Foot posture, foot function and low back pain: the Framingham Foot Study

OBJECTIVE Abnormal foot posture and function have been proposed as possible risk factors for low back pain, but this has not been examined in detail. The objective of this study was to explore the associations of foot posture and foot function with low back pain in 1930 members of the Framingham Study (2002-05). METHODS Low back pain, aching or stiffness on most days was documented on a body chart. Foot posture was categorized as normal, planus or cavus using static weight-bearing measurements of the arch index. Foot function was categorized as normal, pronated or supinated using the centre of pressure excursion index derived from dynamic foot pressure measurements. Sex-specific multivariate logistic regression models were used to examine the associations of foot posture, foot function and asymmetry with low back pain, adjusting for confounding variables. RESULTS Foot posture showed no association with low back pain. However, pronated foot function was associated with low back pain in women [odds ratio (OR) = 1.51, 95% CI 1.1, 2.07, P = 0.011] and this remained significant after adjusting for age, weight, smoking and depressive symptoms (OR = 1.48, 95% CI 1.07, 2.05, P = 0.018). CONCLUSION These findings suggest that pronated foot function may contribute to low back symptoms in women. Interventions that modify foot function, such as orthoses, may therefore have a role in the prevention and treatment of low back pain.

[1]  J. Cambron,et al.  Shoe orthotics for the treatment of chronic low back pain: a randomized controlled pilot study. , 2011, Journal of manipulative and physiological therapeutics.

[2]  F. Prince,et al.  Symmetry and limb dominance in able-bodied gait: a review. , 2000, Gait & posture.

[3]  M. Cibulka.  Low back pain and its relation to the hip and foot. , 1999, The Journal of orthopaedic and sports physical therapy.

[4]  E. Rzońca,et al.  Functional and structural limb length discrepancies: evaluation and treatment. , 1988, Clinics in podiatric medicine and surgery.

[5]  G. Leclercq,et al.  Extracellular calcium downregulates estrogen receptor alpha and increases its transcriptional activity through calcium-sensing receptor in breast cancer cells. , 2004, Bone.

[6]  S. Fonseca,et al.  Bilateral and unilateral increases in calcaneal eversion affect pelvic alignment in standing position. , 2008, Manual therapy.

[7]  R. Jackson,et al.  Radiographic Analysis of Sagittal Plane Alignment and Balance in Standing Volunteers and Patients with Low Back Pain Matched for Age, Sex, and Size: A Prospective Controlled Clinical Study , 1994, Spine.

[8]  Frank L Buczek,et al.  Relative motions of the tibia, talus, and calcaneus during the stance phase of gait: a cadaver study. , 2004, Gait & posture.

[9]  P. V. Munuera,et al.  The short-term effect of custom-made foot orthoses in subjects with excessive foot pronation and lower back pain: A randomized, double-blinded, clinical trial , 2013, Prosthetics and orthotics international.

[10]  H J Hillstrom,et al.  Foot type biomechanics. comparison of planus and rectus foot types. , 1996, Journal of the American Podiatric Medical Association.

[11]  F. Blyth,et al.  The Epidemiology of low back pain. , 2010, Best practice & research. Clinical rheumatology.

[12]  E. Lederman.  The fall of the postural-structural-biomechanical model in manual and physical therapies: exemplified by lower back pain. , 2011, Journal of bodywork and movement therapies.

[13]  K. Lee,et al.  Kinematic aspects of trunk motion and gender effect in normal adults , 2010, Journal of NeuroEngineering and Rehabilitation.

[14]  P. Roussouly,et al.  Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases , 2007, European Spine Journal.

[15]  Gary A Globe,et al.  Sagittal plane blockage of the foot, ankle and hallux and foot alignment-prevalence and association with low back pain. , 2006, Journal of chiropractic medicine.

[16]  P. Cavanagh,et al.  The arch index: a useful measure from footprints. , 1987, Journal of biomechanics.

[17]  Wafa Skalli,et al.  Differences in Male and Female Spino-Pelvic Alignment in Asymptomatic Young Adults: A Three-Dimensional Analysis Using Upright Low-Dose Digital Biplanar X-rays , 2009, Spine.

[18]  T. Fukubayashi,et al.  Gender-based differences in the functional deformation of the foot longitudinal arch. , 2012, Foot.

[19]  D. Backstein,et al.  The Correlation between Pes Planus and Anterior Knee or Intermittent Low Back Pain , 2008, Foot & ankle international.

[20]  B. Rothbart,et al.  Excessive pronation: a major biomechanical determinant in the development of chondromalacia and pelvic lists. , 1988, Journal of manipulative and physiological therapeutics.

[21]  A. Gray,et al.  The economic burden of back pain in the UK , 1999, Pain.

[22]  R A Deyo,et al.  Low back pain. , 2001, The New England journal of medicine.

