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There are many potential causes of low back pain. Herniated disk, joint problems, past injuries, even foot problems. We are bipeds, meaning we walk on only two limbs, not four like dogs, cats, etc. Our hips and pelvis support our body weight while we walk. If we have abnormalities in our feet such as pronation (flat feet) or supination (high arch) this can cause our pelvis and hips to be unlevel. Or more commonly, we have a little bit of each type of foot, pronation in one and supination in the other, to keep our pelvis as level as it can be. If the feet are abnormal, you may have a functional leg length discrepancy. This means that one leg may appear longer than the other, but with stretches, orthotics, manipulation of the spine or extremities the leg length will be even. If you have tightness in your low back, it may cause the pelvis to be unlevel, causing the legs to be different length and the feet to compensate. This helps illustrate that the problem can be from the bottom up or the top down. The average person takes 10,000 steps per day. If you have an abnormality in your feet, your pelvis may not be level causing pain in your feet, ankles, knees, hips or low back which will have to compensate by tightening and causing pain.
So why do we have two drastically different feet?
To sum it up in one word, Industrialization. We now cram our feet into confining shoes and walk on man-made surfaces. Have you ever been on vacation at the beach and not worn shoes for a few days and noticed that they actually feel good? Some of my best running years were when I lived on the beach in Long Island. I was able to get rid of my plantar fasciitis and shin splints by walking in the sand everyday while barefoot! Since most of us can not walk barefoot on a beach everyday the next best solution is custom fabricated orthotics.
Do I even need shoes?
Zola Bud in the 1984 Summer Olympics ran the women's 5000 meters without shoes! The Tarahomara Indians of Mexico run, literally, hundreds of miles each week and they do this barefoot! I would not recommend trying to run without shoes, the body needs time to adapt to stresses imposed upon it: remember we were designed to be barefoot on natural surfaces. The shoe companies have realized this and are now making running shoes with less cushioning than they had just 3 years ago. The foot and ankle were having trouble stabilizing the rest of the body on these shoes which actually caused more injuries than they solved.
Who needs orthotics?
Anyone who wears a shoe and walks, jogs, runs on man-made surfaces. A custom orthotic can address the subtle differences in your feet and the structural differences in your bones that occurred during development. You may not realize how bad you feel until the issues are corrected. These slight differences over time could add up to pain and compensation in your body. The device should be able to capture the foot in its functional range, not just a static imprint of how you sit or stand.
Most companies claim that they offer "custom" orthotic devices, but the methods used to cast the foot are flawed. Some companies will have you step into some foam to get an imprint of your foot, this looks impressive, however it is an imprint of what is incorrect! Others will have you lie on your stomach with your feet over the edge of the table and use plaster to cast your foot. There is a problem with this method. The cast will have a huge curve in the arch that may be over-corrective and force the foot into a supinatory position. This non-weight bearing cast will not address weight bearing problems. If you have pain in the feet when you are not standing, then this technique may help you. There are other companies that will cast your foot while sitting, placing the foot in neutral (the position it should be in). The correction that these companies make is to overcorrect the arch, building it up much higher than it needs to be.
Our office uses an orthotics lab based in Idaho Springs, CO. Extreme Footwerks is run by a Certified Pedorthists who is also an expert in lower body biomechanics. The difference between these orthotics and other so called custom orthotics has a lot to do with the process that goes along with casting. Not only do you have a foam cast taken from your foot while semi-weight bearing with the lower lower extremity and foot placed in neutral, there is also a functional exam that takes approximately 30 minutes which includes a gait analysis that looks at each individual segment from the foot to the pelvis and how they interact. Lastly a pressure print of your foot is taken to see how you distribute your weight when you walk. This last part shows us the function of the lower extremity and gives us a better idea of where the biggest problem your foot has and which are just compensations to that problem.
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