A lower back pain article on a Podiatry blog? Surely not…

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Why on earth is there a blog about lower back pain on a Podiatry website I hear you ask? Well I will get to that later, but for now lets focus on lower back pain and why it happens…

 

Do you suffer from an aching back? Pain shooting from your back into the legs? Do you find it hard getting up when you have sat down for too long? Also having to rub your lower back after walking or standing a lot?   These are common issues people mention to me when treating their feet, though often on the surface we mention these as just “back pain”.  The pain can impact an individuals quality of life significantly and stop you doing what you want to do.

 

Lets start off with a staggering fact about lower back pain. In a study by the Global Pain Index in 2014, they found that 94% of people who experience pain in their body also experience some type of lower back pain. They also quoted that lower back pain is the most common cause of disability.

 

The back is a very intricate part of the body. The spine acts as the main framework that connects our upper body and lower body and provides the route for important nerves running from the brain right down to the feet. It is surrounded by large powerful muscle groups, which in turn, have tendons and ligaments connecting from the spine to the shoulders, rib, pelvis, hips and legs.   The structure has a large bearing on how we move, so should never be ignored by any health professional.

 

Anyone can have back pain at any time. There are many reasons for back pain including:

  • Getting older. Back pain is more common the older you get, you may first have back pain when you are 25 to 40 years old.
  • Poor physical fitness. Back pain is more common in people who are not fit.
  • Being overweight. A diet high in calories and fat can make you gain weight. More weight can stress the back and cause pain.
  • Some causes of back pain, such as ankylosing spondylitis, a form of arthritis that affects the spine, can have a genetic component.
  • Other diseases. Some types of arthritis and cancer can cause back pain.
  • Your job. If you have to lift, push, or pull while twisting your spine, you may get back pain. If you work at a desk all day and do not sit up straight, you may also get back pain.
  • Smoking – believe it or not. Your body may not be able to get enough nutrients to the disks in your back if you smoke. Smoker’s cough may also cause back pain.  People who smoke are slow to heal, so back pain may last longer

 

“But you’re just a Podiatrist – you only look at the feet”

 

An inaccurate assumption is that Podiatrists only look at the feet and ignore everything above the ankle. Though traditional “Chiropody” focused solely on the foot anatomy, in Podiatry we have the skills and knowledge to assess how foot and leg positions can cause issues with the hips and lower back. Conditions such as Osteoarthritis, Sciatica, Bursitis, Illiotibial Band Syndrome and Sacro Illiaic Joint Dysfunction can be affected and caused by anatomical alignment issues and bio-mechanical stress.

 

The body should be considered as a rather complex puzzle. There are direct links to how we move and control our gait with our feet, and the forces which are then placed on our back. For example, restriction of movement at the big toe join can increase knee flexion during walking, therefore cause extra stress on the lower back. It has also been shown that flat feet encourages excessive hip movements, which strains the hips and lower back causing long term strain and pain.

 

Humans also like to compensate for pain. If we suffer from heel, arch or ankle pain, we will change our gait accordingly to offload our discomfort. This leads to unusual and excessive forces being placed on the hips and back creating secondary issues. Therapists should therefore always take a holistic approach to any assessment and while offering treatment, also provide correct referral pathways to other medical professionals who may also be able to help you.

 

At FootPro Podiatry we provide a thorough lower limb and MSK assessment that will review the relationship between the feet, legs and back. Your leg length difference will be assessed during the appointment so that we can identify issues that may or may not be present at that time. We will then offer therapeutic orthotics to help manage your condition and pain along with providing suitable exercise programmes. We will also help to guide you to other suitable therapists who may complement our particular treatments. At FootPro Podiatry we believe in multidisciplinary team working for our patients when necessary to achieve the best results for you. Don’t just live with back pain – deal with it.

 

Corn vs Callus – what’s the difference?

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I write these blogs to try and teach you about Podiatry and how it can really help.  In order to help, I want to answer commonly asked questions I often face in clinics.  One of the more popular ones is: what is the difference between a corn and a callus?

 

So lets start with callus.  It is more commonly known as hard skin and is one of the most common issues podiatrists treat in a clinic. It is created as a response to repetitive stress and pressure. As a form of skin protection, the skin cells harden to stop the skin from being damaged. However, over time this protection can create a thick layer- increasing pressure and creating discomfort. On the heels, callus can sometimes cause skin to pull and splits or skin breaks to occur. These can be very sore and need immediate management.  Callus can form anywhere, from the soles of the feet to the tips of your fingers.  For some people, they live with callus their whole lives without having any pain, for others it is severely uncomfortable.

 

A corn, however, is slightly different.  A corn is a common skin lesion which form into acute areas of hard skin. Often feeling like a stone in the skin, corns can range from mildly uncomfortable to agonisingly painful.  They can become inflamed and in some cases breakdown the soft skin beneath, to cause a wound and ulceration. They develop in response to friction and pressure in very specific areas of the feet. Like callus, they develop as a natural skin response to try and protect the skin.  Though normally hard on touch, pain can come from between the toes where the corns are soft because of the excess moisture in the gaps. These are known as soft corns.  The pain from corns comes from the hard stone like callus pressing against the soft sub tissue layers of the skin.

