ReviewThe relationship between foot motion and lumbopelvic–hip function: A review of the literature
Introduction
Abnormal foot function, particularly in relation to excessive or prolonged pronation, has traditionally been identified as a risk factor and possible aetiology for the development of lower limb overuse injury [1], [2], [3]. Foot pronation has been proposed to propagate more proximal lower limb dysfunction and hence contribute to a wide range of lower limb injuries affecting the lower back, hip, knee, lower leg, ankle and foot [4], [5]. This has lead to functional foot orthoses (FFO) being widely prescribed by podiatrists and other health professionals to treat pronation-related pathology under the assumption that they control foot pronation and restore normal foot and lower limb mechanics [6].
Evidence supports the effectiveness of FFO in the management of several lower limb pathologies [7], [8], [9], many of which are also associated with lumbopelvic–hip and particularly gluteus medius (GMed) dysfunction [10], [11], [12]. The link between the lumbopelvic–hip complex and foot function is increasingly being investigated due to the presence of their concomitant dysfunction in the development of lower limb injury [5], [12], [13], [14] and the evidence that FFO appear to be effective in the management of these injuries [7], [8].
Research into the functional response of the lower limb to FFO is inconclusive. There is some evidence that small alterations to lower limb kinematics and kinetics occur [15], however, such functional change is frequently reported to be subject specific and inconsistent [16], [17]. There is a growing body of literature indicating that muscle activity patterns are more significantly altered by FFO and may be responsible for their therapeutic effect [18].
Just as abnormal foot pronation is thought to propagate proximal pathomechanics, dysfunction of the lumbopelvic–hip complex is proposed to influence the function of more distal structures of the lower limb [19] and may potentially play a role in foot motion [20]. Interventions targeted at the musculature responsible for stability of the lumbopelvic–hip complex may have potential to alter lower limb mechanics and consequently reduce injury risk. Such proximal correction may play an integral role in producing therapeutic effects seen with FFO use.
The first aim of this review is to discuss the association between foot and lumbopelvic–hip complex dysfunction and injury. Secondly, the review will assess the evidence for functional changes to lower limb and lumbopelvic–hip function with FFO use. Finally, the potential for changes to hip musculature activation with FFO use to influence distal mechanics and produce a therapeutic benefit will be discussed.
Section snippets
Methods
The search strategy for this review consisted of an electronic database search of title and abstract. Databases included MEDLINE (1950–2011), Cinahl (1983–2011), EMBASE (1974–2011) and SPORT discus (1985–2011). Search terms used included foot posture, foot mechanics, lumbopelvic, hip, mechanics, kinetics, kinematics, muscle, injury, foot orthoses and gait. No language restrictions were placed on the search. Titles and abstracts were then reviewed and included where relevant to the review topic
Foot function and overuse injury
The human foot has evolved as the foundation for upright standing and movement [21], [22], [23]. In this role, the foot must support body mass, provide for postural balance, absorb shock, adapt to ground surfaces and transmit forces efficiently during gait and other bipedal activities. This is achieved via a complex series of mutually dependent movements of the joints of the foot [24]. Significant movements occur at the talocrural, subtalar, talonavicular, calcaneocuboid and navicular-cuboid
Conclusion
Foot pronation is believed to contribute to the development of lower limb overuse injury [4]. Reduced GMed activity and associated lumbopelvic–hip complex instability is also linked to the development of lower limb injury [12], [13]. Significantly, many pathologies that have previously been attributed to excessive foot pronation and treated successfully with orthoses have also been linked to GMed weakness and also treated successfully with GMed strengthening programmes [106]. Evidence that
Funding
Not applicable.
Acknowledgements
Not applicable.
References (113)
- et al.
An overview of podiatric biomechanics theory and its relation to selected gait dysfunction
Physiotherapy
(2006) - et al.
Foot function and low back pain
The Foot
(1999) - et al.
A clinical longitudinal evaluation of pre-fabricated, semi-rigid foot orthoses prescribed to improve foot function
The Foot
(2007) - et al.
Comparison of 2-dimensional and 3-dimensional rearfoot motion during walking
Clinical Biomechanics
(1995) - et al.
Effects of foot orthoses on skeletal motion during running
Clinical Biomechanics
(2000) - et al.
Effect of foot posture, foot orthoses and footwear on lower limb muscle activity during walking and running: a systematic review
Gait and Posture
(2009) - et al.
Contributions of proximal and distal moments to axial tibial rotation during walking and running
Journal of Biomechanics
(2000) - et al.
Rear-foot, mid-foot and fore-foot motion during the stance phase of gait
Gait and Posture
(2007) - et al.
Invasive in vivo measurement of rear-, mid- and forefoot motion during walking
Gait and Posture
(2008) - et al.
