Happy Wednesday, everyone. This is Dr. Gray from the Redefining Physical Therapy podcast.
And so in today’s episode, I want to build off on this theme we’ve created here. So yesterday I talked about is your patient’s lower back pain stemming from their feet part one.
And so there’s a highlight of yesterday, so we’ve talked a little bit more about how a forefoot valgus can cause that pes cavus foot and how that usually turns into lower back pain. And so I think this is, at times where clinicians will miss things because they have more of a pesky equinus foot.
So they are not able to get a shock absorption during loading response, but they’re also not able to get adequate dorsiflexion. So they end up in early heel off which limits hip extension, which causes lumbar extension.
But also during that loading response, basically get poor shock absorption and then that was forces need to be traveled somewhere.
And one thing, I also forgot to add in, that type of foot for any neck rotational athlete like a golfer, they’re not going to be able to pronate. So they’re going to have the potential.
So they’re potentially going to have reduced hip internal rotation, and external rotation in those a golf swing. So if I am rotating to the right and my backswing, if my left foot can’t pronate, then my pelvis can’t rotate back to the right.
So I’m not getting external rotation on the left hip and I’m not going to get good adequate internal rotation on the right.
So I might use those facet joints, use muscles that maybe your not used to you using, or shouldn’t be using during a golf swing.
So you can apply those mechanics anywhere.
But now today we’re going to switch gears a little bit and we’re going to talk about the most common foot type and that’s an uncompensated rearfoot varus.
So what does that mean? And so if you were to put a foot in subtalar neutral, you’re going to see that their heel is in a varus position and that’s the most common type of foot.
And so this type of person will have kind of a neutral foot. And so they won’t have any abnormalities typically at the forefoot. So the last one was more of the forefoot valgus, which caused the pes cavus.
This type of foot is an uncompensated rearfoot varus. And so what that means is they don’t have, even when they’re embarrassed, they don’t have enough motion at the subtalar joint to compensate into pronation.
So it’s uncompensated.
And actually what this type of patient will do is they’ll actually toe-out.
And the reason why they do that, is they are trying to get their foot flat to the ground. So this type of person will have a ton of hip external rotation going on when they walk and they’ll walk like a duck, you’ll spot it dead on.
And so they’re not getting true ankle dorsiflexion.
They’re getting a little bit of potential with trying of their rearfoot trying to go through diversion and they’ll have calluses on the inside part of their big toe. So it creates a bunch of Pathologies. So it’s going to limit hip extension to some degree.
Because they’re toed-out, they’re not getting full ankle dorsiflexion as we kind of saw last time.
But that’s also what is going to happen is these are the type of people that are going to have that piriformis type syndrome.
And where their piriformis is always tight. And so, which is going to cause back pain potentially sciatica.
So that’s because their hips are always an external rotation. So it’s going to shorten those hip rotators. And so if you don’t fix the progression of the gait, by fixing it with a potential orthotic.
The Crux Shoe wear, you’re going to constantly have it toed-out gait where their hips are on external rotation.
And so you got to be careful on this, you got to be able to discern if this person retroverted.
So, someone who has a structural hip issue can mimic those. But once you’ve cleared the hip, you would look at the foot, you put the foot in subtalar neutral, you then do your glides and you see, they don’t have any eversion of the heel.
You’ll see why they toe-out. And so again, this type of foot will also be stuck in external rotation, they’re not going to have any good potential hip flexion or internal rotation.
So this type of person is predisposed, if you don’t have hip flexion, you’re going to get lumbar flexion.
So they may become more mobile at the lumbar spine when they’re bending and their movement patterns.
They’re not going to have internal rotation, and we know internal rotation is very important to people with back pain. So if this person is an athlete? They’re not going to be able to sit and load their hip as much.
So, they’re going to potentially get more lumbar rotation and to some degree. And then, they’re going to have that say sciatica.
So, but from a gait standpoint, because their foot is toed-out and they’re not going to be able to get adequate excursions through their hip into hip extension.
When walking, your hip actually goes through internal rotation, both in the loading response.
And as you go into terminal stance, they’re not going to get adequate of that either way.
And so they’re not going to be loading their glutes as much as you would think they would help out their back.
That was a kind of recap. So uncompensated rearfoot varus type, is afoot that is stuck in varus. Is the most common type of foot, they’ll be having a neutral arch, there’s no forefoot deformity.
Because they don’t have enough eversion at the heel. They’ll toe-out, and they’ll walk like a duck.
Because this externally rotates the hip, you can get constant shortness of the external rotators that compress the sciatic nerve.
A lot of that gluteal pain type of patient. That’s how you’re going to fix it. You’re also going to see a lack of hip extension, hip flexion, and hip internal rotation, a deduction.
So they’re not going to be able to load that hip. So, in order to fix this type of foot.
Typically, what we see is you need a foot orthotic, you got to bring the ground up to them.
You need to change the progression and the toe-out angle, to allow those internal rotators or the external rotators to relax a little bit.
And the back is going to thank you, and that person’s going to be able to function more because now they’re going to be able to get adequate hip internal rotation.
So stay tuned for part three.
Tomorrow, where I’m going to talk about a different type of foot that’s causing lower back pain.