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Foot Posture and Back Pain

Foot Posture and Back Pain

Broadway Burrard Chiropratic

Back pain is present in around 18% of the general population and is highly preventable in most cases. You are at more risk of developing back pain, especially lower back pain, if you are: female, getting older, obese, have a lower socioeconomic status as well as other occupational and psychosocial related factors. Also, other conditions such as: poor posture, spine curvatures (e.g. lumbar lordosis) and leg length differences have also been a suspected risk factor for back pain. Abnormalities in foot posture have been shown to lead to back pain. Your foot posture is the posture that your foot adopts when in a weight bearing position (that is, when you are standing on it). This position can significantly affect your joints and muscles in the leg all the way up to your upper back and neck, putting added stress on the soft tissues surrounding these joints/structures.

Overpronation and oversupination:

Overpronation is when your foot arches fall and we land on the inside of the bottom of our feet, causing the feet and the legs to turn inwards. Even this small difference can change the way we walk and the forces that go through joints and soft tissue structures. This deviation from normal can also alter the position of our knees, hips, backs and shoulders. You don’t tend to feel the effects instantly, but over time, muscles and tendons can become overworked and lead to pain. Oversupination is the opposite and is where the our foot arches are high and we land on the outside of our foot.

You can test what your foot posture is by simply standing straight and getting someone else to assess whether your heel is aligned with your ankle and knee. If your knee and ankle is excessive deviated inwards (medially) compared to your heel then you are an overpronator. However, if you knee and ankle is excessive deviated outwards (laterally) compared to your heel, then you are an oversupinator. Your podiatrist can give you further details.

Treatment:

Footwear

Footwear is an important factor that can contribute to back pain. More specifically, high heeled shoes can lead to back pain, especially when you have a oversupinated or overpronated foot posture. Wearing high heeled shoes puts you in a posture where the “S” curve in your spine becomes more prominent, and puts more pressure on the muscles and joints in your back. As your height is increased with high heeled shoes you are less balanced, and thus need a lower centre of gravity to make sure that you maintain your balance when walking. As a result of this, your upper back is pushed backwards and your lower back moves forwards. This puts tension and pressure on your muscles, tendons, soft tissue and joints. Therefore, it is essential that you avoid wearing very high heeled shoes for long periods of time as, over time, damage if caused, and can lead to more serious degenerative conditions. Shoes with a lower heel, with a firm heel counter and cushioned soles, will be more beneficial to your back in the long term.

Orthotics

Orthotics are useful to correct your foot posture and improve your overall alignment, especially if you have high or low arches. Orthotics come in two forms: over-the-counter and custom made orthotics. Over-the-counter orthotics are simple insoles that you can purchase from the chemist or shoe store. These are not designed specifically for your circumstances and typically provide cushioning and a simple arch support. Custom orthotics are orthotics that your Podiatrist can make specifically for your foot with a prescription that is based on your individual biomechanics. The type of custom orthotics that are most suitable for you depends upon a number of factors, including the severity of your back pain. It is important to see your Podiatrist for a complete assessment to ensure you get the best treatment.

Foot Posture and Back Pain

Broadway Burrard ChiropraticBack pain is present in around 18% of the general population and is highly preventable in most cases. You are at more risk of developing back pain, especially lower back pain, if you are: female, getting older, obese, have a lower...

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Gout

Gout

Photo courtesy: Consumer Reports

Gout is a type of inflammatory arthritis, often termed ‘the disease of kings’, caused by the deposition of uric acid (monosodium urate) crystals in tissues and typically the joint fluid. This occurs as a result of excessive production of uric acid by the body, or under-excretion of uric acid by the renal system.

Gout is characterised by four clinical phases: 

1. Phase I – involves the deposition of uric acid with no symptoms

2. Phase II – (further uric acid deposition) involves intermittent acute attacks of pain and inflammation which resolves spontaneously over a period of 7 – 10 days.

