We often blame bad posture or lifting heavy weights for back pain, but can foot malalignment be the hidden culprit?

One of the most common causes of back pain is when the ligaments between the vertebrae get overstretched (sprained) or the back muscles get overworked or pulled (strained). This usually happens due to lifting something heavy, overuse, or putting too much pressure on the back. These injuries lead to pain and swelling around the area because of inflammation and muscle spasms. Sometimes, one of the discs between the vertebrae can tear or slip out of place called a herniated disc.
As we get older, the ligaments and joints in our spine become weaker. This can cause a condition called spondylolisthesis, where one spinal bone slips forward over another. Other conditions like sciatica (nerve pain down the leg), lumbar spinal stenosis (narrowing of the lumbar canal), and scoliosis (lateral curvature of spine) can also lead to back pain.

The Foot-Spine Connection

Problems in the lower limbs, especially in the feet and ankles, have also been studied as a cause of back pain. But it’s easy to overlook how important our feet are in supporting the spine. Since foot problems don’t always hurt, healthcare providers sometimes forget to check and treat them. However, poor foot alignment can affect not just the lower back, but also the joints and muscles above the ankle. Over time, walking with an abnormal gait can limit the natural movement between the spine bones. This can lead to bad posture, muscle imbalances, and joint issues in the spine, adding to back pain.

Common foot deformities that affect the back

The foot acts as the foundation of the body, providing stability during walking especially at midstance where the entire sole, from heel to forefoot, makes proper contact with the ground in the absence of any structural abnormalities. Few foot and ankle deviations that have been found to associate with back pain are:

Flat Feet (Pes Planus) This happens when the arch of the foot collapses, and most or all of the sole touches the ground. It can affect one foot (unilateral) or both (bilateral).

• A flat foot does not absorb shock well, so pressure during walking travels up and causes stress or pain in the back.
• It also leads to internal rotation of the tibia and femur.
• The pelvis may tilt forward, causing increase in lumbar lordosis of the lower back, leading to discomfort.

High Arches (Pes Cavus): This is when the arch is too high, making the foot roll outward (supination).

• This creates increased vertical forces up the kinetic chain, leading to poor shock absorption.
• The spine may become stiff or less mobile to adjust for this, especially during movement.
• As a result, pain can develop in the mid and upper back due to the extra strain.

Excessive pronation: Pronation happens when a person’s foot collapses under weight bearing during a walking.

• Unusual loading on the spine results from altered walking mechanics.
• impacts the regulation and timing of trunk and pelvic motions.
• Increased strain on the erector spinae and multifidus, which are the two main spine stabilisers, resulting in pain and fatigue.

Leg Length Discrepancy (True or Functional): One leg becomes shorter than the other either because of discrepancy of actual bone length (true) or uneven foot structure (functional).

• This causes one side of the pelvis is higher causing pelvic obliquity.
• The spine may curve to adjust, leading to structural or compensatory scoliosis.
• It also causes muscle imbalances, stress in the sacroiliac joint, and chronic lower back pain.

Blocked Sagittal Plane Movement: This refers to limited movement in the forward-backward (sagittal plane) direction of the foot, especially in the first metatarsophalangeal joint (Great toe).

• Conditions like functional hallux limitus (limited big toe motion) or ankle equinus which is tight calf muscles limiting ankle movement block normal foot motion.
• This affects walking by restricting hip extension and shortening stride, leading to inefficient body movement and back pain.

Ankle Instability: Ankle instability can happen due to weakness which is called functional ankle instability, structural changes known as mechanical ankle instability, or both.

• Mechanical ankle instability (MAI) happens after injuries and pathological laxity of ligaments, joint wear and tear, or changes in joint structure.
• Functional ankle instability (FAI) is caused by poor muscle control or coordination.
• These issues reduce the ankle’s ability to provide proper support and balance, which can affect walking and increase the risk of developing lower back pain.

