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:
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.
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:
(RA) Rheumatoid 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.
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
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:
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:
Orthotics to correct improper foot alignment which impacts lower limb alignment and the hip
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)
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.
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, 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.
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
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.
With every step, shock is absorbed by the feet, knees, hips and spine to decrease the force of impact. Wearing the correct footwear will reduce these forces further whilst not affecting the normal function of the foot. Wearing the right footwear for the job protects you from stress-related injury to the ankles, knees, hips and spine.
Types of Sprains
The most common type of sprain is a Lateral Ankle Sprain/inversion sprain (or lateral ligament sprain) where the foot turns inwards, damaging the ligaments on the outside of the ankle.
A sprain where the ankle turns inwards (Medial Ankle Sprain) is much rarer often taking significant forces to do so. This sprain damages the ligaments on the inside of the ankle.
In addition to ligament damage there may also be damage to tendons, bone and other joint tissues, which is why it is important to get a professional to diagnose your ankle sprain. If possible an X-ray should be used, as small fractures or (avulsion fracture) are not uncommon.
Grades of Ankle Sprains
Sprained ankles, as with all ligaments sprains, are divided into grades 1-3, depending on their severity:
Grade 1 sprain:
Some stretching or perhaps minor tearing of the lateral ankle ligaments.
Little or no joint instability.
There may be mild swelling around the bone on the outside of the ankle.
Some joint stiffness or difficulty walking or running.
Grade 2 sprain:
Moderate tearing of the ligament fibers.
Some instability of the joint.
Moderate to severe pain and difficulty walking.
Swelling and stiffness in the ankle joint.
Minor bruising may be evident.
Grade 3 sprain:
Total rupture of a ligament.
Gross instability of the joint.
Severe pain initially followed later by no pain.
Usually extensive bruising.
Treatment of Ankle Sprains
As soon as possible, and for 72 hours after injury, use the RICE method:
Rest – Take it easy and only move within your limit of pain.
Ice – As soon as possible, and for 20 minutes every two hours, apply ice or a frozen gel pack wrapped in a damp towel. This helps to control bleeding and pain whilst reducing secondary tissue damage.
Compression – Firmly bandage the entire ankle and lower shin. This helps to control swelling.
Elevation – As much as possible, elevate your ankle higher than the level of your heart to reduce swelling.
Following the initial painful stage, there are other treatments that can help the ankle return to normal as soon as possible. Range of motion exercises such as ankle circles can help to get the ankle moving again, as well as reducing swelling if performed with the leg elevated. The calf muscles often tighten up to protect the joint following a sprained ankle, and so gently stretching the calf muscles can also help to maintain movement at the joint.
A wobble board / balance board is an important part of the rehabilitation of ankle sprains.
There are many different causes of ankle pain and the quickest way to heal an ankle injury is to get a proper diagnosis. The treatment for one injury is can be quite different to another. This is mostly due to the complexity of the ankle and as such the right advice can make all difference.