Sagittal plane blockage of the foot, ankle and hallux and foot alignment-prevalence and association with low back pain

doi:10.1016/S0899-3467(07)60144-X

Journal of Chiropractic Medicine

Volume 5, Issue 4, Winter 2006, Pages 123-127

https://doi.org/10.1016/S0899-3467(07)60144-X Get rights and content

Abstract

Introduction

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.

Methods

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.

Results

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).

Conclusion

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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Lower back pain (LBP), as well as lower extremity injuries, are major problems among young volleyball players. Nevertheless, only few studies have focused on the relationship between lower extremity injuries and LBP.
This study investigated the association between LBP and lower extremity pain, including knee and ankle pain, among young volleyball players.
Cross-sectional study.
Amateur sports association.
Elementary and middle school-aged athletes (6–15 years of age).
LBP and lower extremity pain.
A total of 566 young volleyball players participated in this study. The point prevalence of LBP among young volleyball players was 9.5%. Using absence of lower extremity pain as a reference, the adjusted odds ratio (95% confidence interval) for LBP was 11.07 (5.64–21.71) in the presence of lower extremity pain.
LBP is associated with Lower extremity pain among young volleyball players. Careful attention should be paid to lower extremity complaints to prevent and treat LBP among young volleyball players.
Lower limb kinematics in individuals with chronic low back pain during walking
2020, Journal of Electromyography and Kinesiology
Citation Excerpt :
Most literature focuses on clinical examinations, typically conducted during static positions like sitting, lying down or forward bending. People with CLBP experience less hip internal and external rotations and less hip extension in prone position (Roach et al., 2015, Sadeghisani et al., 2015) and less pelvic posterior tilt during sitting and forward bending (Lim al., 2013); Brantingham et al. suggested that these people display less sagittal plane ankle range of motion (ROM) in the standing position compared to healthy participants (Brantingham et al., 2007). Evidence about dynamic types of movement abnormalities, especially during walking and in frontal and transverse planes is sparse.
Several investigators have suggested the presence of a link between Chronic Low Back Pain (CLBP) and lower limbs kinematics that can contribute to functional limitations and disability. Moreover, CLBP has been connected to postural and structural asymmetry. Understanding the movement pattern of lower extremities and its asymmetry during walking can provide a basis for examination and rehabilitation in people with CLBP. The present study focuses on lower limbs kinematics in individuals with CLBP during walking. Three-dimensional movements of the pelvic, hip, knee and ankle joints were tracked using a seven-camera Qualysis motion capture system. Functional dada analysis (FDA) was applied for the statistical analysis of pelvic and lower limbs motion patterns in 40 participants (20 CLBP and 20 controls). The CLBP group showed significantly different hip motion pattern in the transvers plane, altered knee and ankle motion pattern in the sagittal plane on the dominant side and different hip motion pattern in the transvers and frontal planes on the non-dominant side in comparison with the control group over the stance phase. In terms of symmetry, in the CLBP group, hip and knee moved through a significantly different motion patterns in the transvers plane on the dominant side in comparison with the non-dominant side. In the control group, knee moved through a significantly different motion pattern in the transvers plane on the dominant side in comparison with the non-dominant side. In conclusion, low back pain lead to altered movement patterns of the main joints of lower limbs especially on the dominant side during stance phase. Therefore, care should be taken to examine dominant lower limb movement pattern in CLBP to make a better clinical decision.
What factors can affect lumbopelvic flexion-extension motion in the sagittal plane?: A literature review
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By examining the kinetic chain from the ankle and foot up to the back, mechanical causes of LBP can be better understood (O’Leary, Cahill, Robinson, Barnes, & Hong, 2013). It has been reported previously that decreased ankle dorsiflexion may be a factor in chronic mechanical LBP (Brantingham, Lee Gilbert, Shaik, & Globe, 2006). The influence of foot pronation (measured as calcaneal eversion) on pelvic alignment during standing is not well known.
Clinicians use forward bending and backward return in routine clinical examinations for evaluating spine mobility. The magnitude and timing of lumbar spine and pelvic contributions have been described in the literature as lumbopelvic rhythm. There is still limited knowledge about the factors which can determinate lumbar and hip mobility and coordination in the sagittal plane. The aim of this study is to demonstrate those factors contributing to the lumbopelvic rhythm and to explain the differences observed between subjects. The studies included in the review present possible explanations of observed lumbar-pelvic motion and/or coordination. They measure movement of the lumbar spine, the pelvis and/or the hip in the sagittal plane. The search was conducted in August 2017. Two databases (PubMed and Web of Science) were searched. The search identified 126 potentially relevant articles (53 in PubMed, 73 in Web of Science). Initial screening based on titles and abstracts retrieved 35 articles. The second stage of selection involved reading the full texts of articles. Twenty-four papers were selected in this stage. After careful bibliographic study, seven papers were added for this review, resulting in a total of 31. This literature review demonstrates those factors contributing to lumbopelvic motion. Age and gender, hamstring muscle tightness, feet position, muscle fatigue, movement speed and external loading as well phase of motion can affect various aspects of lumbopelvic rhythm.
Low back pain and disability in individuals with plantar heel pain
2018, Foot
