and improve joint mobility and stability.

There are many things a podiatrist can do to help people with arthritis including:

  • Functional assessment of the lower leg and feet
  • Advice about strategies for managing the condition.
  • Exercise prescription to help to keep the joint moving and relieve any stiffness and pain. This can greatly improve your quality of life and your general comfort and mobility.
  • Orthotic insoles and shoes specifically made to support your foot will increase cushioning or shock absorption, they can also direct pressure away from the more sensitive areas of the feet to make walking easier.
  • Footwear advice about the types of shoes most suitable to the activity and the foot shape.
  • Removal or reduction of Corns or Calluses that may develop on toes or under the foot as a result of joint changes. Advice to protect the areas and prevent recurrence.

Even with the best of treatment, arthritis of the foot and ankle may continue to cause you pain or changes in your activities. However, proper diagnosis and treatment will help to minimise these limitations and allow you to lead a productive, active lifestyle.