Back pain is one of the most frequent problems that humans endure. Unless a history of repetitive trauma exists, it can be difficult to pinpoint the origins of the problem. Patients are usually happy with solutions to resolve or reduce their discomforts.
Leg length discrepancy (LLD) is a problem commonly seen by pedorthists that causes back pain. There are 3 types of LLD s while static: short femur, short tibia, and/or one foot and ankle is in a pronated or supinated position than the other. Depending on the problem, either a lift or an orthoses is needed. There are two types of lifts: external, a build up to the outside of the shoe and internal, under the heel. In most footwear, an internal lift of 3/8 or 6mm is the maximum amount before the foot is pushed out of the shoe too far. We can make internal lifts from 1/8″ to 1/2″ to go inside shoes.
For LLD 1/2 or more, external modifications to the bottom of the shoes (soles) should be used. For patients who cannot plantar flex the ankle or have some form of metatarsalgia, lifts added throughout the entire bottom surface of the shoe is recommended. A balanced lift means the entire amount at the heel, or more of the amount at the ball, then rock forward to or less at the toe to prevent toe drag. For example, a heel lift will have at least 3/8 at the ball then it is toed up to 0 -1/8. Patients are always pleased with the gait improvements.
With the materials available today, lifts can be virtually unnoticeable when applied by a skilled technician. Patients can be assured that they are not unattractive. Often the bottom layer of the sole of an athletic or walking shoe is removed and the lift is sandwiched in between. This is not only effective but can also be aesthetic. The prescribing physician should provide a diagnosis and amount of the discrepancy. Desired outcomes are always helpful. If the pedorthist has questions or concerns about the prescription, a call will be made to discuss the situation with the physician.
Another type of stress upon the back is functional gait imbalances. Since the spine rotates during movement, with opposite arms and legs swinging, gait imbalances, muscle weakness, limited range of motion problems, and asymmetry can be detected to help with treatment plans.
Most common is limited range of motion at the first metatarsal-phalange joint. If the joint is limited on one side and not the other, footwear can be altered with mild rocker soles, Springlite footplates, and/or orthotic devices to cause the gait to be more symmetrical. If one foot pronates more than the other can also create a leg length discrepancy. Orthotics will take care of that problem. The same can be done with relation to range of motion problems to the ankle, knees, hips, and sacroiliacs.
Women who wear heels greater than 1 are especially susceptible to having lower back pain. When wearing heels, the pelvis tilts down and forward as much as 30 degrees causing the lower back (L1 through L5 and the respected facet joints) to become compressed. Women who find it necessary to wear heels that have lower back pain must be advised of the serious consequences.
In today s world with the newest technology and materials, many things can be done with footwear, orthotic devices, and modifications to change a patient s gait to help not only with back pains, but also hips, knees, feet and ankle pains.
Our median age is increasing and footwear and material manufacturers are responding with good-looking shoes in a greater selection of sizes and leathers than ever. Almost everyone has at least one pair of athletic footwear in their wardrobes because they feel good and are acceptable. More casual lifestyles have made comfort fashionable, and that makes it easy to prescribe therapeutic footwear, modifications and orthoses, good solutions for relieving back pain. That makes all of us look good.
Relieving back pain with Sole Control’s orthotics and lifts in St. Louis, MO.
9712 Watson Road
St. Louis, MO 63126
314-822-9494
Written By Michael Lukowsky, Certified Pedorthist
