When Orthotics Can Treat Low Back Pain

Guest Clinical Editor: Nicholas Sol, DPM, CPed

Have you seen your share of patients who have back pain as a result of compensating for gait-related problems? If so, you’re not alone. Some patients may indeed get relief from lower back pain after getting custom orthotics. With this in mind, our expert panelists tackle this important subject.

Q: Podiatrists often report that many of their patients experience relief of low back pain after receiving custom orthotics. What is the relationship?
George Trachtenberg, DPM, believes the majority of lower back pain not caused by direct injury or congenital problems results from abnormal gait. If you see abnormal gait, particularly in the sagittal plane (the predominant plane of movement), Dr. Trachtenberg notes you may also see abnormal and early flexion of the knee, hip, back and cervical spine. This can lead to repetitive motion injuries, Dr. Trachtenberg says.
He says using appropriate orthotic devices will help eliminate these abnormal compensations and assist the aforementioned body parts in functioning more correctly. The low back is just one of those remote areas that can be affected by abnormal gait, notes Dr. Trachtenberg.
Nicholas Sol, DPM, also cites repetitive motion injuries. He notes the spine is an essential part of the kinetic chain, which coordinates and connects the phasic motion of the shoulder girdle and upper extremities with the phasic motion of the pelvic girdle and lower extremities.
“We all have different degrees of muscle strength. Yet, a man, woman and child can enjoy a prolonged walk together because walking is about efficiency and coordination, not muscle strength. When custom foot orthotics restore symmetric function of the lower extremities, both efficiency and coordinated phasic motion between the two girdles is enhanced,” says Dr. Sol.
While diagnosing a short limb effectively and compensating for the short limb with a custom orthosis is “extremely helpful,” Bruce Williams, DPM, says it only works in 50 percent or less of the patients.
“Understanding how important it is for the first metatarsal to engage the ground without jamming up is the most important thing to understand in relation to chronic back pain,” notes Dr. Williams.
Dr. Williams says unimpeded sagittal plane progression is paramount to effectively treating low back pain and if your patients’ feet and lower extremities do not function symmetrically or with similar accelerations, they will change gears from step to step “with disastrous outcomes.”


If a patient presents with excessive foot pronation and/or arch collapse, a torque force will produce internal rotation stresses to the leg, hip, pelvis, and low back. The result is recurring subluxations and eventual ligament instability affecting the sacroiliac and lumbar spine joints. These forces can be decreased significantly with the use of flexible, custom-made orthotics.

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