Tender Tootsies?

Consider the lowly foot, daily stuffed into a shoe and forgotten. Think about those two slender appendages, carrying your 150-or-so pounds uphill and down, over rough terrain and smooth, several thousand steps a day, with no complaint.

No complaint? Not everyone is so fortunate. Foot problems make life difficult for many. Foot pain can be debilitating. The underlying condition that causes the pain can also cause pain in the knees, hips and back.

Many who experience foot pain find relief in orthotic devices. Some people call them arch supports, but today’s orthotics are nothing like the mass-produced heel pads and arch supports of the past.

Dr. Jonathon Pattavina, D.P.M., defines an orthotic as a device that provides biomechanical control of the midtarsal and the subtaler joints in the foot. It is a bracing mechanism that corrects excessive pronation or supination. With pronation, the back of the heel does not line up with the body, but leans outward. With excessive supination, the arch remains high and the heel is tilted inward. Ankle, knee and hip joints will bear the stress of the misalignment. An orthotic makes standing and walking more comfortable and efficient by slightly altering the angle at which the foot strikes a surface.

Another cause of foot pain is plantar fasciitis. The plantar fascia is a band of connective tissue that stretches from the heel to the ball of the foot. With each step it stretches, then contracts. When the plantar fascia is overstretched or injured, it becomes inflamed, usually at the heel. It is the inflammation that causes the pain and anti-inflammatory agents can help. Rest, ice, taping and exercise can also help. But if the underlying structural condition remains, the relief will be temporary. Orthotics can be designed to lessen the stretch required.

We hear more about this condition today than in years past. Dr. Pattavina notes that running and other sports increase the prevalence of foot problems. The extra-light shoes designed to give a competitive edge in racing or golfing don’t give enough support or cushioning. He emphasizes the importance of wearing sturdy shoes. They should have an elevation of about one inch and should flex comfortably at the toes.

People are more aware of foot health now, he says, and many sports stores carry good-quality orthotics. For some people, these devices are helpful. But they are not custom made, specific to the structure of your foot, to address your biomechanical need. Evaluation by a qualified medical specialist will make sure that you get an orthotic designed for your foot problem.

An orthotist makes custom orthotics, based on a prescription from a podiatrist or other specialist. A cast is taken of the feet before the device is designed. Orthotics may be made of plastic or other materials. Dr. Pattavina prefers a graphite composite. Most custom-made devices will last for years and can be adjusted for slight changes in the foot. More substantial changes will require a new cast, a new prescription and new orthotics.

The American Podiatric Medical Association lists three types of orthotics. Rigid orthotic devices, described above, are designed to control function. They require little or no adjustment in shoe size. Soft orthotics, designed to absorb shock and improve balance, are made of a compressible material and may extend from the heel past the ball of the foot to include the toes. A slightly larger size of shoe may be needed. It is bulkier than the rigid orthotic and will need to be replaced periodically. Semi-rigid orthotics provide for balance of the foot while walking or participating in sports. It is usually constructed of layers of soft material, reinforced with more rigid material.

In addition, specialized orthotics can be designed for particular sports, by making a cast of the foot within the ski boot, ice skate boot or other boot or shoe.

Orthotics can be beneficial from early childhood to late life. Preventive orthotics are designed to correct gait problems for children as young as two years. Elders who have severe arthritis in the midtarsal joint may gain relief from pain and a more stable gait when they use a device to brace the foot.

“The foot is beautifully adapted for standing upright and walking,” says Dr. Pattavina. “But we subject our feet to a lot of abuse, from high impact sports to long hours of sitting at a desk.”

Jean Winnett of Concord admits that she has expected a lot from her feet. For several years, she led high-impact aerobic classes four nights a week, in addition to running on weekends. She has worn orthotics for 15 years. “I hate wearing orthotics,” she says. “I’d love to wear sleek dress shoes or lightweight running shoes and cool strap sandals in the summer. But without orthotics, I’d be in pain and I couldn’t do the things that I enjoy. They are worth the cost (about $500) and the bother.” NH