"The foot bone’s connected to the…pelvic bone"

Many patients have visited their pelvic floor physical therapist and wondered, “Why are you looking at my feet when I’m here for pelvic pain?” The answer is the alignment in your feet, and how you walk affects the muscles, joints, ligaments, and bones in your pelvis.

​The foot is complicated. It contains 26 bones, 33 joints, and over 100 muscles, tendons and ligaments.  But let’s keep this explanation simple. Its main functions are to soften, absorb shock and accommodate to the surface on which your foot lands, then become rigid to help you push off and take a step.

The softening of the middle of the foot to absorb shock is also known as pronation. You can have too much pronation. This looks like flat feet or collapsed arches. Alternatively when your foot becomes rigid to push off, this is known as supination. You can also have too much supination. This looks like very high arches.  

Both motions are important for movement. Each in excess can lead to pain and dysfunction. Every time you step, the alignment of your foot affects the way your whole body moves. Your therapist looks at how you stand, step, walk, how your shoes are worn and your foot structure, and puts the pieces together.  In standing, the therapist can see if you excessively pronate or supinate.

Here are two examples of how your foot alignment can affect your pelvis:

1. When a person has too much pronation, or collapsed arches, this causes the leg to turn in.  The hip and pelvic joints absorb the extra rotation leading to strain on muscles that rotate the hip.  One of those muscles, the obturator internus, is a common source of pelvic pain and dysfunction.
2. Alternatively, when a person has too much supination, or a high arch, this is a rigid position.  It has a decreased ability to soften and absorb shock. This increases the demand on ligaments in the pelvis and can lead to too much motion in the sacroiliac joint, or the lower end of the spine.  This can also cause too much outward rotation at the knee and hip.

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There are many more considerations in evaluating the foot than the two examples provided, but they all have a profound effect on the rest of the body.  They can cause instability at joints, pain, strained muscles, overworked muscles, and much more. In pelvic health physical therapy, your therapist is not only treating the symptoms in the pelvis, but always looking for possible causes of the symptoms such as your feet!