Patient case study
Fiona’s story: the plan began at her feetWhat a standing EOS scan showed about her pelvis, and why that changed where treatment started
- Back
- Shoulder
- Neck
- Pelvic imbalance
- Compensating spinal curve
Her pain was at the top of her body. Her plan started at the bottom.
Fiona’s own scan video, shared with her permission.
The short answer
Why did a plan for Fiona’s back, shoulder and neck start at her feet?
Why did a plan for Fiona’s back, shoulder and neck start at her feet? Her standing EOS scan showed that her pelvis was out of balance. Her spine was curving to make up for it. Together, the two were adding to the overload she felt higher up. With every step, load reaches the pelvis from the ground, through the feet, ankles, knees and hips. So her plan did not treat the sore areas at the top of the chain. Instead, it used podiatry and physiotherapy to control how that load arrives. That leaves the pelvis and spine with less to correct for.
- Patient
- Fiona
- What hurt
- Back, shoulder and neck discomfort
- The question
- Why the top of the body was taking the strain
- Plan before the scan
- Treating each painful area separately
- Scan
- EOS full-body standing scan, front and side views
- Key findings
- Pelvic imbalance and a compensating spinal curve, linked
- Plan after the scan
- Foot-to-pelvis load control, with podiatry and physiotherapy
- Where
- ScanAlign, 19 Harley Street, London
Before the scan
The pain was high up. The answer was not
Fiona had discomfort in her back, her shoulder and her neck. When pain sits high in the body, that is usually where everyone looks. Treating it there often helps for a while.
Her scan showed that the three areas were connected, not separate. Her pelvis was out of balance. Her spine had curved to make up for it. Together, they were adding to the overload she felt further up.
That answered one question and raised another. If the pelvis is what is out of balance, what is arriving at it, and from where?
The place that hurts is not always the best place to start.
The load path
Read the body from the floor up
This list runs from the floor upwards. That is the opposite of how people usually describe their pain. Select a level to follow the load up.
- Feet on the floor
- Ankles and lower legs
- Knees
- Hips and pelvis
- Spine, shoulder and neck
Your feet
All of your weight arrives through two small areas of contact. How your foot meets the floor, and how it rolls once it is there, sets the angle the whole leg starts from.
Ankles and lower legs
The ankle turns the position of the foot into a direction for the leg. If the foot rolls inwards or outwards more than it should, the lower leg follows it. So does everything stacked above.
Knees
The knee sits between the hip and the foot. It cannot choose its own position. When either end is out of line, the knee takes the twist, and that is where many people feel it first.
Hips and pelvis
Both legs pass their load to the pelvis. If it arrives unevenly, step after step, the pelvis has to work to stay level, and it may not manage it. This is where Fiona’s scan found a problem.
Spine, shoulder and neck
Above the pelvis, the spine curves to keep the head over the feet. The shoulders ride on the spine, and the neck makes the final adjustment. Three sore areas, at the far end of a chain that starts on the floor.
Seen from the top, Fiona had a neck problem, a shoulder problem and a back problem. Followed from the floor, there is one load path with a weak point partway up. Her plan worked on the load arriving, not on the ache at the end of it.
What the scan found
Two findings, in the middle of the chain
Both findings sit at the pelvis and above it. That matters for what follows. It tells you where the chain was struggling, not where the load was coming from.
A pelvis out of balance
The two sides of her pelvis were not level while she stood.
What it isThe pelvis is where both legs pass on their load and where the spine begins. It is built to sit level and square, and almost everything you do passes through it.
Why it mattered for FionaIt is the point in Fiona’s chain where the trouble showed. It is also the point that load arrives at. That is why the plan looked below it as well as above it.
What the standing scan showsA standing image shows both sides of the pelvis at once, along with the legs below and the spine above. So the whole chain can be compared in one picture.
A spine curving to compensate
Her spine had curved to make up for the uneven base and keep her head over her feet.
What it isA compensating curve is the spine correcting for something below it. It keeps you upright and level, and while it does so it loads muscles and joints unevenly. It is not the same as scoliosis, where the curve sits in the structure of the spine itself.
Why it mattered for FionaThis is what carried the problem up to her back, shoulder and neck. Those areas were doing the correcting. That is why they ached even though nothing had happened to them.