 

So the answer to the question-  both callus and corns are formed in similar ways, corns are made from localised callus development in very specific areas.  Callus can develop where there is general friction and pressure, but corns always develop in smaller more localised high pressure sites.  On the whole, corns cause more pain than the callus build ups, but thick callus build up can still cause pain especially if cracks develop from the thickened tissue.

 

Podiatrists, especially at FootPro Podiatry provide slow, gradual and careful debridement and enucleation of both callus and corns.  After the painless treatment, instant relief can be felt. You will then be provided with advice about how to stop the corns and callus from developing again in the future and provide offloading devices such as wedges, orthotics or padding to help further relieve the pressure that created the issues.  However, these don’t necessarily cure your issues and regular treatments may be necessary to ensure you are comfortable and are not in pain when you walk.

 

Have any questions? Why not contact me at info@footpropodiatry.co.uk.

 

Commercial Sales of Trainers – the issues

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My previous blog about sports shoes covered some of the things we need to consider before buying footwear for the various different sports we participate in.  On doing this research, I have come across some really alarming trends online or some “quick fit guides” to recreational running and exercise trainers.  I want to write this blog to discuss some of these issues and try to stop you from falling into some of these online traps.

When you search for trainers online, whether it be on websites from large sports brands to daily health blogs, they always base any shoe prescription on putting you into three different categories.  Your feet are either:

  1. Flat/Pronated feet
  2. Normal/Neutral feet
  3. High/Suppinated feet

neutral 300x100 - Commercial Sales of Trainers - the issues

This basic model classification was first used in 1947 and has since been  re-used by magazines, websites and sports shops to help sell you running shoes.  This model makes many assumptions about you and your body.  These assumptions are:

  1. Pronation of the foot is predisposing to future risk of injury
  2. To function perfectly our foot should be a Neutral/Normal foot
  3. Marketing claims by sports companies about their shoes are always achieved
  4. You can simply diagnose yourself by doing a “wet foot test”

 

So lets start with the issues around each point.  First of all, the assumption in point one is completely inaccurate.  Several scientific studies* have found that there is no association between foot type and risk of injury.  A study actually found that pronated feet can PROTECT you from injury**.  So what this shows is that you can’t just assume because you have a type of foot, that you are going to have an injury and that it needs correcting.  This assumption does not take into account technique, style, muscle tightness, general fitness level and conditioning of each person.  To make a choice of shoe based on foot shape is not right.

 

Point two, what exactly is normal?  Health care professionals always like to make sure you realise every treatment you receive is different because the reaction of a treatment is subjective you.  No one on this planet can tell you that the way you move is wrong.  I have met 95 year olds with “flat feet” who are fitter and have had less injuries than a 25 year old with “neutral” foot type.  If you look at the averages of arch heights across the spectrum, normal is actually slightly pronated/flat.  We spend our lives accepting differences in human beings, but when it comes to running shoes we accept such a rigid simplistic model.

 

Point three, can we really trust every claim made by running shoe companies and brands? We have to remember that they are trying to SELL A PRODUCT.  That’s right, they are trying to make money from selling you an item.  This is the normal sales market and part of everyday life.  By making claims about their trainers with very little supporting evidence, they are able to convince you that their trainer is the one for you.  As a paying customer, you shouldn’t just look at fancy claims made to sell you the product.  What you should do is be empowered with the knowledge about your own body to lead yourself to the style of trainer that is right for you.

 

The last point, the “wet foot test”.  Now, when this was mentioned in 1947, it was created by the US army to categorise their soldiers.  This has now been adopted by many websites as the way to diagnose your feet to then match against the styles available.  In Podiatry, we spend many years studying, analysing and measuring static and dynamic foot structure and leg movements.  The wet foot test simplifies all of our study and simply puts you in a group, that’s if you do the test right of course!  It doesn’t take in to account any additional information about your feet, legs or back.  The wet foot test is not predictive of dynamic function and is completely and utterly useless.

 

At FootPro Podiatry I can help accurately assess your gait and biomechanics and help guide you to the right styles and types of running trainers.  Just remember though, what you find comfortable may be different to someone else and if something works for you, don’t change it just because you think it looks better or helped your friend be more comfortable.  The right shoes, the right orthotics, along with the right stretching and strengthening programme – may hold the key to your comfort and improved performance.

 

 

 

References.

*Franettovich M, Chapman AR, Blanch P et al.  Altered neuromuscular control in individual with exercise related leg pain.  Medicine and Sport Science and exercise.  42 :546, 2010

Barrett JR, Tanji JL, Drake C et al.  Injuries in runners, a prospective study in alignment.  Clinical Journal of Sport Medicine. 8: 187, 1998.

**Carvan D, Jones B, Robinson J.  Foot Morphologic Characteristics and risks of exercise related injury.  Archives of family medicine 2: 773. 1993.

Ian Griffiths, Sports Podiatry. Choosing Running Shoes: evidence behind recommendations. www.sportspodiatry.co.uk