Foot kinematics during walking measured using bone and surface mounted markers
Journal of Biomechanics
(2007)
Foot type classification: a critical review of current methods
Gait and Posture
Development and validation of a novel rating system for scoring standing foot posture: the Foot Posture Index
Clinical Biomechanics
Effect of foot posture, foot orthoses and footwear on lower limb muscle activity during walking and running: a systematic review
Gait & Posture
Effects of arch height of the foot on angular motion of the lower extremities in running
Journal of Biomechanics
Back and hip extensor fatigability in chronic low back pain patients and controls
Archives of Physical Medicine and Rehabilitation
Ankle inversion injury and hypermobility: effect on hip and ankle muscle electromyography onset latency
Archives of Physical Medicine and Rehabilitation
Gluteus medius muscle activation patterns as a predictor of low back pain during standing
Clinical Biomechanics
Quantitative functional anatomy of the lower limb with application to human gait
Journal of Biomechanics
An investigation into motor pattern differences used during prone hip extension between subjects with and without low back pain
Clinical Chiropractic
Gender differences in lower extremity mechanics during running
Clinical Biomechanics
A comparison of knee joint motion patterns between men and women in selected athletic tasks
Clinical Biomechanics
Effect of foot orthoses on magnitude and timing of rearfoot and tibial motions, ground reaction force and knee moment during running
Journal of Science and Medicine in Sport
Influence of a custom foot orthotic intervention on lower extremity dynamics in healthy runners
Clinical Biomechanics
Effect of foot orthoses on the kinematics and kinetics of normal walking gait
Gait and Posture
The effect of three levels of foot orthotic wedging on the surface electromyographic activity of selected lower limb muscles during gait
Clinical Biomechanics
Do foot orthoses change lower limb muscle activity in flat-arched feet towards a pattern observed in normal-arched feet?
Clinical Biomechanics
Foot orthoses affect frequency components of muscle activity in the lower extremity
Gait and Posture
Association between foot type and tibial stress injuries: A systematic review
British Journal of Sports Medicine
Foot type and overuse injury in triathletes
Journal of the American Podiatric Medical Association
The correlation between pes planus and anterior knee or intermittent low back pain
Foot and Ankle International
Foot orthosis prescription habits of Australian and New Zealand podiatric physicians
Journal of the American Podiatric Medical Association
Foot orthoses in lower limb overuse conditions: a systematic review and meta-analysis
Foot and Ankle Specialist
Custom-made foot orthoses for the treatment of foot pain
Cochrane Database of Systematic Reviews
Epidemiology of anterior cruciate ligament injuries in soccer
American Journal of Sports Medicine
Hip abductor weakness in distance runners with iliotibial band syndrome
Clinical Journal of Sport Medicine
Hip strength in females with and without patellofemoral pain
Journal of Orthopaedic and Sports Physical Therapy
Anterior cruciate ligament injury in female athletes: epidemiology
Journal of Athletic Training.
Effect of excessive subtalar joint pronation on patellofemoral mechanics: a theoretical model
Journal of Orthopaedic and Sports Physical Therapy
Foot orthoses and gait: a systematic review and meta-analysis of literature pertaining to potential mechanisms
British Journal of Sports Medicine
Core stability and its relationship to lower extremity function
Journal of the American Academy of Orthopaedic Surgeons
Fossils, feet and the evolution of human bipedal locomotion
Journal of Anatomy
Evolution of the human foot 1
American Journal of Physical Anthropology
Evolution of the human foot 2
American Journal of Physical Anthropology
Biomechanics of the normal and abnormal foot
Journal of the American Podiatric Medical Association
Lessons from dynamic cadaver and invasive bone pin studies: do we know how the foot really moves during gait?
Journal of Foot and Ankle Research.
Reliability of the Foot Posture Index and traditional measures of foot position
Journal of the American Podiatric Medical Association
Measurements used to characterize the foot and the medial longitudinal arch: reliability and validity
Physical Therapy
The effect of foot structure and range of motion on musculoskeletal overuse injuries
American Journal of Sports Medicine
Factors contributing to the development of medial tibial stress syndrome in high school runners
Journal of Orthopaedic and Sports Physical Therapy
Incidence and risk factors in the development of medial tibial stress syndrome among naval recruits
American Journal of Sports Medicine
Cited by (56)
Influence of lower limb torque, range of motion, and foot alignment in patellar rotation (Arno angle) in athletes
2022, Brazilian Journal of Physical TherapyCitation Excerpt :Patellar misalignment may cause imbalance of forces exerted on periarticular tissues and alter pressure distribution of the patellofemoral joint contact areas.7,8 Considering the influence of the hip and foot on knee biomechanics9–12 it is possible that non-local factors may contribute to patellar alignment. Frontal plane patellar alignment is influenced by passive (e.g. lateral and medial retinaculum, ligaments, tendons, iliotibial band, and patellar joint geometry) and active stabilizers (e.g. quadriceps muscle).13,14
Differences in lower-extremity kinematics between the male military personnel with and without plantar fasciitis
2021, Physical Therapy in SportCitation Excerpt :This finding suggested the possibility that an alteration of the lower extremity movement pattern, consisting of excessive femoral adduction and medial rotation as well as knee valgus, may have substantial implications for distal limb function in the individuals with PF (Harutaichun et al., 2019). Owing to these changes, the overload weight-bearing activity produced excessive medial rotation of the femur and tibia as well as more foot pronation, which could lead to the disruption of the plantar fascia (Barwick et al., 2012; Chang et al., 2014). Such functional changes in the lower extremity kinetic chain provide the path of least resistance to motion and the site of compensation for various proximal structures, such as the lower extremity muscles, ankle joint, knee joint, and hip joint (Bolgla & Malone, 2004; Nigg, 2001).