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Foot Posture, Foot Function and Low Back Pain: the Framingham Foot Study

by MASS4D® Prescription Orthotics April 17, 2017


The objective of this study was to explore the relationships between foot posture, dynamic foot function and low back pain in men and women who participated in the Framingham Foot Study, using objective biomechanical measurements.

The study sample, the Framingham Foot Study cohort, was derived from two large, population-based samples of residents of Framingham, MA, U.S.A.

The Framingham Foot Study conducted a physical examination of the foot and collected participant history, performance measures and other data via questionnaires between 2002 and 2005.

A validated foot examination was used with specific criteria to assess foot pain, foot symptoms and the presence of foot disorders.

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Low back pain was documented with a structured questionnaire highlighting 10 regions of the body; participants marked an ‘X’ on the chart indicating which regions were affected.

Foot posture was assessed using the arch index (AI) – from the maximum peak pressure image of the participant’s bipedal relaxed stance, the AI was calculated as the ratio of the area of the middle third of the footprint to the entire footprint area, with a higher value representing a ‘flatter’ foot.

Foot posture was categorised as cavus (lowest 20%), the normal reference group (in the middle 60%) or planus (those in the highest 20%).

Foot function was assessed by calculating the centre of pressure excursion index (CPEI) of the walking trials – this represents the degree of lateral deviation of the centre of pressure at the anterior one-third trisection of the foot relative to a line connecting the first and last centre of pressure data points.

The findings of the study indicated that pronated foot function is significantly associated with low back pain in women after adjusting for age, weight, smoking and depressive symptoms.

The authors concluded that orthotic interventions to modify foot function can have a role in the prevention and treatment of low back pain.

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  1. Menz, H. B., Dufour, A. B., Riskowski, J. L., Hillstrom, H. J., Hannan, M. T. (2013) Foot posture, Foot Function and Low Back Pain: the Framingham Foot Study. Rheumatology (Oxford): December 2013, Vol. 52, No. 12, pp. 2275-2282. DOI: 10.1093/rheumatology/ket298

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