What the standing scan showsThe whole spine is captured standing, head to feet. So a curve and the pelvis driving it can be seen together. A full spine X-ray taken standing is the usual way to measure it.
To be exact about what was and was not found: the scan recorded an uneven pelvis and a compensating curve. It did not record a fault in her feet. Her plan started at the feet because that is where load enters, not because anything was found wrong there.
Something you can check tonight
What your shoes have been recording
You already own a record of how you load your feet. Most people have several pairs of it in a cupboard. Shoe wear is a clue, not a diagnosis, but it is a clue you can check tonight.
What it tends to mean
Nothing to act on by itself. Worth knowing as your normal, so you notice if it changes.
What it tends to mean
Often goes with a foot that stays rolled outwards, instead of rolling in to absorb the step. The leg above it then has less give to work with.
What it tends to mean
Often goes with a foot that rolls inwards more than it needs to. That turns the lower leg inwards too, which changes the angle at the knee and the hip.
What it tends to mean
The clearest sign that the two sides are not sharing the work. It is worth taking seriously, because it repeats with every step you take.
Shoe wear tells you that something has happened, not why. A worn edge can come from the shape of your foot, the way you walk, a difference in leg length, an old injury you now move around, or simply the shoes. Our guide on what uneven shoe wear means goes through the possibilities properly.
Watch the scan
Watching Fiona’s scan: what to look for
The video goes through Fiona’s real EOS images, front and side. You do not need any medical training to follow it. Watch it from the bottom of the picture upwards. That is the order in which the body is built up.
What to look for in the video
- Start at the feet and ankles at the bottom of the front view. This is where load enters the body.
- Check whether both sides of the pelvis are level.
- Follow the curve of the spine above it.
What a standing EOS scan shows
- How your bones and joints line up from your feet to your head, standing
- Whether the two sides of your pelvis are level
- How your legs line up from hip to heel, at true size
- The curves of your whole spine, front and side, under your own weight
- The shape of your joints and the space inside them while they carry weight
What it does not show
- Discs and nerves in detail
- Cartilage, muscles, tendons and ligaments in detail
- How you move, because a scan is a still picture of you standing
For discs, nerves and soft tissue, MRI is usually the better tool. For movement, gait analysis looks at what happens while you walk. The two answer different questions, and they work well together.
After the scan
How Fiona’s plan changed
Before
Treating separate pains
After the scan
Restoring foot-to-pelvis load control with podiatry and physiotherapy
Her plan used that chain in reverse. Podiatry and physiotherapy were used to control how load travels from her feet to her pelvis. That way, less of it arrives unevenly, and there is less for the areas above to correct for.
In practice, that can mean work on how the foot meets the ground, on the strength and control of the leg and hip, and on footwear. Whether anything goes inside the shoe is for the clinician to judge. Our guide comparing off-the-shelf insoles and custom orthotics explains what the options involve.
It is worth being clear about what did not change. Her back, shoulder and neck still needed care, and easing them is worth doing. What changed was the order, and the reason. Those areas were treated as the end of a chain, not as three separate faults.
ScanAlign is a diagnostic imaging clinic. We show you what is going on and explain it clearly. Treatment is planned by the specialists you choose, with the findings in hand.
Why standing matters
A load path only exists when you are standing on it
Load only travels through the chain while you are standing on it. Your feet carry your weight, your legs pass it up, and your pelvis takes the result. Take that weight away and there is no load path to look at.
Lying down does exactly that. Muscles relax, the spine settles into the table, and an uneven pelvis and the curve correcting for it can soften or disappear. That does not mean the pain only happens when you stand. Many people have pain lying down too, and night-time back pain is common. It means the cause often lies in how you are aligned and loaded when upright and carrying your weight, even if you feel it at other times.
An EOS scan is a full-body weight-bearing scan in 15 seconds, unstitched and non-magnified, with front and side views captured at the same time. Because it runs head to feet in one pass, the feet, knees, pelvis and spine are measured in the same image, not in separate ones. It uses about 90% less radiation than a standard X-ray, around ten times less.
Before you start a treatment, or change the one you are on, it is worth getting a detailed diagnosis. Knowing whether the cause lies in the pelvis, the legs or the spine changes what will actually help.
