Surveying the Relationship Between Flatfoot and Chronic Mechanical Low

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Indian Journal of Fundamental and Applied Life Sciences ISSN: 2231– 6345 (Online) An Open Access, Online International Journal Available at http://www.cibtech.org/jls.htm 2015 Vol. 5 (1) January-March, pp. 79-83/Farzad et al. Research Article SURVEYING THE RELATIONSHIP BETWEEN FLATFOOT AND CHRONIC MECHANICAL LOW BACK PAIN Farzad Amoozadeh1, Gholamhossein Kazemian1, *Alireza Manafi Rasi1, Peyman Kazemi1, Fatemeh Safaeinik2 and Ahmad Khazanchin1 1Department of Orthopaedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2Department of Internal Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran *Author for Correspondence

ABSTRACT The objective of this study was to determine the relationship between flatfoot and mechanically chronic Low back pain. It seems odd to associate back pain with foot disorders but taking the role of foot in body balance in to consideration any change in the foot components can affect the forces on muscles and subjects and functioning. This study focused on two groups: flat foot subjects and healthy one with mechanical low back pain. navicular drop test was used to test the two groups of patients. The case- control studied on 100 people, evaluated the relationship between flat feet with low back pain. After a careful examination, the obtained data were recorded and analyzed. T-test was used to compare quantitative data and chi-square test was used to compare quantitative data. In this study, the significant level was considered p<0.05. In the end, the data related to the age and weight of the two groups shows that the mean age of patients with chronic low back pain (36.7 ± 13.5) is more than the patients without pain (35.4 ± 15), but they do not have significant difference. (P=0.538) Also, the average weight of people with chronic low back pain was more (71.6±19.7), but it has no statistically significant difference (68.5 ±17) with the other group (P=0.211). The obtained results from navicular drop test in both groups show that the obtained measurements in patients who have less chronic low back pain were less, which caused more longitudinal arch or flatfoot. (Figure 1) shows the results of the survey that there is a significant difference between two legs of the two groups (left foot P=0.034, right foot P=0.023). The findings revealed significant relationship between flat foot and low back pain. Therefore, we can conclude that foot disorders cause back pain through affecting body posture, balance and gait pattern.

Keywords: Flat Foot (FF), Low Back Pain (LBP), Foot Disorder (FD)

INTRODUCTION LBP is the most common type of back pain and one of the most common musculoskeletal disorders in modern societies (Kordi and Rostami, 2011; Kumar et al., 2013) and about 70-85% of people experience it in their lifetime (Anderson, 1989; Andersson, 1999; Magee, 1997). The term of low back pain (LBP) for the first time was applied by Andersson as a pain which was limited to the area between the lower edge of the ribs 12 and gluteal folds (Andersson, 1977). The incidence of LBP in adults and adolescents is alike (Burton et al., 1996; Leboeuf-Yde and Kyvik, 1998). LBP is usually self-limiting, but it is estimated that approximately 10% are involved in the form of chronically illness (Andersson, 1999; Furlan et al., 2002; Furlan et al., 2012). Some studies express the incidence of chronic LBP between 16-62% in 6 to 12 month after the initial injury (Hestbaek et al., 2003). However, it should be noted that the high prevalence of chronic LBP and a high percentage of these cases are associated with heavy costs on individuals and the health care system (Andersson, 1999; Furlan et al., 2012; Hestbaek et al., 2003; Furlan et al., 2009). An interesting point is that currently, despite the simple look of LBP and conducting numerous studies on the causes and treatment, it is not yet clear how these patients must be treated. Flatfoot is one of the most common foot problems, which can be seen in many orthopedic medical centers. Studies have reported the incidence of flatfoot in children between 0.6-77.9% (Dida et al., 1987; Gould et al., 1989). Although, it seems that waist and legs are separated from each other, but based on

Indian Journal of Fundamental and Applied Life Sciences ISSN: 2231– 6345 (Online) An Open Access, Online International Journal Available at http://www.cibtech.org/jls.htm 2015 Vol. 5 (1) January-March, pp. 79-83/Farzad et al. Research Article biomechanical principles and rules concerning the kinematic chain, it appears that they are effective on each other and probably any change in the normal functioning of the area can also affect other areas. Previously, some researchers have suggested that abnormalities such as flatfoot are associated with changes in gait and effects associated with lumbar (Cibulka et al., 1998; Rothbart and Estabrook, 1988). Several studies have surveyed the relationship between flatfoot and LBP and different and sometimes contradictory results were obtained (Gould et al., 1989; Cibulka et al., 1998; Rothbart and Estabrook, 1988; Borges et al., 2013; Brantingham et al., 2006). Accordingly, in this study we surveyed the relationship between flatfoot and mechanically chronic LBP.

