If you’ve ever experienced persistent low back pain, you may have been told the problem starts with your feet. It’s a common claim in musculoskeletal care—and one that contains some truth. The feet are, quite literally, the foundation of your body. When that foundation lacks stability or symmetry, the ripple effects can travel all the way up the kinetic chain—through the knees, hips, and ultimately to the spine. We hope you enjoy this blog post about, Orthotics and Back Pain.

Orthotics are often prescribed to “correct” issues in the foot that may be contributing to pain elsewhere in the body. But do they really fix the problem? At Central Ohio Spine and Joint, we believe orthotics are sometimes helpful—but they’re not a long-term solution for most people. In fact, many cases of back pain attributed to foot dysfunction are better managed through strength, mobility, and functional movement training.

Let’s break down how your feet influence spinal health, when orthotics are actually necessary, and why active care is often the best course of action.

The Feet as Your Foundation

Every time you walk, run, or stand, your body must handle and distribute force through the feet. The average person takes over 5,000–7,000 steps per day, and with each step, your foot must absorb shock, stabilize the body, and prepare for push-off. If the foot isn’t functioning properly, it can disrupt this sequence and lead to abnormal movement patterns up the chain.

Consider the following examples:

• A collapsed arch (overpronation) can lead to internal rotation of the tibia and femur, stressing the knee and hip.

• An overly rigid arch (underpronation) can reduce shock absorption, transmitting excessive impact forces into the lower back.

• Ankle immobility or weakness can alter your gait mechanics and reduce your ability to stabilize during dynamic tasks like squatting or running.

Over time, these compensations can contribute to pain and dysfunction in the lumbar spine.

The Orthotics Argument

Orthotics are designed to provide structural support and correction to the foot. They are most commonly used to:

• Realign the foot and ankle

• Improve gait mechanics

• Offload painful or inflamed areas (e.g. plantar fasciitis)

• Reduce stress transmitted to other parts of the body, such as the knees or lower back

There’s evidence that custom orthotics can be helpful for people with significant structural deformities—such as rigid flat feet, high arches, or limb length discrepancies. In these cases, the foot may lack the ability to support the body naturally, and orthotics can offer a mechanical advantage that reduces stress and improves comfort.

But here’s the catch: most people do not have structural foot problems—they have functional ones. And functional problems are best addressed with functional solutions.

When Orthotics Are NOT the Answer

Orthotics are often overprescribed for vague or nonspecific back pain, especially in cases where the real culprit is weakness, poor mobility, or movement compensation. Think of orthotics like a crutch: they may help in the short term, but they can also lead to dependence and limit your body’s ability to build resilience on its own.

Here’s when orthotics may do more harm than good:

• No structural deformity: If your foot shape is within normal variation, forcing it into a rigid orthotic can create new problems.

• Weakness and deconditioning: Relying on orthotics instead of addressing foot and hip strength only postpones the underlying issue.

• Poor mobility: Orthotics don’t fix restricted ankle dorsiflexion or tight calves. They just mask the symptoms.

• Acute overuse: In the early stages of injury, orthotics may offer relief, but long-term care should still focus on restoring strength and mobility.

The Real Fix: Strength and Resilience

At Central Ohio Spine and Joint, we take a movement-first approach. If your feet aren’t strong or mobile, your body will compensate—and those compensations often show up as low back pain.

Here’s what we prioritize over orthotics for most cases:

1. Foot Intrinsic Strengthening

Muscles like the abductor hallucis and flexor digitorum brevis help maintain arch support and shock absorption. Simple exercises like short foot drills, toe splaying, and barefoot walking can go a long way.

2. Ankle Mobility

Restricted ankle range of motion can force compensations at the knee or hip. We routinely assess and train ankle dorsiflexion, especially in patients with back pain during squats or lunges.

3. Hip and Core Stability

Your hips and core are your body’s control center. Weak glutes or poor core control often lead to compensations at the lumbar spine. By improving these areas, we offload the back and allow it to move more efficiently.

4. Gait and Movement Retraining

Sometimes it’s not the foot itself that’s the problem—it’s how you move. We analyze gait mechanics and teach patients how to walk, squat, and lift in ways that protect the spine.

When Orthotics Make Sense

We’re not anti-orthotic. In some cases, a well-designed custom orthotic can help a person stay active while they build strength and correct faulty movement patterns. These situations include:

• Rigid flat feet or high arches with limited mobility

• History of foot trauma or surgery

• Significant limb length discrepancies

• Neurological conditions affecting foot control

In these cases, orthotics act as an adjunct—not a replacement—for active care.

Bottom Line: Your Feet Matter, But They Need Strength—Not Just Support

Back pain is a complex, multifactorial issue. The feet absolutely play a role—but that doesn’t mean everyone needs an orthotic. At COSJ, we help you determine whether your foot structure is contributing to your symptoms and whether orthotics are appropriate. But more often than not, we find that strengthening the foot, improving mobility, and retraining movement patterns lead to longer-lasting relief than any insert ever could.

If you’re struggling with back pain and think it may be related to your feet, don’t reach for orthotics just yet. Schedule a movement evaluation with our team at Central Ohio Spine and Joint. We’ll assess your foot function, posture, and strength to get to the root cause of your pain—and help you build a foundation for lifelong movement health.

Click here to book your evaluation

For a deeper dive into the connection between foot mechanics and spinal pain, check out this article from the National Library of Medicine on foot posture and low back pain.