[23]  J. Taylor,et al.  Low-Back Pain Associated With Leg Length Inequality , 1981, Spine.

[24]  S. Shultz,et al.  Sex differences in clinical measures of lower extremity alignment. , 2007, The Journal of orthopaedic and sports physical therapy.

[25]  W. Kannel,et al.  The Framingham Offspring Study. Design and preliminary data. , 1975, Preventive medicine.

[26]  A. Bird,et al.  Foot function and low back pain , 1999 .

[27]  M. Hannan,et al.  Foot posture, foot function and low back pain: the Framingham Foot Study , 2013, Journal of Foot and Ankle Research.

[28]  L. Radloff.  The CES-D Scale , 1977 .

[29]  M W Whittle,et al.  The effects of pelvic movement on lumbar lordosis in the standing position. , 1996, The Journal of orthopaedic and sports physical therapy.

[30]  Ricardo Pietrobon,et al.  Estimates and Patterns of Direct Health Care Expenditures Among Individuals With Back Pain in the United States , 2004, Spine.

[31]  M. Nyska,et al.  The effect of insoles on the incidence and severity of low back pain among workers whose job involves long-distance walking , 2005, European Spine Journal.

[32]  P. Hodges,et al.  Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb. , 1998, Journal of spinal disorders.

[33]  J. Griffin,et al.  Effect of viscoelastic insoles on pain. , 1987, Orthopedics.

[34]  Kevin Morgan,et al.  In the UK… , 1991 .

[35]  T. Dawber,et al.  Epidemiological approaches to heart disease: the Framingham Study. , 1951, American journal of public health and the nation's health.

[36]  Botte Rr.  An interpretation of the pronation syndrome and foot types of patients with low back pain. , 1981 .

[37]  C. Saltzman,et al.  Does Arch Height Affect Impact Loading at the Lower Back Level in Running? , 1999, Foot & ankle international.

[38]  Matthew J Young,et al.  Arch index as a predictor of arch height , 1997 .

[39]  H. Menz,et al.  Validity of 3 clinical techniques for the measurement of static foot posture in older people. , 2006, The Journal of orthopaedic and sports physical therapy.

[40]  J. Basford,et al.  Shoe insoles in the workplace. , 1988, Orthopedics.

[41]  James Neil Weinstein,et al.  Low back pain [5] (multiple letters) , 2001 .

[42]  D. Globe,et al.  A single-blind pilot study to determine risk and association between navicular drop, calcaneal eversion, and low back pain. , 2007, Journal of manipulative and physiological therapeutics.

[43]  W. McMullen,et al.  Correlates of low back pain in a general population sample: a multidisciplinary perspective. , 1988, Journal of manipulative and physiological therapeutics.

[44]  Ziva Yizhar,et al.  Effect of feet hyperpronation on pelvic alignment in a standing position. , 2007, Gait & posture.

[45]  A. P. Bendrups,et al.  The effect of foot wedging on electromyographic activity in the erector spinae and gluteus medius muscles during walking. , 2003, Gait & posture.

[46]  S. Fonseca,et al.  Temporal couplings between rearfoot-shank complex and hip joint during walking. , 2010, Clinical Biomechanics.

[47]  T. McPoil,et al.  Foot orthoses and gait: a systematic review and meta-analysis of literature pertaining to potential mechanisms , 2009, British Journal of Sports Medicine.

[48]  B. Walker,et al.  Low Back Pain in Australian Adults: The Economic Burden , 2003, Asia-Pacific journal of public health.

[49]  A study of ankle joint height changes with subtalar joint motion. , 1981, Journal of the American Podiatry Association.

[50]  M. Betsch,et al.  Influence of foot positions on the spine and pelvis , 2011, Arthritis care & research.

[51]  P. Shekelle,et al.  A Consensus Approach Toward the Standardization of Back Pain Definitions for Use in Prevalence Studies , 2008, Spine.

[52]  R. Botte.  An interpretation of the pronation syndrome and foot types of patients with low back pain. , 1981, Journal of the American Podiatry Association.

[53]  P. Hissaria,et al.  Cigarette smoking in patients with systemic sclerosis reduces overall survival: comment on the article by Hudson et al. , 2011, Arthritis and rheumatism.

[54]  Hylton B Menz,et al.  Reliability of the TekScan MatScan® system for the measurement of plantar forces and pressures during barefoot level walking in healthy adults , 2010, Journal of Foot and Ankle Research.

[55]  R. Pietrobon,et al.  PNP24: ESTIMATES AND PATTERNS OF HEALTHCARE EXPENDITURES AMONG INDIVIDUALS WITH BACK PAIN IN THE US , 2003 .

[56]  Cara M. Wall-Scheffler,et al.  Gender differences in walking and running on level and inclined surfaces. , 2008, Clinical biomechanics.