Elsevier

The Foot

Volume 22, Issue 3, September 2012, Pages 224-231
The Foot

Review
The relationship between foot motion and lumbopelvic–hip function: A review of the literature

https://doi.org/10.1016/j.foot.2012.03.006Get rights and content

Abstract

Excessive pronation has been implicated in the development of numerous overuse injuries of the lower limb and is suggested to cause more proximal biomechanical dysfunction. Functional foot orthoses (FFO) are frequently prescribed for lower limb injury associated with excessive foot pronation and have been demonstrated to have efficacy with specific conditions. However, the mechanism of action of FFO is largely unknown. Research investigating the kinematic and kinetic changes associated with FFO use is inconclusive. Furthermore there is a growing body of evidence suggesting that changes to muscle activity patterns in response to FFO may be responsible for their therapeutic effect. Additionally, current research suggests dysfunction of musculature of the lumbopelvic–hip complex is involved in lower extremity functional changes and is related to the development some pathologies traditionally attributed to excessive foot pronation. Evidence of temporal coupling between the hip and the foot and changes in hip muscle activity associated with FFO use further suggest a relationship between proximal and distal lower limb function. The aim of this review is to discuss the association between foot and lumbopelvic–hip complex dysfunction and injury, assess the evidence for functional changes to lower limb and lumbopelvic–hip function with FFO use and finally to discuss the potential for changes to hip musculature activation with FFO use to influence distal mechanics and produce a therapeutic benefit.

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.

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