When you think about what affects your back health, foot posture might not be the first thing that comes to mind. However, the way your feet align as you stand, walk, or run plays a more critical role than you might imagine. In one way or another, everything in the body is connected. The alignment of your feet can affect your knees, hips, and even your back! While there are orthotics and specific shoes that can help improve your foot posture, there are also exercises that can help keep your foot strong and mobile. Proper foot posture is essential for so many daily activities. This article will address proper foot posture, its link to the low back and other parts of the body, and review ways to help improve your foot posture.
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**This is not medical advice. Please consult your medical provider for more information.
Understanding Foot Posture
What exactly is foot posture? Foot posture refers to the structural alignment of your feet. A normal foot should have a regular, moderate arch height which can move freely into pronation and supination. In other words, it should not be stuck or locked into one direction or another.
The other two categories include a flat foot (pes planus) or a high arch (pes cavus). Not only will these categories affect shoe fit, but changes in foot structure can influence overall health through the impact on foot function. By adjusting foot posture and understanding its association with other areas of the body, interventions can be taken to improve health outcomes.
Imagine being out on a long hike when a lingering discomfort in your lower back pops up and you’re only halfway through your hike. You may not have been dealing with this back pain before, so why is it showing up randomly now? Depending on what is going on with your feet, it could have something to do with this!
The interventions for adjusting foot posture can address issues like low back pain, hip pain, or knee pain. This places the spotlight on the importance of footcare in back pain prevention and reducing risk of injury. This is not just for athletes, hiking, or running, but for every day life as well.
The Link Between Foot Function and Low Back Pain
Just how does the foot possibly contribute to low back pain? It acts like a chain reaction. Excessively pronated feet will cause the tibia to internally rotate. The tibia internally rotating will cause the femur to internally rotate. Femur internal rotation then leads to the pelvis rotating forward (anterior rotation). This rotation of the pelvis causes the lumbar spine to arch more than normal. This is what we call increased lumbar lordosis, which can place more stress on the muscles and ligaments within the low back.
It is important to remember that just because you have pronated feet does not mean that this will cause back pain. It just places you at an increased risk of developing back pain. Also, if you do have pronated feet and also have back pain, it does not mean your feet are the sole cause of your back pain. It could be a multifaceted approach. You have to look at all possible causes that are driving your back pain. This article is meant to shed light on other potential causes of back pain that are largely forgotten about (aka the feet).
Make sure you are considering all possible causes if dealing with back pain. This includes your feet…don’t forget your feet!
How Foot Posture is Assessed by a Physical Therapist
When assessing foot posture, it’s important to take a thorough and scientific approach to ensure accurate identification of issues that could be affecting your foot health and overall health.
Sitting and Standing Posture
The first thing a physical therapist will look at is the posture of your feet. It will be looked at while both sitting and standing. Your feet might be in a different posture when under load, meaning as you sit your feet might look normal, but when you stand, the weight of your body might cause a different posture than when you’re sitting. Commonly you will see a flattening of the arch as the muscles needed to stabilize the arch are not strong enough or coordinated to hold the weight of your body. Other things that can be looked at are the heel (calcaneus), great toe extension, the tibial tuberosity, the femur, and the hips/pelvis to check alignment from the foot all the way up the chain. This can give insight as to what to look at more closely at moving forward.
While standing, rotating your trunk left and right should cause rotation through your legs. This should make your feet pronate and supinate. Naturally, your feet should be able to move in and out of these postures. If your feet don’t pronate or supinate with rotational forces, you would have something called a fixed foot posture. You want a flexible foot posture meaning that your feet can move in and out of the pronated and supinated positions. In other words, in standing you should exhibit a normal foot posture with adequate arch height. But when you start rotating your trunk with your feet evenly planted on the ground, your feet should pronate and supinate as you rotate.
Gait Analysis
Gait analysis is next and will show what your feet, legs, and hips look like when adding movement into the mix. Similar to looking at sitting or standing posture, observing how you walk gives an idea as to what is going on with your feet and the rest of your body when doing common activities such as walking. The idea is to look for common patterns and movements that may be contributing to movement dysfunction and subsequent pain. Your physical therapist may also ask to look at other movements based on your pain complaints and activities you commonly participate in. This can include squatting, lunging, jumping, running, etc.
Muscle Strength and Joint Mobility
From all the information gathered from your standing posture and movement analysis, the final things to look at are range of motion and strength. Your physical therapist will take measurements looking at how well your ankle and great toe move to see if it moves too much or is stiff. They will check if the main joint of the ankle, the talocrural joint, moves adequately, along with all of the many other joints within the foot. And finally, checking the strength of various muscles, including the ones needed to support your arch!
Types of Foot Posture
The two types of foot posture, aside from a normal foot posture, are pes cavus and pes planus.
