Why Your Feet Could Be Giving You Back Ache - and could cure it
There is a new buzzword in foot care: Orthotics. The science of treating deformities and abnormalities in the musculo-skeletal system - traditionally associated with ungainly corrective footwear - has been given a high-tech makeover.
Now, off-the-shelf or custom-made insoles worn in shoes to correct the gait (walking style) and support weakness in the foot are created using the latest in computer scanning technology. Available from £15 at High Street foot clinics, the great thing about them is no one can tell you're wearing them.
Experts also say that orthotics could be the answer to curing leg, knee and even lower back pain.
Delicate: Damage in the feet can make itself felt in other parts of the body
Do you need orthotics?
Some estimate that the distance we travel on our feet every ten years is equivalent to the Earth's circumference. So the 26 bones and 33 joints that make up each foot take a pounding over the course of a lifetime.
And given that between one and two times a person's entire body weight is
absorbed to as much as three-and-a-half times when running, it is hardly surprising they are susceptible to injury.
'Feet are fairly delicate structures,' says consultant podiatrist Simon Costain of the Gait & Posture Centre in Harley Street. 'Damage may be painless in the foot but felt elsewhere in the body.'
For instance, collapsed foot arches - also known as flat feet - which can be inherited or brought on by weakening of the muscles in the feet through sustained strain caused by wearing high heels, ageing and weight gain, are a common cause for knee pain.
'The condition can cause the heel to turn outwards at the ankle,' says Costain. 'This misalignment can result in painful grinding of the knee. We can track even further up the body, to lower back pain caused by the feet.
'For example, leg length inequality can cause a tilt in the pelvis - if the legs are functionally different because of a collapsed arch in one of the feet, we can use orthotics.'
Therapy often centres on treating pain caused by walking with high or flattened arches, and problems caused by overpronation or oversupination - the way the foot rolls inwards or outwards through a step to distribute impact throughout the foot.
'Our feet are like shock absorbers, and the ability to roll inward or outward is essential,' says Costain.
Difficulties begin when there is too much or too little pronation or supination, or if it happens at the wrong time when walking.
By creating extra support underneath specific parts of the feet - lifting the ankle a few millimetres, for example - insoles, made of foam rubber or carbon fibre, rebalance the action of the foot and correct other mechanics of the gait.
Walk away from your sore feet
Orthotics are frequently used by footballers, rugby players and runners - but their uses go beyond the playing field. They can be used to treat a range of common medical problems, experienced by one in five of the population.
These include metatarsalgia (pain in the ball of the foot, sometimes caused by dropped metatarsals where the bones we use to push off when we walk become misaligned) achilles tendonitis (soreness of the large tendon that connects the back of the ankle to the calves) and plantar fasciitis (a painful condition caused by tearing and inflammation of the tissues around the ligaments that connect the heel to the front of the foot).
Tibialis posterior pain, also known as acquired flat feet, causes pain on the inside of the ankle as a result of the collapse or rupturing of the muscles that hold up the arches.
Costain says: 'Moving from high heels to flat shoes often provokes this kind of pain but an orthotic can be worn in either or both type of shoe to help alleviate the problem.'
Costain says that about 70 to 80 per cent of patients referred to his clinic by GPs can benefit from orthotics and estimates that they could also help up to 70 per cent of the general population to treat or prevent injuries or improve the efficiency of the gait.
'Not enough people use them,' he says. 'The analogy we use is with racehorses - most have orthoses put on before each race and they would not run without them.'
Screen test: A scan can reveal feet are the cause of many problems
Pinpointing the problem
While gait analysis is increasingly available in sports shops and gyms, Michael O'Neill, from the Society for Chiropodists & Podiatrists, says prospective wearers should undergo a full gait analysis with a trained podiatrist or other medical expert (see below).
'A full analysis will include watching how someone walks, from their neck and shoulder to arm swing, knee function and leg swing, rather than just the foot,' says O'Neill. 'From there, we make a temporary device and subsequently make improvements once we know we are on the right track.
