When Orthotics Can Treat Low Back Pain

Author(s): 
Guest Clinical Editor: Nicholas Sol, DPM, CPed

Q: How do you use technology in your biomechanical practice to help treat these patients?
A:
All three panelists use the F-Scan System (Tekscan).
“I feel that using an in-shoe pressure system is the only way to accurately treat complicated foot and ankle deformities with orthotics, as well as upper body postural problems with custom foot orthotics,” notes Dr. Williams.
Dr. Williams says the F-Scan can give you a preliminary dynamic assessment, before any therapy has been instituted. He notes you can use the system to gauge the effectiveness of any adjustment you make to help improve the patient’s function.
Dr. Trachtenberg supplements his use of the F-Scan with a conventional exam for his biomechanical patients.
“This technology gives me information that I was unable to get before that greatly assists in writing an orthotic prescription for the patient that will enhance normal movement,” says Dr. Trachtenberg. “The emphasis now is on appropriate foot function rather than support.”
By having the patient move toward a more normal gait, there is no need for the previous compensations the patient was making in his or her movements, according to Dr. Trachtenberg. He says this facilitates improved posture and will decrease or eliminate proximal symptoms as the source of the repetitive motion dysfunction.
Dr. Sol calls video gait analysis and in-shoe sensors “indispensable” and has used the F-Scan system for several years. Video gait analysis lets him do a frame-by-frame review with the patient. Regarding in-shoe sensors, Dr. Sol adds there is no substitute for being able to see a patient’s shoes when he or she is walking and the technology lets him assess force from a “where, when and how much” standpoint.
“Using these technologies together permits me to stop time, assess movement and force and calculate a solution,” comments Dr. Sol. “Technology has greatly improved my ability to correct pathomechanics that affect the kinetic chain. This is the fastest growing part of my practice.”

Q: What are the three most frequent considerations when prescribing custom orthotics for patients with low back pain?
A:
Dr. Williams emphasizes concentrating on the function of the first MPJ and first ray, saying the battle is half won if you can eliminate functional hallux limitus. You should also adjust properly for limb length difference and assess and treat ankle joint equinus. “All of these come into play regarding sagittal plane progression,” notes Dr. Williams.
Dr. Trachtenberg advocates an interdisciplinary approach that includes chiropractic, physical therapy, massage therapy and sometimes acupuncture. If you address the etiology (abnormal gait) and then add the appropriate interdisciplinary care, “the results can be remarkable,” he says. Dr. Trachtenberg also emphasizes that evaluating leg lengths is an important aspect when dealing with back pain.
In Dr. Sol’s opinion, the most important consideration in prescribing custom orthotics for patients with low back pain is determining when the pathomechanic event happens. He says your solution will depend to a large extent on whether the event occurs before or after heel lift.
If the pathomechanic event occurs before heel lift, then you can find the solution in the rearfoot, forefoot or both, according to Dr. Sol. However, if the event occurs after heel lift, then the correction must be in the forefoot. “Most patients require correction of several pathomechanic events in each foot,” explains Dr. Sol.

Comments

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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