Health
Best foot forward Print E-mail
Written by George Florence, 2008   
Many niggling foot problems, including bunions, can be dealt with successfully without resorting to surgery, advises podiatrist George Florence.

As a podiatrist I am aware that many women are unhappy with the look of their feet and want them to stop deforming. If they have already started to develop a bunion they are likely to want to do something to prevent it developing into a chronic condition.

But first, what is the difference between chiropody and podiatry? Chiropody is general foot care and maintenance and includes nail cutting and the paring of corns and callouses. Podiatry encompasses the study of biomechanics and the body in motion - how foot dysfunction can affect other parts of the body such as the ankles, knees, hips, and back and may cause postural problems.

There are many things that can be done to prevent foot problems, but if there already is some damage there is much that can be done by a podiatrist and physiotherapist to help before surgery is considered.

Bunions have a mechanical cause and not a physiological one, but most medical practitioners are inclined to treat the patient's symptoms with drugs, advising rest and blaming their shoes.

Treating symptoms may be helpful with acute pain in the short-term, but it is the source of the problem that should really be addressed long-term. Orthopaedic surgeons in the UK tend to have a narrow approach to their work, unlike their counterparts in North America.

Unfortunately in the UK, a woman consulting her GP with a foot-related problem can find herself being referred to a surgeon - unnecessarily.

The body is an amazingly sophisticated organism, coping well with our often hostile environment; and most people can actually go through life without a great deal of medical intervention.

Our feet were designed originally to walk over uneven, rocky surfaces, soft earth and sand but the problem with our modern environment is that the surfaces upon which we walk are nearly always perfectly flat.

Our shoes, while protecting the feet from injuries from sharp objects, also often prevent them moving naturally and deny the brain crucial information about the undulations of the ground. This all adds up to a situation where our bodies have to cope with, and compensate for, difficult and unnatural hard, flat surfaces. The resulting compensatory movement not only affects the feet but also the ankles, knees, hips and spine.

There are studies and anecdotal evidence that suggest the majority of hip and knee replacement patients have bunions and these are hard evidence that the body has had to cope with the excessive compensatory motion dictated by our modern environment.

There would appear to be no other reason why hip joints should wear out and need replacing in such numbers, particularly as most patients have been doing nothing more excessive than living a normal active life. In fact, you wonder how a relatively healthy, middle-aged woman could end up with such an appalling condition, which can severely affect the enjoyment of her everyday life.

Of course, shoes do have a part to play. Women's shoes in particular, can constrict the toes and high heels tend to redistribute body weight and degrade the condition of the Achilles tendon. For men, however, stiff-soled leather brogues or work boots can also be damaging over a period of time - perhaps they are not such 'sensible' shoes after all.   

But believe it or not, it is not all bad news. There is a lot that can be done by studying the body in motion (biomechanics). I believe it is important for someone attending my own practice to know exactly what is going on so that they can make an informed decision about how they want the treatment, and their life, to progress.

First, I explain that it is vital to forget all the horror stories they may have heard from their granny, their GP, whose armoury consists of prescribing anti-inflammatories, paracetamol, rest or "get on with it", or the ad in the Sunday newspaper that promises to cure the problem with a £19.95 shoe insert.

In the enlightened 21st century we should all be able to make an informed judgment about what we want from our bodies and what we can do to help them serve us. My patients' ages range from 8 to 80 and they take part in such diverse activities as running, shop working, fell walking or simply just walking the dog.

If anyone decides to wear four-inch heels most of the time that is fine, but they will have to deal with the consequences and should not be surprised if they end up crippled with bunions or worn-out hip joints. If, however, they wear what are considered to be good, low-heeled comfortable shoes or trainers and still have painful or distorted feet, then they owe it to themselves to find out why.

Very often, the excessive compensatory motion can be eliminated by wearing something in the shoes called orthoses but more commonly known as orthotics or insoles. These should not be considered as medical appliances but rather as beautifully-crafted, custom-made inner soles, made by an orthotic laboratory and not by a shoe manufacturer for thousands of people. Current custom-made orthotics can be made in various materials such as carbon fibre, EVA and high-grade polypropylene.

There are also, it has to be said, some off-the-shelf orthotics that are available from chemists or by mail order. These are usually made from softer materials than custom-made devices and are designed to provide comfort rather than proper control. No detailed advice is available at the point of sale and often do not have any effect - nor do they last longer than about six months.

Coping with dysfunctional feet is very debilitating and it does grind you down to the point where you feel old, when clearly you are not. It is not unusual for my clients to say that the proper treatment has been life-changing and many have put on hold their plans for surgery as a result of the reduction in pain and discomfort they had been experiencing.

A life transformed

In my practice I consider it essential to look at the whole body and how it moves. You never find a distorted foot without knock-on effects in the ankles, knees, hips, spine or associated muscles and tendons.

There are also often long-term and undiagnosed issues in the lower back resulting from accidents and falls, sometimes going back several years, which have affected the way someone now walks.

This is how one patient describes her treatment:

"The difference to my body since wearing my custom-made orthotics has been truly remarkable. I will tell anyone who is prepared to listen about the relief I now experience from the back, neck and hip pain that had dogged me for so long - not to mention the dramatic recovery of my big toenails that had fallen off but are now restored.

I first visited George in August 2006, seeking a second opinion on the diagnosis of a fungal infection in both of my big toenails. They had thickened, discoloured and, eventually, dropped off. I expected to leave the consultation room bearing a tube of ointment but instead was asked to stand while George looked at my feet and legs from the front, back and sideways.

First, he asked me to stand on one foot and then the other while he enquired about my footwear and lifestyle. Then, as I sat on a chair he asked if I had been experiencing any pain or discomfort in my legs and hips, and pressed various points on the soles of my feet.I was astonished to learn the niggling aches and pains in my legs and hips - which I had attributed to my over-enthusiasm at the gym and the approach of my 40th birthday, not to mention an old whiplash injury I had grown accustomed to living with - were all related to the poor posture I was suffering as a result of fallen arches. His diagnosis of trauma to my toenails caused by my malfunctioning feet made absolute sense.

The remedy - custom-made orthotics - has been successful. On the first day I wore my new insoles I felt as if I was two inches taller. My entire body was somehow more balanced and I could tell I was carrying myself better. I then experienced 24 hours when every muscle in my legs, arms and back seemed to ache, and I could not lift my right arm higher than my shoulder. Shortly afterwards, though, things settled down. 

I now feel like I have been given a new, younger body. I transfer my orthotics from one pair of shoes to another with something approaching religious fervour, and cannot believe that I never made the connection between my fallen arches, of which I had been aware for a couple of years or more, and the aching in my legs that I had borne so stoically."
CS, Coggeshall, Essex
 
George Florence is a chiropodist and podiatrist who can be contacted at www.topfootie.co.uk

Further information

Visit the website of The Society of Chiropodists and Podiatrists at www.feetforlife.org to find your nearest podiatrist and for advice on foot complaints call 020 7234 8620.
 
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