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Instep Dance Magazine Articles

Reprints of monthly column as first appearing in Instep Dance Magazine.

September 1998

Orthotics - Giving Your Feet A Lift - Part 1

By Rick Allen, DC

"Better health leads to better dancing."

Dancing puts a lot of wear and tear on your feet. Based on the number of dancers who have come in to my office seeking help with painful feet, I bet that about one in five of you have gone to a chiropractor, medical doctor or podiatrist for help with common foot problems, such as hyper-pronation (flat feet), metatarsalgia, plantar fasciitis, hammer toes, and bunions. Problems with the feet may, in turn, play havoc with your knees, hips, low back, and even neck. There are interrelations both up and down between the feet, legs and back.

So, it is just common sense that when a patient comes to my chiropractic office complaining of foot pain, I check their back. Likewise, if they present with back pain, I check their legs and feet, too. If I find something wrong with their feet, I may fit them for custom foot supports (orthotics), which are inserted into their shoes. If the situation requires more than an insert, I may send them to a shoemaker who specializes in modifications to shoes. Let's take a look at how custom fitting or orthotics can help your feet and back.

Clinical Rationales

According to John Hyland, DC, DACBR, DABCO, CSCS, orthotics advisor for Chiropractic Products Magazine, there are five general categories or "rationales" for using orthotics:

  1. Structural alignment - compensation for bony malformation and misalignment,
  2. Functional balance and symmetry - excessive rotary forces transmitted to joints,
  3. Shock absorption - reduce chronic stress-loading to improve cartilage health,
  4. Neurological coordination - sensory integration of nerve patterns and gait habits, and
  5. Lower extremity symptoms - relieve local pain to reduce secondary spinal problems.

There is some overlap between these five categories. Patients may present with several of these problems. Let me give you an overview of each of these five categories, with special emphasis on how they may affect your dancing.

[ Comparison of Pronated and Correct posture ]

Structural Alignment

Our feet, legs and pelvis are the structural support for the spine. Frequently, patients seek chiropractic treatment for chronic neck and back problems that really stem from structural foot problems, leg length differences, and pelvic tilt. Chiropractic adjustment, myofascial therapy and muscle balancing may give temporary relief, but long-term relief will require orthotics and/or heel lifts.

Functional Balance and Symmetry

Walking and running movements create twisting forces from the feet into the legs, pelvis, and spine. Overuse or improper form can create excessive stresses, particularly at the knee and sacroiliac joints that can develop into abnormal movement patterns. These can be the underlying source of spinal complaints. Several simple procedures can detect such problems. Have your coach or doctor check the wear patterns of your shoes, the way you walk, and the amount your foot flattens as weight is applied. Look especially for the signs of hyper-pronation: wearing of the outside of the heels of your shoes, foot flare with the toes out, and excessive drop of the navicular bone. Also check for pain on the inside of the knee and bowing of the Achilles tendon. Gait analysis with high-speed videography is helpful when available for complex cases.

Shock Absorption

Ever dance on a concrete floor? I did for three days straight at a dance festival and paid the price - painful overuse of the feet, knees and low back. Thank goodness (1) I don't dance concrete all the time and (2) I got good chiropractic and massage care as soon as I got home. The amount of time many people spend standing, walking, and even running on such rigid, non-resilient surfaces is a significant factor in back pain and spinal degeneration. Osteophytes, spurs, disc thinning, joint space narrowing, and bony remodeling are often the result of years of abnormal stress. Orthotics made with shock absorbing materials can significantly reduce spinal joint microtrauma and relieve chronic degenerative symptoms.

Neurological Coordination

Poor posture and movement patterns are learned and perpetuated by the nervous system, resulting in stresses extending throughout the body. As pointed out by Dr. Hyland, orthotic support to the sensitive proprioceptive nerve endings in the feet can improve sensory integration of postural balance, nerve reflex patterns, and gait habits.

[ Diagram of foot conditions ]
[ Diagram of foot conditions ]

Lower Extremity Symptoms

Other problems of the feet, knees and hips can result in spinal problems if left uncorrected. For example, metatarsalgia, plantar fasciitis, hammer toes, and bunions, an unstable ankle joint, tracking problems of the patella (knee cap), and hip joint asymmetry can all result in chronic subluxations with recurring back and neck pain. Long-lasting improvement again may require orthotics as well as chiropractic care.

In conclusion for this month, let's check our feet and keep on dancing!

Next article: Now that we have examined the clinical rationales for using orthotics, let's take a look at the options we have in orthotic supports.

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