A US survey of patients attending GPs found overwhelmingly foot pain was one of the main reasons why people consulted their physician. Previous guesstimates prefer about one third of population (any age and any stage) will sometime in their life require the services of professional foot care. Despite the presence of foot physicians i.e. podiatrists, only a third of the foot challenged seek professional help with the vast majority preferring to self-medicate or go elsewhere for care. This is what makes the above study so interesting. If foot pain is so endemic within our population then could it be, by ignoring this foot pain epidemic we tread a dangerous and expensive path for our future?
In the Western World as the general population ages and systemic disease such as diabetes mellitus, peripheral vascular diseases and arthropathy impact on our health, foot problems become rather more important. In many cases early symptoms of systemic disease can be picked up with mild foot discomfort. After all we walk on them and in an average life span will tramp around the circumference of the works, three and a half times. We certainly cannot pick them up and put them in our pocket when they are sore or wear them on out head where they could look beautiful but have no other function.
Foot pain can be broken into four categories; infections such as bacterial, fungal and viral (warts) superimpose themselves on perfectly healthy feet. These are often acute infections, and in the main, respond to treatments in a predictable manner. Pathomechanics of the leg and foot contribute to many aches and pains from the tip of the toes to the top of our heads. Usually chronic and repetitive, faulty mechanisms caused by twisted bones and misaligned joints present with symptoms in both the young and old. The vast majority is mild but conditions apply. Just ask anyone who continually wear shoes down for no obvious reason.
Relief of symptoms varies from the miraculous to no appreciable difference. Foot orthoses (aka arch supports) have become popular and at best alleviate symptoms, at worse they make no difference and provided they do not feel uncomfortable, and then by some quasi logic, they must be effective. Scientific evidence to support their use remains scant but anecdotal claims of efficacious outcomes are significant and universal. Currently foot orthoses are available either bespoke or over the counter. They come in two forms. Accommodative foot orthoses (simple insoles) rely on material properties to accommodate the foot from the rigors of friction, impact and pressure.
Functional foot orthoses are usually made in harder plastics and nestle against the heel and forefoot, within the shoe. There are many variations on this theme but in essence the purpose of the shell is to cradle the heel and/or balance the forefoot with the heel during specific phases of walking. Rule of toe, functional foot orthoses are more expensive but not always more effective than accommodative devices. Prescribed foot appliances from surgical shoemakers or podiatrists will invariably incorporate both accommodative and functional capability.
Conventional wisdom would prefer well-fitting shoes appropriate to the activity of its owner as the ultimate foot orthoses. Traumatic injury to the foot is certainly common, presenting as either chronic recalcitrant foot strain, or acute wounding. Outcome of treatments vary with severity but in the main are episodic not requiring lifelong treatment. Care in prevention forms a major part of the physician’s role and empowering the foot weary to ‘take care of their pair’ is an effective outcome in many cases. Corns and callus account for approximately one fifth of reported foot problems.