Back pain, and more commonly lower back pain, is a common problem that generally stems from a multitude of factors. Factors including age, working environment, activity levels, types of activity, footwear, posture, etc.
This blog is going to focus on seeing whether you can relate your back pain or risk of potential back pain to some key contributing factors that stem from the feet.
Are your feet flat?
Having slightly flat feet, which is generally viewed as someone with a decreased arch profile is a common finding in people with lower back pain. Why? Because standing with your arch flattened closer to the ground means generally your shins and your hip bones rotates inwards. If you try to twist your leg in now look what happens to your low back. For the majority of you, you will find it becomes more concave. Or as for those who do Pilates on a Saturday morning know it, an anterior pelvic tilt. This anterior pelvic tilt compresses the discs in between your vertebrae causing sustained pressure the longer you’re in that position. And furthermore changes the tone of the postural muscles that try and align your spine.
Do your pronate as you run?
Before you think pronation is a bad thing… It’s not! Pronation for simplicity’s sake is the motion of “rolling in”, and it helps reduce shock in the process of moving from heel to toe during walking and running. The ideal running style for a heel runner would be to land towards the outside of their heel, pronate through the midfoot or roll into what podiatrists define as a neutral calcaneal or heel position, and then push off straight through all your toes. Pronation becomes an issue when you “roll” well past the point of neutral, causing excessive loading through your calfs, quads and glutes to try and oppose that force. Excessive strain on these muscles, especially the glutes, reduces the support around the pelvis and compromises the stability of the lower back.
On the occasion that you have a very high arch and don’t naturally pronate at all, you will find that a few methods to absorb shock when you run are:
Do your toes point straight when walking and standing?
- Make sure you don’t run with a wide base
- Wear quality neutral runners
- Address your running technique or see a podiatrist who can wedge your shoe.
I’m very big on this, the direction in which your foot points will predetermine how the rest of your body is aligned. If you point your feet in when you stand, you will tend to find your adductors or groin muscles over work. As a result of this, it opposes the Glute muscles from working on rotating the hips out and supporting the pelvis and spine. On the contrary if your feet point out, you will find that your Center of mass moves into the insides of your feet reducing your arch profile and increase tension on the knee joint. This also tends to compress the outside of the ankle and reduces the capacity of your big toe working in movement. Once these factors have all added up, you will find there is an increase risk of lateral hip and knee pain as well as a high risk of pronating uncontrollably during walking and running gait.
If you’ve never had a blister and are reading this to hopefully never get one, let me explain what it feels like, how it’s caused, and my strategies to aid and prevent blisters.
Firstly, the feeling. Imagine a sting on your skin that throbs and burns the more you put pressure on it. Sounds horrible right? The formation of these nasties come as a result of two things in combination.
- Friction on the skin for an extended period of time.
- The skin producing excessive fluid, sweat or oils on the surface during activity.
Now if you don’t control these factors, Podiatrists like myself usually treat this by draining the blister safely and with proper infection control (important!). However, if you’d prefer never to have one drained, the next bit will break down four ways in which you can avoid both fluid and friction around your feet.
- Addressing your shoe size
A size too big and your foot will move around the shoe whether you like it or not. And if you don’t move, you should accept that your toes will at least claw to grip the shoe as you move through gait. Crunching your toes or gripping your shoes will still create friction within the forefoot.
In contrast, a shoe that’s too small will generally result in the shoe compressing and causing friction around the borders and arches of the foot. The most common site of pain as a result of this is the back of the heels. Other common places include the tops of toes, underneath or on the inside of the 1st and 5th toe, and under the arches.
Keeping the toes separate when walking is important when it comes to blisters. The reason being is crunching your toes (generally through poor balance, footwear, walking technique etc.) causes greater load through the balls of your feet and also increases how prominent the bones at the tops of your toes become to the upper of the shoe. Buying a toe separator from your chemist or having a custom one created by your podiatrist using a silicone mould may be a good option for you.
- Socks – By far my favourite socks for blisters are the toe socks. The toe socks have a sleeve for each individual toe. And although they feel like your feet have turned into ET’s feet, they work. Similarly, any sock that works on the premises to absorb moisture is going to be important to delay the fluid component of a blister. On some occasions you may have to change socks regularly to maintain a dry environment for your feet.
- Powders and Sprays – talcum powder, friar’s balsam, methylated spirits, etc. have all been used in tandem, or in conjunction with one another to assist with reducing the fluid build-up underneath the feet or in between the toes. There are various brands and companies that offer different products. In my opinion, the process of finding out what works for you is trial and error, because how you feel when moving is the most important thing. The preferred option often varies from patient to patient.