3. Phase III – The stage between acute gout attacks and persistent crystal accumulation.

4. Phase IV – If the excessive crystal deposits are not controlled, individuals can transition into phase IV of gout, which is characterised by chronic crystallisation involving numerous joint attacks and the deposition of crystals in joints as well as in soft tissues.

Risk factors:

Men are more likely to develop gout and a family history of gout also increases the risk of developing the disease.

Risk factors for gout includes:

  • Some drugs: e.g thiazide diuretics, cyclosporine, low-dose aspirin
  • Diet that mainly consist of meat, seafood and refined sugars/drinks or alcohol.
  • Other factors that are associated with gout include insulin resistance, metabolic syndrome, obesity, renal insufficiency, hypertension, organ transplantation and congestive heart failure.

Recurrent attacks or flares can also be induced by the use of recent diuretics, alcohol intake, surgery or trauma and recent hospitalisation; initial use of uric acid lowering drugs can also trigger gout attacks in the early periods, however reduce the risk of attacks in the long term.

Signs and Symptoms:

Clinical features of gout include spontaneous onset of intense pain, swelling and redness that most commonly affects the big toe joint (known as podagra). It can also affect other joints of the foot, ankle, mid-tarsal, wrist and knee.  Other problems that can cause similar symptoms include pseudogout, psoriatic arthritis and septic arthrtis.

Investigations:

The standard for the diagnosis of gout still remains removal of the joint fluid and evaluation to check for monosodium urate crystals under a microscope. As gout and septic arthritis can co-exist it is also essential to analyse the joint fluid for bacteria through culture. Radiographic imaging of the joints can show the changes due to a chronic history of gout. Sometimes, evidence of crystals in the joint may be seen, but not always. Recently, ultrasound, CT and MRI are also emerging techniques for the diagnosis of gout.

Treatment:

Treatment of gout can involve drug therapy as well as support and rehabilitation measures. Pharmacological management aims to treat acute gout attacks and also helps to maintain an appropriate level of uric acid in the blood in order to prevent recurrence. The British rheumatology guidelines prefer the use of NSAIDs at a high dosage (given no contraindications to its use) with a treatment period of 1-2 weeks. Therapy starts with high doses of anti-inflammatory medications for the first few days with a decrease in the dosage as the symptomatology subsides. For acute attacks of gout, another drug called colchicine is also used in addition to anti-inflammatory medicine.

Long-term management for gout consists of managing the urate levels and maintaining the concentration below a certain level. However, urate-lowering drug therapy is only indicated in patients who have experienced multiple gout attacks or chronic joint pathology and extensive crystal deposition.

Chronic gout can be painful and significantly reduce the mobility in the joint due to the crystal deposits, and the inflammation and damage caused by this. Orthotic therapy is often beneficial in order to increase the range of motion of particular joints and protect the foot from further deformity that can be caused by chronic gout.

Köhler’s Disease

Köhler’s Disease

Photo credit: Fixmyfeet.co.za

Köhler’s disease is a condition that impacts a bone on the inner arch of the foot. This bone is called the navicular.

This relatively rare disorder of the foot typically affects males more than females and occurs between the ages of 2 and 10 years of age with a peak occurs during the ages of 3 to 7 years.

It is not fully understood why this condition occurs. Some researchers suggest that it is caused by excessive strain on the navicular bone, while others believe that it is caused by injury/trauma to the area. As a result of this, the blood supply to the bone get compromised as the child is growing. This leads to loss of blood flow (ischaemia) to navicular resulting in progressive degeneration of the bone. If not treated promptly, the bone can become permanently deformed.

The signs and symptoms of Köhler’s disease can differ, but they generally include:

  • Redness around the inside of the foot, near your arch
  • A swollen foot
  • Tenderness/pain along the inside of the arch
  • Pain worse if putting pressure on the affected foot

This is an uncommon condition that warrants proper diagnosis, care and management. Generally, it does resolve on its own. It is important not to aggravate the condition as it can lead to complications later on in life. If the condition is very severe (as determined by X-ray/CT scans) then a fibreglass cast or moon boot may be required in addition to other treatment options. See our Podiatrists here for more information regarding this condition.

