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.
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 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.