Sagittal plane blockage of the foot, ankle and hallux and foot alignment-prevalence and association with low back pain.

Director for Research and Associate Professor, Cleveland Chiropractic College Los Angeles.
Journal of chiropractic medicine 02/2006; 5(4):123-7. DOI: 10.1016/S0899-3467(07)60144-X
Source: PubMed

ABSTRACT Some practitioners believe mechanical low back pain may be caused or aggravated by a stiff ankle, stiff great toe or flat feet. This study investigates subjects with and without mechanical low back pain and measures ankle and great toe range of motion and flattening of the medial longitudinal arch in both groups.
The study was a blinded, 2-arm, non- randomized clinical study involving 100 subjects with chronic or recurrent mechanical low back pain (intervention group) and 104 subjects without chronic mechanical low back pain (control group) between the ages of 18 and 45. A blind assessor performed weight-bearing goniometry of the ankle and big toe and the navicular drop test on all subjects in both groups.
An independent t-test (inter-group) revealed a statistically significant decrease (p </= 0.05) in ankle dorsiflexion range of motion in individuals with chronic mechanical low back pain. The independent t-test suggested individuals with chronic mechanical low back pain have a significantly smaller navicular drop and higher arches (p < 0.05).
This study supports previous reports suggesting decreased ankle dorsiflexion may be a factor in chronic mechanical low-back pain. Further research and replication of this study is necessary before firm conclusions or recommendations can be made.

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    ABSTRACT: STUDY DESIGN: Systematic literature review with meta-analysis. OBJECTIVES: To investigate the association between non-neutral foot types (high arch and flat foot) and lower extremity and low back injuries, and to identify the most appropriate methods to use for foot classification. METHODS: A search of 5 electronic databases (PubMed, EMBASE, CINAHL, SPORTDiscus, and ProQuest Dissertation and Thesis), Google Scholar, and reference lists of included studies was conducted to identify relevant articles. The review included comparative cross-sectional, case control, and prospective studies that reported qualitative/quantitative associations between foot types and lower extremity and back injuries. Quality of the selected studies was evaluated and data synthesis for the level of association between foot types and injuries was conducted. A random-effects model was used to pool odds ratios (OR) and standardized mean differences (SMD) results for meta-analysis. RESULTS: Twenty-nine studies were selected and included for meta-analysis. A significant association between non-neutral foot types and lower extremity injuries was determined [OR (95% confidence intervals (CI) = 1.23 (1.11, 1.37); p < .001]. Foot posture index (FPI) [OR = 2.58 (1.33, 5.02); p < .01] and visual/physical examination [OR = 1.17 (1.06, 1.28); p < .01] were 2 assessment methods using distinct foot type categories that displayed significant association with lower extremity injuries. For foot assessment methods using a continuous scale, measurements of Lateral Calcaneal Pitch Angle [SMD = 1.92 (1.44, 2.39); p < .00001], Lateral Talo-Calcaneal Angle [SMD = 1.36 (0.93, 1.80); p < .00001], and Navicular Height (NH) [SMD = 0.34 (0.16, 0.52); p < .001] displayed significant effect sizes in identifying high arch foot, while Navicular Drop Test [SMD = 0.45 (0.03, 0.87); p < .05] and Relaxed Calcaneal Stance Position [SMD = 0.49 (0.01, 0.97); p < .05] for flat foot. Subgroup analyses revealed no significant associations for children with flat foot, cross-sectional studies, or prospective studies on high arch. CONCLUSION: High arch and flat-foot foot types are associated with lower extremity injuries but the strength of this relationship is low. Although FPI and visual/physical examination are methods that displayed significance, they are qualitative measures. Radiographic and NH measurements can delineate high arch foot effectively, with only anthropometric measures accurately classifying flat foot. LEVEL OF EVIDENCE: Prognosis, level 1b.J Orthop Sports Phys Ther, Epub 11 June 2013. doi:10.2519/jospt.2013.4225.
    The Journal of orthopaedic and sports physical therapy. 06/2013;
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    ABSTRACT: Mechanical low back pain is a very common, expensive, and significant health issue in the western world. Functional musculoskeletal conditions are widely thought to cause mechanical low back pain. The role of foot posture and leg length discrepancy in contributing to abnormal biomechanics of the lumbopelvic region and low back pain is not sufficiently investigated. This critical review examines the evidence for the association between foot function, particularly pronation, and mechanical LBP. It also explores the evidence for a role for foot orthoses in the treatment of this condition. There is a body of evidence to support the notion that foot posture, particularly hyperpronation, is associated with mechanical low back pain. Mechanisms that have been put forward to account for this finding are based on either mechanical postural changes or alterations in muscular activity in the lumbar and pelvic muscles. More research is needed to explore and quantify the effects of foot orthoses on treatment of particularly chronic LBP, especially their effects on lumbopelvic muscle function and posture. The clinical implications of this work are significant since foot orthoses represent a simple and potentially effective therapeutic measure for a clinical condition of high personal and social burden.
    The Foot 01/2014;
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    ABSTRACT: [Purpose] This study examined the effects of an ankle-foot orthosis worn during balance training on lower limb muscle activity and static balance of chronic stroke patients. [Subjects] The subjects were twenty-five inpatients receiving physical therapy for chronic stroke. [Methods] The chronic stroke patients were divided into two groups: thirteen patients were assigned to the ankle-foot orthosis group, while the remaining twelve patients wore only their shoes. Each group performed balance training for 20 minutes, twice per day, 5 days per week, for 6 weeks. The lower limb muscle activities of the paralyzed side tibialis anterior, medial gastrocnemius, and the stability index were measured before and after the 6-week intervention. [Results] Comparison of the groups indicated a significant difference in the muscle activity of the paralyzed side tibialis anterior and the stability index of the eyes-open standing position. After the intervention, the ankle-foot orthosis group evidenced a significant difference in the muscle activities of the paralyzed side tibialis anterior and paralyzed side medial gastrocnemius as well as the stability index of the eyes-open standing position, eyes-closed standing position, eyes-open standing position on a sponge, and eyes-closed standing position on a sponge. The group that only wore their shoes showed significant differences in the stability indexes of eyes-open standing and eyes-open standing on a sponge. [Conclusion] Using the ankle-foot orthosis was effective during the initial training of lower limb muscle activities and the static balance training of chronic stroke patients. However, it was not effective for a variety of dynamic situations.
    Journal of Physical Therapy Science 02/2014; 26(2):179-82. · 0.18 Impact Factor

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