- Botox – Hyperhidrosis in the feet is a condition that is hard to just treat with the powders and sprays method. In circumstance that cannot be controlled, it often requires individuals to seek professional advice. Botox treatments are a scientifically proven treatment option for this. Consult your dermatologist to find out more.
This is generally done by a podiatrist, but there’s nothing wrong with trying this at home. I have found padding around the blister is much more successful than using a blister pad in the areas of the heel and arches. If you can offload a blister by creating pressure around the blister using a pad but not on itself i.e. creating a pad in the shape of a doughnut; you will find it will offload the pain to almost its entirety. And although it doesn’t address the cause of the issue it will help you get through your day.
There are some general traits with foot types that in my practice I have seen make the client more predisposed to certain injuries and problems. And preventing pain or injury is something I think everyone should have the ability to pre-determine. So… What are the three signs you should look out for?
A bunion. This the easiest thing to see for yourself. A bunion is when in most circumstances your big toe points in towards your second toe and the bone on the side of your big toe protrudes out. Regardless of whether it’s hereditary, biomechanical or footwear related. Bunions are a functional deformity that generally only gets worse and affects propulsion through walking and running. By not using your big toe when you run you will tend to compress through your joints in the forefoot and furthermore not activate muscles in your leg and backside efficiently. Especially the muscles used when you’re in the last 15% of your walking gait or running cycle. The three I see most commonly impacted are the medial gastrocnemius (calf), VMO (inside muscle of the knee) and gluteus maximus. Getting an assessment on your bunion is important, because simply letting it get worse can lead to significant pain and weakening of these muscles.
Your feet point out or in when you walk. Dancer’s feet or being pigeon toed are common issues developed at a young age where your bodies mass does not evenly go through your feet. To put into context. Imagine trying to crawl fast. Now point your hands out or in and see how hard it is. Think about how slow you automatically become , a s well as how much stress now goes through your wrist, elbow and shoulder. Repeat it daily and watch how eventually you predispose yourself to injuries anytime you try and accelerate beyond your body’s capacity . Now by no means if you have done this for ages should you just try and just straighten your foot. Your body won’t tolerate it initially . Rather you need to be smart and start of by implement ing cues or drills to provide mild corrective changes over time . This will assist you in preventing injuries and correcting your movement which is vital at any stage on life.
Do you have a flat arch or a very high arch? This is probably the most common one you’d expect to see in this blog. And most people tend to be aware of this. However what most people don’t know are the implications of having what I like to call a pancake foot or a harbour bridge foot, until they are in some degree of pain or discomfort. Ironically the majority of time the issues that present from th ese foot types are not located in the feet .
Generally it’s in the knees, shins and lower back that cop all the joint pressures because they are having to compensate for a poor foundation . So having a foot and gait check is always good idea no matter what your level of activity . This is not the thing at the shoe stores where they get you to stand on the machine and it tells you if you’re flat or high arched. Rather a gait check is a movement screening done by a professional that understands walking, running, footwear and most importantly how to help you conservatively and non-conservatively look after your feet and the rest of your body.
So the question you want the answer to… Do you really need orthotics? This article will allow you to make an informed decision about the benefits of orthotics as well as whether your podiatrist has explored the proper conservative options available for you prior to considering orthotics.
My experience with orthotics is extensive. In short, I have in the past and still do create orthotics regularly. I have previously taught and tutored at La Trobe University on orthotic theory and manufacturing. Finally, and most importantly, I have also worn orthotics previously myself (which I ended up throwing out because they were too bulky).
Orthotics, for those who are unaware, is a device that is either pre made or custom made to create a change or accommodate the alignment of the foot. There are many pre made orthotics out there. You’ll find them at chemists, physio and chiro practices; most podiatrists will tend to have these options too. A couple of brand examples include: Vasyli, Formorthotics, and Superfeet. On a side note, a Scholl gel support is not an orthotic!
These pre made orthotics tend to be good for the consumer that just wants a bit of support in their arch, and something relatively cheap compared to a custom pair from their podiatrist. However, what if you’re in pain or discomfort? What do you do if your podiatrist recommends you a custom orthotic?
As a consumer you are to know 5 things:
- Orthotics are created differently by all podiatrists – so your friend’s experience, for instance, may be different to yours, unless you see the same podiatry professional.
- Costs for orthotics vary based on how much a podiatrist believes their custom designs are worth. Similarly to an architect designing a house, you will find premium designers, some that provide good value, some that are rip offs, and some that are run of the mill.
