Foot and Shin Issues

Flatfeet and rotation of the leg

The feet are the foundation of the lower limb. Poor biomechanics often start with the foot. If a foot is flat or has high arches there are abnormal changes that can occur to all of the postural joints of the body.

Our feet are highly adaptable. As they hit the ground and begin to absorb load, the motion they undergo is called pronation. The flexibility of our joints determines how much energy the lower extremity chain (foot-ankle-knee-hip-pelvis-low back) can absorb.

For different reasons, both flat and high-arched feet channel a large amount of energy to skeletal structures high in this chain — especially the knee, hip and lower back—making those structures more susceptible to injury.

For example, it is common for the kneecap (patella) to develop pain because a flat foot forces the patello-femoral joint to absorb more energy. The patella can become poorly aligned because of rotation of the foot as shown in the picture below.

Running sports add ‘impact loading’ to the equation. Running and jumping amplify the effects of failed biomechanics.

Sprains and strains are likely to occur when joints are poorly aligned or when they absorb forces that should be directed to another part of the body. Make sure your footwear is supportive and appropriate for the activity you’re doing.
Did you know that we have metatarsal pads for sandals and dress shoes?

Heel lifts are used when there are leg length discrepancies – one leg can be shorter due to lower back, hip, knee, leg and/or foot issues.

Lower back pain due to the legs

 

Figure 2:  When the feet flatten out, this causes shifting of the legs and a change to the lower back curve.

There are a number of causes for low back pain. In many patients excessive foot pronation may contribute to lower back problems. Bilateral excess pronation causes internal rotation of the tibia which in turn leads to anterior tilt of the pelvis and a forward shift of the body’s center of gravity.
The result is increased lordotic curvature. Increased lordosis at L1-L5 and compensatory muscular tightness of the lumbo-sacral region causes pain and discomfort especially when standing upright for longer periods of time. The thoracic region commonly develops a secondary kyphotic curvature. Unilateral pronation lowers the vertical distance of the foot to the ground, creating a functional short leg and causes a hip mis-alignment. Structural leg length discrepancy means that one leg is actually shorter than the other. In this case the patient will often present with unilateral pronation (i.e. worse on one foot) as a natural compensation for the structural imbalance.Both functional and structural leg length discrepancy can cause back pain. Patients presenting with a leg length discrepancy often also exhibit Scoliosis. Back pain can be treated with stretching and strengthening exercises, chiropractic spinal adjustments, soft tissue massage therapy, and active release. Adding orthotic therapy to your treatment regime can be beneficial. Correcting excessive pronation with FootMaxx orthotics will assist by posteriorly rotating the pelvis, thus reducing pressure on the sacro-iliac and lower back area. A heel lift should be added to the orthotic on the shorter leg. By doing so the shorter leg will be raised which aids in rebalancing the lower limb and removing compensatory mechanisms that contributes to lower back pain. If you have lower back pain, have your leg lengths checked. Also, check the alignment of your feet, femur, tibia, fibula, and patella bones checked for rotational problems. Also, have a foot scan/gait analysis. Please book an exam with Dr. Barbara Rodwin to have these checked. 

Shin splints and Achilles tendonitis

Figure 3: Shin Splints

Shin splints are caused by overusing the lower leg or by using it incorrectly. Improper stretching, warm-up or exercise technique will increase the chances of shin splints. They can also be caused by improper footwear and flatter feet (pronation) which causes rotation of the shin. The soft tissue becomes inflamed due to the stress that has been put onto the shin. This area is enclosed in a compartment and if the tissue swells, there is no place for it to go so the pressure increases. The increased pressure makes it hard for the blood to flow freely and the net result is pain and sometimes tingling, numbness or weakness.

 

Figure 4: Both the Achilles tendon and the plantar fascia

Achilles tendonitis is a common injury in the running community. It is an inflammatory process that leads to swelling, pain and tissue damage. It results from repetitive strain, which in turn makes it more susceptible to tearing or even rupturing. The Achilles tendon attaches onto the heel of the foot as do the posterior muscles of the leg, which help to plantar flex the foot (point the toes down). It is responsible for providing the push that drives the foot down and forward when walking, running, and jumping. All in all, it generates a lot of tension and absorbs a lot of force. It‘s involved in most actions of the lower extremity and becomes more susceptible to tendonitis when engaging in sports where it is under a constant, repetitive load.Chiropractic treatment of shin splints involves addressing any joint restrictions in the foot, ankle, and knee, muscle tightness and imbalances as well as assessing any biomechanical deficiencies in the feet that may be causing the shin splints. If deemed appropriate orthotics are prescribed to remedy the condition. Also stretching and strengthening exercises will be given.The goals of massage are to reduce any inflammation, pain, and swelling, muscle spasm, and trigger points. Massage will also maintain range of motion as well as eliminate any scarring or adhesions. Muscular imbalances that may be causing the problem would be addressed during the treatment. The Active release technique is very effective in treating these problems!

 

Plantar Fascia

The plantar fascia (fash-ah) of the foot is a thick band of tissue that connects your heel to the base of your toes. When it is torn, inflamed or over-stretched, this is called plantar fasciitis (fash-e-it-is). This condition can be a result of: an acute injury (strain) that places an excessive load on the foot, prolonged or excessive pronation (flat foot) of the foot, a high-arch or a change in footwear. You will often feel the pain at the base of your heel when you step out of bed in the morning or through the arch of your foot. This injury can be very pesky and quite painful limiting your daily activities significantly.

Self Care Tips: Before you get out of bed, wrap a towel around your toes and gently pull them towards you. Do this with your knees straight as well as bent. Massage your arch often by sitting on a chair and rolling a marble, golf ball or another massage device under your foot. Stretch your calf and Achilles tendon – we have specific stretches that we can suggest for you to take home….Just ask us!! Keep your shoes by your bed and wear around them house. Rolling a frozen water bottle under the foot helps too!Chiropractic adjustments, active release, and massage are effective treatments for plantar fasciitis. Custom orthotics are also very effective because they can correct the excessive pronation of the foot causing the problem.