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Excessive foot pronation has been associated with the occurrence of low back pain, possibly for generating changes in lumbopelvic alignment. However, the influence of foot pronation (measured as calcaneal eversion) on pelvic alignment during standing had not been well established until a recent study by Pinto et al (1).

“Fourteen young healthy subjects participated in the study. A Motion Analysis System was used to obtain pelvic positions in sagittal and frontal planes and calcaneal position in the frontal plane. Volunteers were filmed in relaxed standing position during three trials, in three conditions: control; unilateral experimental with increased right calcaneal eversion and bilateral experimental with increased bilateral calcaneal eversion. Increased calcaneal eversion was obtained using wedges tilted 10 degrees medially, unilaterally and bilaterally. Repeated measures were used for statistical analysis. Unilateral and bilateral use of medially tilted wedges produced a significant increase of calcaneal eversion bilaterally, which was associated with average pelvic anteversion of approximately 1.5 degrees.

The authors concluded: “Excessive calcaneal eversion during standing does change pelvic alignment and should be considered, along with other relevant factors, when assessing pelvic misalignments.”

We have yet to hear of a reliable way to make long lasting changes to calcaneal eversion measurements through rehabilitation alone. If there are any studies please let us know so we can incorporate those protocols in ChiroUP. However, using medial heel wedges can create changes upstream to have an influence on back pain. This is a simple, effective adjunct. Take home point: Based upon these findings, our patients with lumbar facet irritation might be good candidates for medial heel wedges. (Please review our “Foot Hyperpronation” protocol for a more detailed description on how hyperpronation contributes to LBP).

1. Pinto RZ, Souza TR, Trede RG, Kirkwood RN, Figueiredo EM, Fonseca ST.  Bilateral and unilateral increases in calcaneal eversion affect pelvic alignment in standing position.  Man Ther. 2008 Dec;13(6):513-9. Epub 2007 Oct 1.

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