Pes cavus refers to a foot with an abnormally high arch. It is also commonly referred to as a supinated foot. It can place increased stress on the ball of the foot and on the heel when standing or walking. People with a high arch can often complain of pain in the ball of the foot, heel, knee, or back. Lateral foot pain, lateral ankle instability and IT band syndrome can be common complaints due to the amount of stress placed on the lateral portion of the leg and foot. Symptoms will vary per person and based on the degree of the deformity.
Pes planus refers to a foot with loss of height in the arch of the foot. It is also commonly referred to as a pronated foot or flat foot. Individuals with a flat arch will often complain of pain on the inside of the ankle or along the arch of the foot, as well as knee or back pain. Having an overly pronated foot can increase your risk of developing plantar fasciitis, hallux valgus (bunion), posterior tibial tendon dysfunction (PTTD), arthritis, and shin splints. As the same with pes cavus, all symptoms will vary per person and based on the degree of the deformity of pes planus.
The Impact of Improper Foot Posture
Your posture starts with your feet. What happens with your feet affects the rest of the chain all the way up to your head, neck, and shoulders. Paying attention to your feet is what lays the foundation for the rest of your body.
A pronated or supinated foot doesn’t just stay a foot problem. It has the potential to disrupt the muscles, bones, and joints up to your lower back. Now if you live a largely sedentary lifestyle, you might not notice such problems. However, if you are on your feet a large majority of the day, you might notice more problems. And for those who are participating in more heavy activities aside from walking, such as hiking and sports, there may be an even bigger problem.
Lets take a runner for example. Lets say this runner is going on a 7 mile run. Think about how many times their foot is striking the ground. Then think about how much harder their foot is striking the ground compared to someone who is walking. All of that added force, along with the distance they are going, adds up over time. It is a lot easier to start to feel pain and other issues creep their way in. There could be pain in the bottom of the arch, the knee, or low back. It might even show up in multiple places.
Ignoring these symptoms might contribute to even more issues later down the line. Opting for a more supportive shoe or orthotics can be helpful, especially for those with a pronated foot.
Supportive Shoes for Better Posture
Supportive shoes have the ability to adjust how we stand, walk, and distribute weight. It provides the arch with much needed support it may not otherwise be receiving, especially for those with a pronated foot. A good supportive shoe should be flexible enough that it allows your foot to move as it naturally should, but should be supportive enough that it holds your foot in a somewhat fixed position. Depending on the shoe, it may also provide the ankle with greater stability. Hiking boots are a great example of this as they often provide extra support around the ankle to help prevent ankle sprains.
Related Articles On Ankle Pain
- Managing Pain in the Back of the Ankle
- Weak Ankles Running? Stabilization and Strengthening for Pain Free Running
- What to Know About the Achilles Tear Recovery Time
- How to Fix Weak Ankles: The Ankle Support You Need
- Ankle Pain When Walking? Why it Hurts and How to Fix It
While there is no one shoe that is perfect for everyone, there are certain brands that I highly recommend to many of my patients. It may take some trial and error to find a shoe that properly supports your foot and your needs. Take a look at a few of the options provided below for some suggestions.
Practical Tips for Maintaining Healthy Foot Posture
If you’re stepping forward into the world of footcare, take heart in knowing that maintaining a healthy foot posture is within your stride. Think of your feet as the foundation of a building; if the foundation is skewed, the entire structure feels the pressure. This becomes especially important in the context of preventing low back pain, as studies, such as the Framingham Foot Study, have shown how crucial foot function is, particularly for women’s health.
- Consider Supportive Footwear: If you have a pronated foot, giving your arch some added support can be helpful. Anyone can benefit from the right support.
- Assess Your Foot Posture Regularly: Over time, things can change. The way we walk and move adapts over time and this can change the positioning of our foot when we stand and walk. Regularly assess your foot posture and make any necessary changes to footwear that might be needed.
- Assess Wear and Tear on Your Shoes: The soles of your shoes should not be worn through. For avid runners, replacing running shoes every 6-12 months might be necessary. For every day walking, you might not need a new shoe every 6 months, but pay attention to the sole of your shoe. If it is worn through and you can’t see the tread, its time for a new shoe.
- Practice Foot Strengthening Exercises: Simple exercises can significantly improve foot function by enhancing strength and flexibility, thereby aiding in back pain prevention. Head over to this article and try the exercises included here!
TL;DR
Foot posture and function are crucial for overall health, particularly concerning low back pain. If you have either a high arch or a flat foot, it could be contributing to hip, back, and knee pain. Finding supportive shoes could play a vital role in preventing and treating low back pain by addressing foot function.
Tera Sandona is a licensed Doctor of Physical Therapy (DPT) and the founder of PT Complete. She helps high-achieving women break out of cycles of chronic pain, stress, and burnout through her Regulate and Rebuild Method, a sequenced approach that addresses the nervous system first and builds strength second. Her work focuses on helping women finally understand their bodies, rebuild strength, and create lasting resilience that fits real life.
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