Article

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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Available from: Junaid Shaik, Jan 15, 2014
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    • "This over-rotation might induce muscle imbalances, as one side of the body could compensate for the abnormality in the contralateral side. The association between podiatric deviations and nonspecific low back disorder has been established in previous literature (Cibulka 1999, Marshall et al. 2009, Bird et al. 2003, Brantingham et al. 2006, Kosashvili at al. 2008). A latest review article discussed the effects of podiatrical deviations on nonspecific chronic low back pain (LBP), and concluded that ankle and foot deviations act as a potential cause for LBP due to the disruption of the kinematic chain from the foot to the back (O'Leary et al. 2013). "
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    • "Physical therapists often deliver manual therapy and/or orthotic interventions to the tarso-metatarsal, subtalar, or talocrural joints in order to manage patients with low back pain;195–199 likewise, the insertion of needles without injectate into bodily areas that are asymptomatic but distal or proximal to the site of pain is supported by the myofascial pain syndrome literature.149 As Melzack et al.27 points out: "
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    • "It is therefore, difficult to determine which of these factors causes the other. Brantingham and colleagues [38] conducted a blinded non-randomised study of 204 participants, with and without recurrent or chronic mechanical LBP, and found that persons with mechanical LBP were more likely to have an average of 2.2  less dorsiflexion in the right ankle (p = 0.002), and 1.7  in the left (p = 0.032); and an increased navicular drop by an average of 1.7 mm on the right (p = 0.003) and 1.6 mm on the left (p = 0.009). The same researchers were not able to confirm these findings in a smaller subsequent study [39], which suffered from limitations such as: small sample size; low power; and mild severity of back pain in the subjects recruited. "
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