Quick Foot assessment at Home

The foot serves as the body’s foundation, so maintaining spinal alignment and proper posture depends heavily on its shape and function. Identifying typical foot abnormalities that may lead to spinal stress can be accomplished with simple assessment. Start by visually examining your foot posture when standing. Keep an eye out for symptoms such as inward/outward ankle rolling, flattened arches, or high arches.

An additional rapid method is the Wet Footprint test, which shows that a full imprint implies flat feet, a narrow midfoot region indicates regular arches, and a hardly perceptible midfoot indicates high arches. Walking barefoot and observing gait patterns might potentially highlight excessive pronation or asymmetries. Tests of balance, including standing on one leg for 30 seconds, can reveal deficiencies in neuromuscular control and foot stability.

Corrective Exercises and Footwear Recommendations

Exercises for flat feet: Restoring medial arch support and minimizing excessive pronation are the goals.

• Short Foot Exercise: Raise the midfoot lightly without curling the toes to engage the intrinsic arch muscles.
• Towel Grabs: Use your toes to scrunch a towel on the floor for 10 to 15 repetitions each foot to strengthen your foot flexors.
• Strengthen the posterior chain with calf raises, which should be performed slowly and with controlled descent in three sets of ten to twelve repetitions.
• To improve foot coordination, practise toe mobility by isolating toe movements, such as raising the big toe while keeping the others planted and vice versa.

Exercises for High Arches: Increase shock absorption, balance, and foot flexibility.

• Plantar Fascia Release: To reduce tension and increase mobility, roll a tennis or massage ball beneath the foot for one to two minutes.
• Stretching the stiff Achilles and gastrocnemius muscles while standing might help ease the tension on the foot and spine.
• Walk on your heels for 30 to 60 seconds, two to three rounds, to strengthen your anterior tibialis muscles.
• Dynamic balance Exercises: To test proprioception, practise single-leg balance on foam pads or with light reaching.

Exercises for Excessive pronation: Improve ankle-hip coordination and realign foot mechanics

• Theraband Eversion: Use resistance bands to strengthen your peroneal muscles (3 sets of 15 reps per side).
• Single-leg Stability with Functional Reach: Improve postural alignment and ankle control when moving dynamically.
• To activate hip stabilisers and lessen compensatory foot stress, incorporate clamshells, lateral band walks, and bridges into your glute activation series.

Exercises for Functional Leg Length Discrepancy: Promoting pelvic symmetry and lowering compensating spinal stress are the goals.

• Exercises for Pelvic Tilting: To mobilise and align the pelvis, do anterior and posterior tilts.
• Regulated Step-Ups: To reduce asymmetrical loading, prioritise symmetry and equal weight bearing.
• Techniques for Sacroiliac (SI) Mobilisation: Mild, therapist-led exercises to regain pelvic mobility and balance (suggested under supervision).

Selecting the appropriate footwear is essential for maintaining normal foot alignment and avoiding excessive strain on the spine when performing corrective exercises. For everyday stability and comfort, footwear with sufficient arch support, solid heel counters, and appropriate cushioning is crucial. For people with flat feet or overpronation, brands like Birkenstock (https://www.birkenstock.in/?) provide exceptional support thanks to their ergonomically designed footbeds. Similar to this, more recent Crocs (https://www.crocs.in/) models—especially those with LiteRide^TM technology offer orthotic-grade cushioning and shock absorption, making them appropriate for extended walking or standing. It is advised that those with structural or recurrent abnormalities get custom orthotics from a podiatrist or physiotherapist.

Additionally, proprioceptive training can also improve foot strength, sensory feedback, and neuromuscular coordination, which can ultimately lead to improved posture and spinal health. Examples of this include safe barefoot walking on grass, sand, or textured mats.

Take away

In conclusion, the entire musculoskeletal chain, particularly the spine, is fundamentally impacted by foot biomechanics. Chronic back discomfort is frequently the result of compensating adjustments in stride, pelvic alignment, and spinal posture brought on by ignoring foot abnormalities. We can treat the underlying causes of poor foot mechanics and stop their cascading effects by using proprioceptive training, supportive footwear, focused exercises, and early assessment. A solid foundation, literally beginning at the feet, is essential for a spine that is pain-free and in alignment.