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The Spine-Foot Connection: Investigating Compensatory Mechanisms in Degenerative Spine Disease Through Foot Deformity
Sereen Halayqeh1, Austin Kaidi1, Tomoyuki Asada1
1Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA.
Medicina (Kaunas, Lithuania)
|July 28, 2026
Summary
Flatfoot is linked to sagittal spinal imbalance in degenerative spine disease. This suggests foot posture may influence overall body alignment and reflect compensatory changes.
Area of Science:
- Orthopedics
- Spine Surgery
- Biomechanics
Background:
- Degenerative spine disease triggers compensatory mechanisms involving the entire body to maintain posture.
- Foot alignment adaptations may be associated with spinal sagittal balance.
Purpose of the Study:
- To investigate the relationship between foot alignment and spinal posture in degenerative spine disease.
- To determine if foot deformities correlate with sagittal imbalance.
Main Methods:
- Retrospective review of 98 patients with degenerative spine disease.
- EOS imaging to measure foot angles (Meary's, talocalcaneal, calcaneal pitch) and spinopelvic parameters.
- Statistical analysis (ANOVA, linear regression) to compare parameters across foot types and assess associations.
Main Results:
- Flatfoot was significantly associated with greater forward sagittal imbalance (SVA).
- Increased forward trunk inclination correlated with flatter feet (inverse relationship with talocalcaneal angle and calcaneal pitch).
- Degenerative scoliosis patients showed more flat/cavus feet; herniated disc patients showed more flatfoot.
Conclusions:
- Foot posture abnormalities, especially flatfoot, are linked to sagittal spinal imbalance in degenerative spine disease.
- Foot posture may play a role in global alignment and represent distal postural adaptations.
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