'We can use orthotics to control problems, improve the way the foot works and change its mechanics.'
Custom-made orthoses are created by taking plaster casts of the foot, but specialist clinics increasingly use cameras and lasers to map a three-dimensional image.
Ready-made insoles can also be bought. However, Jimmy Walsh, of fitness chain Runners Need, says: 'Off-the-shelf insoles can help sportsmen and women who have already been diagnosed with overpronation or supination, but prescribing orthotics really requires a trained medical professional.
'There are some trainers that help remedy these problems and some off-the-shelf insoles such as Sorbothane, Sofsole and Spenco have an orthotic function and will take more impact out of the foot when running, but they won't correct the gait.'
So, what's the next step?
Your GP can refer you to NHS podiatry services, however simple orthotic insoles are available from chiropodists, with more specialised appliances costing from £75 to several hundred pounds from clinics.
'I'd never say orthotics are the magic bullet,' says Costain, 'but very often they prove to be extremely helpful in a range of ways.'
And O'Neill argues that orthotic therapy will work only as part of a wider package.
'A person's mobility, stretching regime and muscle balance are all as important. Orthotics on their own won't work.'
Scan that reveals secrets of the sole
During gait analysis, a practitioner - usually a podiatrist, osteopath or chiropractor - takes a detailed medical history, including any specific complaints such as pain in the foot or elsewhere in the body. This is followed by a physical examination of the foot to check for any abnormalities.
'The GaitScan pad has thousands of pressure sensors linked to a computer which shows on a screen the distribution of pressure across the feet,' says Dr Roger Reid, a chiropractor at London's Body 4 Life Healthcare.
'Red shows most pressure, and blue the least. Pressure should be evenly distributed across the sole. The patient first stands still on the pad, where an uneven distribution of pressure could indicate a musculo-skeletal problem such as different leg lengths or misaligned hips.
'After this, the patient walks across the pad a number of times. Problems with pronation - the rotation of the foot - would show up as uneven pressure during this part of the scan.'
If needed, the scans, above, can be used alongside a mould of the foot which is sent to a specialist orthotic manufacturer that uses CadCam technology.
'This uses cameras and lasers to scan the surface of the mould and is the most accurate way of capturing the anatomy of the foot,' says Pat McGonigle, of Pegasus Orthoses, who create orthotics for Chelsea Football Club and the Royal Family.
'This is then used together with patient-specific information about sex, age, weight, height and medical problems, to create a 3-D computer model of an orthosis, which can then be manufactured.'
Running insoles cured my painful shins
Relief: Katharine Vile wears orthotics for high arches
Literary agent Katharine Vile began using orthoses after experiencing severe shin pain.
'I was suffering from soreness in the lower leg, and found I was in pain just standing up and walking. It was even stopping me wearing my favourite heels. I enjoy running but it got so bad in February this year that I had to stop exercising. Friends suggested I look at orthotics,' says the 38-year-old.
Katharine visited a physiotherapist who discovered that she had high arches, a common inherited condition in which the arch of the foot is higher than average, often requiring supporting insoles.
'High arches often mean the feet are very poor shock absorbers and they can lead to pain in the knee, lower back and the arches themselves,' says Simon Costain.
The orthosis is built up under the arch of the foot to help take the weight of each step as it is distributed through the foot. Treatment was simple - the physiotherapist prescribed orthoses to use in her running shoes. They cost about £70.
Katharine says she noticed an improvement almost immediately.
'Within a couple of days I could feel the difference. Now, when I'm standing, my feet are flat rather than falling in on themselves,' she says.
She was able to return to running and has found that she no longer suffers leg pain when wearing her everyday shoes.
'The physio suggested I should wear them in my other shoes.
'I like wearing high heels and I know it would help, but just wearing them in my running shoes has helped and the pain has gone, so I think I can get away with it.'