MATERIALS AND METHODS In this case-control study, 100 men, 18 to 60 years referred to an orthopedic clinic, were divided into two types of chronic low back pain and chronic low back pain. In patients aged between 18 and 60 years, back pain from 6 months prior to admission, lack of pathological pain, lack of spine and lower extremity surgery, lack of deformity or spinal cord disorders such as scoliosis, lack of underlying disease such as rheumatoid arthritis, malignancy, brucellosis, tuberculosis, or lack of central nervous system diseases such as stroke, lack of disk herniation, stenosis, and spondylolisthesis and degenerative changes of the spine, lack of trigger points in check up and natural reflexes and also, lack of pain in the lower extremities back were entered the study. Then, navicular drop test was used to test the two groups of patients. To perform this test, the patients were required to be in the standing position. Then, the patients were asked to put their weight on the contralateral limb. In this case, the distance of navicular bumps or navicular bones were measured from the ground. Then the patients were asked to put their weight evenly on both the lower limbs. The height difference between the navicular bones was measured. If the size is greater than 10 mm, the distance is abnormal and represents more plantar arch. After a careful examination, the obtained data were recorded and analyzed. T-test was used to compare quantitative data and chi-square test was used to compare quantitative data. In this study, the significant level was considered p<0.05.

RESULTS AND DISCUSSION Findings In the end, the data related to the age and weight of the two groups shows that the mean age of patients with chronic low back pain (36.7 ± 13.5) is more than the patients without pain (35.4 ± 15), but they do not have significant difference (P=0.538). Also, the average weight of people with chronic low back pain was more (71.6±19.7), but it has no statistically significant difference (68.5 ±17) with the other group (P=0.211). The obtained results from navicular drop test in both groups show that the obtained measurements in patients who have less chronic low back pain were less, which caused more longitudinal arch or flatfoot. Figure 1: Shows the results of the survey that there is a significant difference between two legs of the two groups (left foot P=0.034, right foot P=0.023)

Table 1: Comparison of age, gender and weight of both groups P value NO LBP LBP Group )n=50( )n=50( 0.538 35.4±15 36.7±13.5 Age (year) )19-58( )18-57( 0.211 68.5±17 71.6±19.8 Weight (kg) )58-103( )55-106( >0.001 8 29 LBP Chronic mechanical

4 LBP 3 NO LBP

0 Left foot Right foot

Figure 1: The amount of the navicular drop test in both groups

Discussion In this study, we have observed that flatfoot can have a relation with the development of mechanical chronic LBP. Feet disorders and deformities are one of the factors that have been introduced as one of the possible causes of LBP. Of course, on the principles of biomechanics, it seems that there is a relationship between feet deformities and spine performance. LBP is one of the common problems in modern societies that seem we will deal with it increasingly, due to establishing changes in lifestyle. This problem seems very simple, but it has always been a challenge for physicians and in the cases that no cause be found for back pain, such as disc herniation or degenerative changes, treatment can be very difficult and long-term. However, some factors have been implicated in the occurrence of LBP, but still we see that many people suffer from LBP and refer to treatment centers. LBP is associated with widespread physical, social, psychological and economic effects and consequences in life (Kumar et al., 2013). Similar to our study, Borges Cdos et al., stated that LBP in women has relation with the increased longitudinal arch of the foot. They also found that there is a moderate correlation between the flatfoot and increased lumbar lordosis (Brantingham et al., 2006). Kosashvili et al., in their study also found that moderate and severe flatfoot can be associated with a significant increase in the incidence of anterior knee pain and LBP with mild smoothness, while slight flat does not have a relation with it. They also indicated that flatfoot in adults with moderate or severe flatfoot needs to be treated. Menz et al., on the Framingham study found that foot posture is not associated with LBP, while pronated foot function can be associated with an increased risk of LBP in women and for this reason, using some modalities such as foot plantar arthritis can play an important role in the prevention or treatment of LBP is the people (Rosner et al., 2014). In a systematic review, O'Leary et al., demonstrated that distortion and deformity of the foot and ankle due to impairment in the lower limb kinematic chain can be considered as one of the possible causes of LBP (Menz et al., 2013). There are also some studies that obtained different results and reject the relationship between flatfoot and LBP. Such as Brantingham et al., in their study stated that navicular drop in people with LBP is significantly lower than others and in fact, the amount of arc in these people is more (O'Leary et al., 2013). These researchers in another study surveyed 58 people with LBP and stated that flatfoot cannot be a risk factor for mechanical LBP (Kosashvili et al., 2008).

Indian Journal of Fundamental and Applied Life Sciences ISSN: 2231– 6345 (Online) An Open Access, Online International Journal Available at http://www.cibtech.org/jls.htm 2015 Vol. 5 (1) January-March, pp. 79-83/Farzad et al. Research Article The limitations of the study were a small statistical population and lack of follow-up and treat intervention in patients. Thus, the necessity of intervention studies is specified in this field. The results of this study indicate that flatfoot and increase the longitudinal arch of the foot can be a cause of chronic mechanical LBP and shows the necessity of intervention studies in this field.

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