- Orthotic bulkiness is something in this day and age you can ask to have at a minimal. Not all orthotics have to be a big bulky brick under your feet.
- Your foot should be casted properly prior to the orthotic being made. Anyone that traces your foot, gets you to step in a foam box or walk across a plate is probably a bit too dated or doesn’t create custom orthotics regularly enough in my opinion. A proper sock mould or quality laser scanner is in my opinion are the premium methods for casting the foot.
- If orthotics are the only option a podiatrist or orthotist for that matter gives you on your first consult to address your complaint… Go somewhere else.
Now in reference from my last point. Please note, orthotics can be looked at similarly to braces from your dentist. Sometimes you just need them, and sugar coating it will otherwise waste time. They both can come off eventually and they’re both expensive. Orthotics being comparatively quite less expensive… but you get what I mean
However for the majority of the time I believe if your podiatrist performs the below methods, then they have taken reasonable enough care to warrant thinking an orthotic is necessary. These methods include:
- Assessing walking and running technique: It’s important your Podiatrist assesses the way you move and run day to day. There are cues which you can implement when moving to assist and retrain how your feet, knees and hips accept load and ground reaction forces.
- Footwear assessment – Now this doesn’t mean you have to go get the shoe with the most cushion or support. Each foot responds differently to different footwear, so it’s important your podiatrist advises you on this prior to looking at orthotics.
- Taping and Padding the foot – if the injury is acute in nature it may not be all biomechanically related. So some temporary support may be all you need to remove your pain.
- Recommendations to change your activity frequency, intensity or the way an activity is performed – For example taking a look at your squat technique, where often we may find poor technique reducing ankle mobility leading to pain and visa versa.
- The Podiatrist has attempted soft tissue work, stretching, exercise prescription or dry needling to address the muscles contributing to the pain that you’re currently experiencing..
Your podiatrist being able to perform the majority of these 5 things are paramount too not only show that the Podiatrist is genuinely competent at treating your concern, but also that they are not purely financially motivated to sell orthotics.
Remember each podiatrist is their own designer when it comes to this. So if you feel the design has been created as a result of valid testing, then I believe you’ll be in good hands.
I love moving fast! Since being a little kid at primary school, all I ever wanted to do was run fast, bowl
a cricket ball fast and do a roundhouse kick fast. But it didn’t just come as I developed. It came from
being around parents, coaches and friends that all shared a like-minded love for all things revolving
around developing power and speed.
So I will share 5 pearls today that I learnt growing up and implement now with my clients in the clinic – and hopefully this will help your kids or even yourselves to help improve your running speed.
- Think of your feet as springboards that you see at the diving pool. The end of the springboard like your feet should when you run should point forward…..NOT down. Obviously as you propel of the ground your toes will point down. Similar to as you push into the diving board, it points down through force. However as you jump up or drive up with your legs that springboard always comes back up quick to its original position. Apply this with your feet and get those toes pointing up in swing phase and contact phase. This will reduce contact time on the ground and allow for better propulsion forward.
- Long legs… Shorter strides. My issue growing up was having long twig like legs. So to combat that, I looked at making sure that my feet landed close to underneath my body and never lagged too far behind my body. In saying that, with these assets, make sure you put them to good use by extending your legs out as you run. However, the concept of bringing that foot back quickly close to underneath your body does not change.
- Use your arms! Your arms are like the point on a compass guiding your balance. If there moving across your body, keeping low or flailing above your ears, then there’s a fair chance the rest of your body is doing something a little out of sync also. So to change this, you can do a couple of things. Firstly, try sitting on the ground and moving your arms as fast as you can whilst keeping still. You’ll see the easiest way to do this is by moving them up and back in a straight line. Secondly, when running see if you can hold a stick in each hand and keep that stick facing forward as you run.
- Sort out your feet when you walk. Flimsy feet are a child’s worst nightmare when it comes to moving fast. Simply because firstly the springboard effect becomes very hard, and secondly it becomes an unstable platform to develop power from the rest of your body’s muscles – including hamstrings, glutes and calves. So by walking in the right shoes, with the right technique and patterns, it becomes much easier to transition into running.
- Prime the muscle! Before any running or power event, it’s important that the movement that is about to be performed has been mimicked through a warm up. Your nervous system won’t just magically activate at 100% of its potential when your child wants to do an activity such as sprinting. So making sure they perform a series of drills or similar movements to replicate the action or activity that they are going to do. It’ s important to getting the most out of their effort by priming the key muscles beforehand