The heart of podiatric foot health management revolves around insoles, inlays, appliances or orthotics. These are some of the terms that we use. The older generic ‘arch’ support is mystifying but does not lift the arch per se but influences foot motion and stability. Moving aside from this I want to touch on appropriate use of orthoses in my piece this week due to the fact that many patients see podiatrists, in some cases physiotherapists and chiropractors, and fail to get on with their shoe inserts. When failure happens or it might be the fact that foot pain is not relieved, then a different prescription or design may not be the answer if the foot concern is not dealt with first. Podiatric pain management aims to diagnose, confirm and plan foot health care in line with proven stages of care. This means without a diagnosis one might not know how well anything will fare. I offer two golden rules to both podiatrists and patients. (1) If an orthosis fails, do not throw it away but clarify a diagnosis from a podiatric or an orthopaedic foot surgical specialist. These are dedicated specialists with access to wider diagnostic methods. Keep the orthoses and see if it can be used later. (2) The second rule is that orthoses may make matters worse initially as they are not a panacea. Chronic pain, which can reach acute levels of symptoms should not be treated first with orthoses. Clinicians work to pathways of care and as such, orthoses may be required lower down the order of priorities. Examples include:
- Heel pain present for more than three months.
- Acute corns with underlying deep tissue involvement
- Inflamed joints including gout
- Midfoot pain including synovitis
- Painful bunions and other lesser toe joints
- Irritated hammer toes
- Morton’s neuroma (nerve)
- Fasciitis (pronounced fash –ee-itis)
Remember an insert fills the shoe up and can add to pain and existing swelling. For information on orthoses check Education Information or if you are a patient please use Treatment Centre and use the password provided found in my introductory leaflet when you attended clinic. The use of orthoses have their place so it is not wrong to use them but a little care is needed to reap the full benefit. Ask your podiatrist or doctor first if you are unsure.