What to Do If You Have Suffered a Sporting Injury

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Intoed Gait

Intoed Gait

In-toeing

 

Do you feel like one of your leg points inwards when you walk, and you often find yourself tripping over? Or do you observe that your child’s feet tends to turn inwards (or perhaps they are clumsy when playing with friends)? This condition is known as in-toeing. In-toeing commonly occurs due to four main factors that stem from either your hip, legs, feet or muscles:

1.    Thighs are turned inwards (femoral anteversion)
2.    Leg is turned inwards (internal tibial torsion)
3.    The front part of the foot turns towards the midline of the body (metatarsus adductus)
4.    Tight muscles in the legs

Most children with intoed gait will outgrow it, so in most cases it is something so keep and eye on and manage, but does not usually lead to long term problems.

Your Podiatrist will be able to assist you in determining where the in-toeing is stemming from and will be able to provide you with advice regarding non-surgical management of the condition (it is very rare to require surgical treatment).

At home there is a few things you can do. If you are worried that your child maybe in-toeing, get them to perform a squat. Firstly, avoid sitting in a W-position but instead start sitting cross-legged to stretch out your hips. We also encourage that you take up activities that position your hips, leg and foot in an outwards position, including activities such as horse riding, ballet and swimming (breast stroke preferred). See your podiatrist today for assessment and further advice. At the Perth Foot & Ankle Clinic we can use our Bodytech gait analysis machine to assess intoed gait and monitor over time.

not assigned 105
foot disorders 5
sports injuries 2
Common Foot Problems 12
foot care tips 12

Foot Posture and Back Pain

Broadway Burrard ChiropraticBack pain is present in around 18% of the general population and is highly preventable in most cases. You are at more risk of developing back pain, especially lower back pain, if you are: female, getting older, obese, have a lower...

Tinea pedis/Athlete’s foot

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Wart is this on my foot? – Verruca Pedis

Wart is this on my foot? – Verruca Pedis

foot wart

Plantar warts, medically termed verruca pedis, are painful, solid and thickened lesions that are caused by the Human Papilloma Virus (HPV). If the wart is located on the bottom of the foot, warts can be extremely painful and it can sometimes significantly affect a person’s quality of life.

Warts can be contracted or transmitted when an individual comes into direct contact with the virus when the outer layer of the skin becomes damaged. Sometimes, these warts can resemble calluses or corns. This is because, its location on the plantar aspect of the foot subjects the lesion to increased pressure and forces. Hence, it is necessary to seek professional assistance in order to determine the correct diagnosis and thus the correct treatment option for the lesion. Typically, warts can resolve on their own, it usually takes from a few months to 2 years to completely disappear. Often the pain can be unbearable for some (because of its location on the sole of the foot), in which case other treatment options may be required.

Treatment for plantar warts:

  • If the wart isn’t bothering you, you can simply wait for resolution
  • Topical acids for plantar warts
  • Cryotherapy for plantar warts (this can be slightly painful)
  • Laser plantar wart removal
  • Wart surgery/curettage

Advice we give regarding warts:

  • Make sure you don’t pick at or scratch your warts
  • Cover the wart with medical tape to prevent spreading
  • Avoid sharing articles of clothing that have come into contact with the lesion
  • You can use a small corn pad (which fits the wart’s diameter) to offload the area.

Do I need surgery for my wart?

Wart surgery (curettage) is required if the wart is persistent, has been present for several years, is not responding to other treatment, is extremely painful or you require quick plantar wart removal. At the Perth Foot and Ankle Clinic we can perform the surgery here at our clinic in our operating room. The surgery typically involves numbing the area with local anaesthetic, after which one of our Podiatrists will remove the wart in a sterile manner; we also use a small amount of chemical to destroy any remaining wart tissue to reduce the risk of recurrence. Speak to one of Podiatrists if you require further information.