When Orthotics Can Treat Low Back Pain
“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. Q: What have you found to be most effective when prescribing custom orthotics specifically for patients who have low back pain? A: For Dr. Sol, one of the most effective strategies is assisting with limb lift. In the average adult, each lower extremity accounts for 15 percent of total body weight. Each leg weighs approximately 18 pounds in an average 120-pound patient. Since we walk at 90 to 120 steps a minute, Dr. Sol says that represents a cumulative lifting load of 810 to 1,080 pounds per side in each walking minute. “Compensating for failed limb lift mechanics causes many gait-related repetitive injuries to the low back," says Dr. Sol. Dr. Williams favors an in-shoe pressure system to provide symmetric function in both feet and lower extremities. He adds that this effectively eliminates most of the upper body compensations which perpetuate chronic low back pain. “Eliminate the limp and the patients look, feel and function much better,” he says. Educating patients is important to Dr. Trachtenberg. “They must be committed to wearing their orthoses full time, wearing them in appropriately constructed shoes and getting involved with an interdisciplinary model of treatment if it applies to their situation,” he says. Dr. Sol (pictured) founded the Walking Clinic, PC and practices in Colorado Springs, Colo. He is a consultant to Tekscan. Dr. Trachtenberg has a private practice in Vestal, N.Y., and specializes in video and computerized gait analysis. Dr. Williams is in private practice in Indiana. He is also a Fellow of the American Academy of Podiatric Sports Medicine and a Fellow of the American College of Foot and Ankle Surgeons. He is a consultant to Tekscan.