Are you an athlete with foot and ankle pain? Or an elderly person with balance issues? Or suffering from bunions or fallen arches? Surprisingly, there are some common denominators found in the body that connect all of you. Though the feet are the part of our body that connect with the ground, they can strongly be affected by our low back. The alignment of our low back affects the posture of our feet and ankles. By addressing the low back with treatment as well as the feet and ankles directly, we can make great strides in reducing pain, improving foot posture, and improving overall function, strength and balance.
There are a variety of approaches that can support improved foot and ankle health. One of these approaches is a combined approach of Integrative Manual Therapy and shoe orthotic intervention (shoe inserts). Though the feet and low back are not directly neighboring, it is helpful to understand that they are strongly related. Whereas the forces from the ground enter through our feet as we walk or run, these forces are then transcribed and dispersed up the legs and low back. This process is essential to being able to function through life with any kind of movement. Having mobility in the feet as well as the low back allows us to move through life without pain. When the alignment or biomechanics of the low back is affected, this affects the alignment of our feet and ankles and causes us to ‘break down’. Correcting the biomechanics at these sites in the body typically will help to reduce pain, improve function and strength, and improve overall movement in the whole body.
Manual Therapy
Integrative Manual Therapy (IMT) is a gentle type of treatment that can identify underlying reasons for pain. An IMT practitioner looks at the ability of the joints to move, for example, the low back and pelvis. They also assess the alignment of the joints. Gentle techniques are used to improve mobility and alignment. IMT Therapists assess the tension of the fascia in the low back and pelvis to determine areas of compression. Assessment goes beyond the joints and includes soft tissue to find possible underlying contributors to pain. IMT is beneficial in creating a more neutral alignment in the low back and pelvis, to support reduction and elimination of pain.
Upward movement of the foot and ankle is critical for proper alignment of the foot, leg and low back. This upward movement is called ‘dorsiflexion’. Stretching of the calf muscle will correct mild problems, but often, this does not correct more severe limitations. Biomechanical correction of the ankles by a skilled therapist that practices manual therapy will lead to an outcome that can then be maintained by stretching. IMT is a very effective way to improve alignment and soft tissue dysfunction of the ankles, knees, hips, and low back joints. Combining IMT with custom orthotics can help to create and maintain these positive changes.
Shoe Orthotics
There are many different brands of shoe orthotics or shoe inserts. Some are soft to attempt to relieve foot pain or pressure on the bottom of the foot. These are often used with people that have medical conditions such as arthritis or diabetes. More rigid foot orthotics are also available. These were developed to control the posture of the foot during walking, specifically when the foot hits the ground. Many people are aware that their foot position is important when running. They ‘pronate’ which means that their foot arch collapses and the foot rolls inward, contributing to conditions like foot pain, shin splints, and reduced performance.
Biomechanics of the low back, or healthy alignment of the low back joints, serves as the foundation to the house that is our body. This is like the alignment of a car. If the car alignment is ‘off’, the tires will wear down incorrectly. If your low back, hip, knee, ankle or foot alignment is ‘off’, you may develop ‘wear patterns’ in other joints. Commonly, when the mechanics of the pelvis and legs are faulty, the leg usually rolls inwards during impact with the ground. That rolling inwards of the leg causes our foot to flatten and over-pronate.
The position of the foot in such sports as skating or skiing is also very important. When people have foot or ankle pain or other symptoms such as swelling, and they seek therapy for these symptoms, the therapist must evaluate the whole person. Forces from the ground must be normalized through good joint alignment therapy techniques or the stresses of this joint dysfunction can cause pain.
Custom orthotics are precisely measured to each person’s foot. A rigid orthotic helps to change the forces traveling from the ground as they contact the foot. Sole Supports, a brand of custom rigid orthotics, offers a unique quality to orthotic intervention. Firm orthotics actually distribute the forces evenly. Whereas most custom orthotics maintain a corrected posture of the foot during standing, Sole Supports orthotics maintain this optimal foot posture throughout the whole walking cycle, from standing through ‘swing phase’. This is very important especially at heel strike when the heel first hits the ground.
People may experience many positive results from wearing custom orthotics in their shoes that include reduced back pain and foot pain, reduced shin splints, as well as improved endurance, faster running, and better athletic performance. Even sciatica or disc degeneration can be improved by proper dissipation of these forces from the ground.
Dr. Ayelet Connell, PhD, PT, IMT, C is the President and owner of Integrative Wellness & Physical Therapy in Bloomfield, CT, a wellness center offering Physical Therapy, Integrative Manual Therapy, Chiropractic, Acupuncture, and nutritional wellness. Ayelet is a Physical Therapist and Certified Integrative Manual Therapist and has taught courses all over the world in Holistic Physical Therapy. Ayelet is also a local of this community and has been living in the Greater Hartford area for many years, where she integrates a healthy lifestyle at home with her wonderful family.
George Giannoni, PT, GDMT, IMT,C is a Clinician and serves an advisory role at Integrative Wellness & Physical Therapy in Bloomfield CT. His education includes a Master’s Degree in Physical Therapy from Columbia University, and a Graduate Diploma in Manipulative Therapy from Curtin University in Perth, Western Australia. George is a Certified Sole Supports Practitioner. One of his special passions includes the use of manual therapies and orthotics in the treatment of spinal, pelvic, and lower extremity soft tissue, muscular and biomechanical dysfunctions. George brings over 33 years of experience as a practicing Clinician.
For more information about Integrative Manual Therapy (IMT), Sole Supports Custom Orthotics, and Integrative Wellness & Physical Therapy, visit: www.IntegrativeWellnessAndPT.com.