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While most studies of PHP exclude individuals with lumbar radiculopathy, low back pain (LBP) or low back dysfunction is not an exclusion criterion [6,13,15,16]. Yet, foot mechanics have a known association with LBP, including increased arch height, greater dynamic foot pronation that increases vertical ground reaction forces and loading rates, and decreased ankle dorsiflexion and navicular drop [17–19]. In addition, foot mechanics influence low back function; for example, foot eversion is associated with anterior pelvic tilt [20,21], lateral forefoot wedges are related to earlier onset of lumbar paraspinal muscle activity during gait [22], and low foot arch is associated with reduced shock absorption at the low back during running [23].
Lack of response to plantar heel pain (PHP) treatment may be related to unmanaged low back pain (LBP) and low back dysfunction, but a relationship between LBP and PHP has not been established. The purpose of this investigation was to compare the prevalence of LBP among individuals with and without PHP and to assess the association between low back disability and foot/ankle function.
A cross-sectional study compared the prevalence and likelihood of LBP in individuals with (n = 27) and without (n = 27) PHP matched to age, sex, BMI, foot posture, and foot mobility. In individuals with PHP, correlations were examined between foot/ankle function using the foot and ankle ability measure (FAAM), low back disability using the Oswestry low back disability questionnaire (OSW), duration of PHP symptoms, body mass index (BMI), and age.
A greater percentage of individuals with PHP had LBP (74% versus 37% of controls, odds ratio = 5.2, P = 0.009) and higher levels of low back disability (17% higher OSW score than controls, P < 0.001). In individuals with PHP, FAAM scores were correlated with OSW scores (ρ = −0.463, P = 0.015), but not with duration of PHP symptoms, BMI, or age (P > 0.150).
Individuals with PHP had a greater prevalence of LBP and higher low back disability that was correlated to reduced foot and ankle function. Treatment to address both local and proximal impairments, including impairments related to LBP, may be warranted to improve the management of PHP.
Effect of Foot Manipulation on Pregnancy-Related Pelvic Girdle Pain: A Feasibility Study
2017, Journal of Chiropractic Medicine
Citation Excerpt :
If asymmetric, these tilting movements could elicit pain in the pelvic joints and may contribute to PPGP. However, some studies have suggested that there are fewer cases of LBP related to the pes cavus17 and some others have suggested that flat feet are not the reason for LBP.18,19 In a Cochrane review20 of pelvic pain and back pain during pregnancy, it was found that acupuncture reduced pelvic pain better compared with exercise, and that compared with usual care, both acupuncture and training were better.
The objective of this study was to investigate if the research process to evaluate the effect of foot manipulation on pregnancy-related pelvic girdle pain (PPGP) is feasible.
A randomized, single-blind (patients and evaluators) pilot trial was performed to compare foot manipulation to a comparative group at 6-weekly treatment sessions at 5 physiotherapy outpatient clinics in Skaraborg primary care (Skövde, Sweden). Women at 12 to 31 weeks of pregnancy with well-defined PPGP (n = 97) and joint dysfunction or decreased range of movement in the feet were included. Women with a twin pregnancy, low back pain, rheumatoid arthritis, or other serious diseases and those who had previous foot manipulation were excluded. Visual analog scale scores were recorded before study start, before and after each treatment session, and 3 months after delivery.
One-hundred and two women were eligible, and 97 were included (group 1: foot manipulation, n = 47; group 2: comparative treatment, n = 50); 40 and 36 in the foot manipulation and comparative treatment groups, respectively, completed the study. The foot manipulation group had a nonsignificant pain relief score compared with that of the comparative group, which had higher pain relief scores. The difference was most pronounced at the first and second treatment sessions. A power analysis showed that at least 250 individuals would be needed in each group to confirm the effect of foot manipulation.
This study showed that it is feasible to assess the effect of foot manipulation on PPGP in a multicenter physical therapy outpatient clinic setting. A new larger study should choose a different comparative method and test this hypothesis in a full-scale trial.
Reliability and Accuracy of Static Parameters Obtained From Ink and Pressure Platform Footprints
2016, Journal of Manipulative and Physiological Therapeutics
The purpose of this study was to evaluate the accuracy and the intrarater reliability of arch angle (AA), Staheli Index (SI), and Chippaux-Smirak Index (CSI) obtained from ink and pressure platform footprints.
We obtained AA, SI, and CSI measurements from ink pedigraph footprints and pressure platform footprints in 40 healthy participants (aged 25.65 ± 5.187 years). Intrarater reliability was calculated for all parameters obtained using the 2 methods. Standard error of measurement and minimal detectable change were also calculated. A repeated-measure analysis of variance was used to identify differences between ink and pressure platform footprints. Intraclass correlation coefficient and Bland and Altman plots were used to assess similar parameters obtained using different methods.
Intrarater reliability was >0.9 for all parameters and was slightly higher for the ink footprints. No statistical difference was reported in repeated-measure analysis of variance for any of the parameters. Intraclass correlation coefficient values from AA, SI, and CSI that were obtained using ink footprints and pressure platform footprints were excellent, ranging from 0.797 to 0.829. However, pressure platform overestimated AA and underestimated SI and CSI.
Our study revealed that AA, SI, and CSI were similar regardless of whether the ink or pressure platform method was used. In addition, the parameters indicated high intrarater reliability and were reproducible.

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: Sources of support: Funded by the Department of Chiropractic, Durban University of Technology, Durban, South Africa.

View full text

Sagittal plane blockage of the foot, ankle and hallux and foot alignment-prevalence and association with low back pain

Abstract

Introduction

Methods

Results

Conclusion

Lancet

Clin Podiatr Med Surg

Orthop Clin North Am

J Manipulative Physiol Ther

J Manipulative Physiol Ther

Unilateral hip rotation range of motion asymmetry in patients with sacroiliac joint regional pain

Spine

Excessive pronation: a major biomechanical determinant in the development of chondromalacia and pelvic lists

J Manipulative Physiol Ther

Validity of 3 clinical techniques for the measurement of static foot posture in older people

J Orthop Sports Phys Ther