Lying down: MRI and CT
The load comes off
Muscles relax and the body settles into the table. The feet carry nothing, so there is no load path to follow. These scans are excellent for discs, nerves and soft tissue.
Standing: EOS
Your real working position
Feet, knees, pelvis and spine appear in one image while they carry your weight. So the way load travels up can be followed from the ground.
An honest note about MRI. EOS shows bones, joints and alignment. If your problem is mainly discs, nerves or soft tissue, MRI is usually the better tool, and we will tell you so on your free call. See how EOS compares with MRI, CT and X-ray.
Seek urgent help first if you have new numbness, weakness in your arms or legs, or loss of bladder or bowel control. Contact your doctor or your nearest emergency department.
Your story
Has anyone looked below where it hurts?
Questions to ask your specialist
These questions turn the conversation downwards, towards where load comes from.
- Could my neck and shoulder pain be coming from lower down?
- Is my pelvis level when I am standing?
- Has anyone looked at how load reaches my pelvis from my feet?
- Would seeing my feet, legs, pelvis and spine in one standing image change the plan?
Good clinicians welcome these questions. If you are not sure who to ask, our guide on when to see a specialist can help.
How a story like Fiona’s starts
A free video consultation
Tell us what has been going on and what you have tried. You do not need a referral from your doctor, and we will tell you honestly whether a scan is likely to help.
Your standing scan at 19 Harley Street, London
You stand naturally, with light undressing, and the scan captures you from head to feet. Read what to expect on the day.
A clear written report
A plain-English report of your findings, with a summary you can take to your doctor, physiotherapist or podiatrist back home.
Questions
Questions people ask after reading Fiona’s story
Why would neck or shoulder pain be treated at the feet?
Because the feet are where your weight enters the body. If load arrives at the pelvis unevenly, the spine above it curves to compensate, and the shoulders and neck finish the correcting. Treating the neck eases the symptom. Changing how load arrives takes work off the whole chain. Both have a place.
Can flat feet cause back pain?
Not on their own, and many people have flat feet and no pain at all. What matters is whether the shape of your foot changes how load travels up the leg, and whether anything above is struggling with the result. Our guide on flat feet in adults covers when they are worth doing something about.
Does uneven shoe wear mean something is wrong?
Not by itself. Some unevenness is normal, and shoes vary. It becomes interesting when the pattern is strong, when one shoe is clearly more worn than the other, or when it shows up alongside pain that keeps coming back. Treat it as a clue worth mentioning, not as an answer.
Will I need insoles?
Maybe, maybe not. Insoles are one tool among several, and they suit some problems much better than others. Strength and control work often does more of the lasting work. Our guide on orthotics and overpronation sets out when they tend to help.
Is gait analysis the same thing as this scan?
No, and they answer different questions. Gait analysis looks at how you move. A standing scan measures how your skeleton lines up and shares load while you hold yourself up. Our comparison of video gait analysis and 3D imaging explains where each one is strongest.
What does a podiatrist actually do for a problem like this?
A podiatrist assesses how your foot is built and how it behaves under load. They then work on changing what arrives at the leg above it. That might mean footwear advice, exercises, something inside the shoe, or a referral to someone else. They are the right person for the bottom of the chain.
Is the EOS scan safe?
Yes. EOS uses about 90% less radiation than a standard X-ray, around ten times less. You stand in an open scanner, with no tunnel and no injections. There is more detail on our safety page.
How much does it cost?
The price for patients travelling from abroad is confirmed during the free video consultation, and you can read more on our cost page. There is no obligation to go ahead.
Keep reading
Guides linked to Fiona’s findings
- GuideFootwear and postureWhat your shoes change, and what they do not.Read the guide
- GuideOrthotics and knee painHow changing the foot can change the joint above it.Read the guide
- GuideStanding all dayWhy hours on your feet find the weak point in a chain.Read the guide
- GuideWhen one leg feels longerWhat causes that feeling, and how it is checked properly.Read the guide
Your story
Pain up top, and nobody has looked lower down?
If your neck, shoulder or back has been treated on its own without lasting change, a free video consultation is the easiest way to find out whether a standing scan could show where the load is coming from.
Fiona’s story, first name and scan video are shared with her permission. Individual findings and care plans vary, and this story does not predict your results.
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital’s CQC licence.