Back Pain
Additionally, most people with long-standing Back Pain have had their back examined thoroughly. Some have had it scanned. Very few have had anyone look below the knee.
That’s a reasonable oversight — the pain is in the back, so that’s where attention goes. But your feet are the only part of you in contact with the ground, and every step you take sends force upwards through the ankle, knee and hip before it reaches your spine. Around 5,000 to 10,000 times a day, depending on how active you are.
If something at the bottom of that chain has changed, the load arriving at the top changes too.
I want to be straightforward about the strength of the evidence.
This is an area where some clinics overclaim considerably.
There is a genuine signal in the research, and Back Pain merits four checks.
First, the Honest Version of the Evidence
A systematic review with meta-analysis examining lower limb alignment and low back pain found a consistent link between a reduced medial longitudinal arch — flat feet — and a higher prevalence of back pain, with the meta-analysis showing greater prevalence of flat foot in the back pain group. That finding is supported by a large retrospective study involving over 97,000 people.
The same body of work found that during the stance phase of walking, people with back pain showed less inversion and more eversion at the ankle than those without.
Broader reviews have linked flat feet, ankle instability, restricted movement in the sagittal plane and excessive pronation to low back pain — while also noting that the overall volume of research in this area is limited.
What that means in plain terms: these things are associated with back pain. Association isn’t proof that one causes the other, and plenty of people have flat feet and perfectly comfortable backs.
So this isn’t a claim that your feet are the reason your back hurts. It’s a case for having them looked at when nothing else has explained it — particularly if you’ve had back pain for a long time and nobody has assessed below the waist.
Check One: Ankle Movement
What to look for: How far your knee can travel forwards over your foot with your heel staying flat on the floor.
How to test it: Kneel with one foot forward, facing a wall. Keeping the heel down, push that knee towards the wall past your toes. Note how close you can get. Compare sides.
Why it matters: Walking requires a certain amount of forward travel over the planted foot. If your ankle can’t provide it, that movement has to be found elsewhere — often through the midfoot, the knee, or by rotating the whole limb outwards. Any of those changes how your pelvis and spine are loaded, thousands of times a day.
Who tends to have it: anyone with a history of ankle sprains, Achilles problems, or a previous ankle injury they never fully rehabilitated.
A clear difference between sides is the most informative finding here. Symmetrical stiffness is common. Asymmetry means one side of your body is moving differently from the other, all day.
Check Two: An Old Ankle Sprain
What to look for: An ankle that has been sprained before — particularly more than once — and never had proper rehabilitation.
Why it matters: Ankle instability appears in the literature as one of the deviations linked to low back pain. And a sprain does more than stretch ligaments; it degrades the sensory feedback the joint provides, which alters how you load that leg.
Most ankle sprains in this country are managed with rest, ice and a hope that it settles. It usually does, symptomatically. The strength deficit, the balance deficit and the altered movement pattern frequently don’t.
How to test it: Stand on one leg with your eyes open, near something to hold. Time it. Then compare with the other side. Then, if you’re steady, try it with your eyes closed.
A clear side-to-side difference — even years after the injury, even with no ankle pain at all — tells you that leg is behaving differently from its neighbor.
Check Three: Foot Posture and How You Load
What to look for: How your feet actually behave under load, rather than what your arch looks like standing still.
Why it matters: This is where the flat foot and pronation evidence sits. Excessive pronation has been described as producing a functional leg length difference, which in turn affects pelvic position.
A practical check anyone can do: look at the soles of your shoes. Wear patterns tell you a great deal about how you’re loading, and asymmetric wear between left and right is worth noticing.
An important caveat: having flat feet is not a disorder requiring correction. Enormous numbers of people have them without symptoms. The question is whether your particular foot mechanics are contributing to your particular back problem — which is an individual assessment, not something determined by arch height alone.
Check Four: Leg Length
What to look for: A genuine difference in leg length, or a functional one produced by how you’re standing and loading.
Why it matters: Leg length discrepancy has been associated with low back pain — and notably, one study found this association specifically among people whose work requires them to stand.
That’s directly relevant round here. Walsall works standing up — distribution, manufacturing, care, retail, trades. If you spend eight hours a day on your feet on a concrete floor, a small asymmetry gets a great many repetitions to make itself felt.
On treatment: research into heel lift correction in people with non-specific back pain and leg length discrepancy has reported benefits, though this needs proper measurement and fitting rather than guesswork. Sticking a shop-bought insert in one shoe on a hunch is as likely to create a problem as solve one.
What This Doesn’t Mean
It doesn’t mean you need orthotics. The evidence for insoles in treating back pain is not strong, and they’re frequently sold to people who don’t need them. They’re one option, for specific findings, not a default.
It doesn’t mean your feet are the cause. Most back pain is multifactorial. Load, strength, sleep, stress and what you believe about your back all play a part — and I’ve written elsewhere about how much the last of those matters.
And it doesn’t mean your back doesn’t need treating. The strengthening and load work still has to happen. Addressing something at the foot might remove a contributing factor; it won’t build the capacity your back needs.
What It Does Mean
You’ve had Back Pain for a year or more, and your spine has been examined repeatedly.
But nobody has yet looked at how you move from the ground up, so a key piece is missing.
That’s particularly true if you have any of the following: a previous ankle injury on one side, a clear difference in ankle movement or balance between sides, uneven wear on your shoes, a job that keeps you standing, or back pain that’s noticeably one-sided.
None of those prove anything on their own. Together, they’re a reason to assess the whole chain rather than the painful bit.
When to See Your GP Rather Than Me
Some symptoms need medical assessment first:
Go to A&E for numbness in the groin, genitals or inner thighs; new problems controlling your bladder or bowels; or weakness in both legs.
See your GP promptly for progressive weakness in a leg or foot; a foot that drops or catches when you walk; back pain with fever, unexplained weight loss or night sweats; severe unrelenting night pain; back pain after significant trauma; any history of cancer with new back pain; or a first significant episode of back pain over the age of 50.
And note that numbness in both feet, starting in the toes and creeping upwards over months, is a different problem entirely and needs bloodwork rather than a biomechanical assessment.
Let’s Assess the Whole Chain
If your back has been treated in isolation and it hasn’t resolved, assessing how you actually move from the ground upwards is worth an hour of anyone’s time.
We offer a free discovery visit at no cost and no obligation. You’ll get a proper assessment — spine, hips, knees, ankles and feet — a clear explanation of what’s actually driving your symptoms, and an honest view of whether anything below the knee is contributing.
If it isn’t, I’ll tell you that too, and we’ll focus on what is.