Mary Moore often has clients turning up at her door with a bag of orthotics they’ve bought over several years in an attempt to eliminate foot pain.
Mary is a podiatrist specialising in foot mechanics and is based in Dublin.
“They will have bought these orthotics in various places, and they may have been some help, but not totally resolved whatever pain issue they are having,” she says.
Her advice, therefore, is to get a diagnosis from a podiatrist first, rather than hope that a particular orthotic – off-the-shelf or otherwise – will solve the problem.
“You can be lucky and what you buy can be beneficial, but in other cases they may not be and you may have spent a lot of money – so it can be an expensive lesson,” she says.
“The value you get depends on the knowledge of the assessor. I’d be saying, ‘Let’s get a diagnosis’ and really understand what’s wrong, what needs to be improved with your feet or your pain and then make the orthotic work for that.”
Mary worked in St James’s Hospital for 16 years as a diabetic podiatrist, where she saw the importance of good foot care in preventing mechanical pain, injury or ulceration. She has since gone on to open two foot mechanics clinics: one in Glasnevin and one in Donnybrook.
She points out a podiatrist’s four-year degree is based on the study of foot mechanics.
“As part of that training, we have to make orthotics from scratch so you have to understand the anatomy of the foot, the person’s pain issues and the shapes and densities of material available for orthotics.”
A detailed history is taken, the person’s foot and gait are studied and the person’s goals are understood.
“You need functional tests to break down how the person walks and each part of the sequence of walking, as well as standing,” she says, “to let us know what is going to work best for the feet.”
Options for orthotics and/or strengthening exercises are then discussed, and also shoes and how they are going to work with orthotics (if prescribed).
“The important thing to remember is that orthotics are a tool,” Mary says.
“They are not a panacea, but a properly prescribed orthotic can be very helpful in the right settings. The prescription should, of course, match the person.”
Off-the-shelf v custom-made
Off-the-shelf pre-made orthotics are available, as are custom-made (tailored) ones.
“There are made-to-measure orthotics, specific to the individual, and then there are orthotics made with certain foot conditions in mind and certain foot types in mind,” Mary explains.
“I would use a combination of both pre-made and made-to-measure, and I find the pre-made ones can give wonderful results in the right cases.
“For example, there are some really cost effective orthotics for foot arthritis that I’ve had wonderful results from and they cost €50. Those people don’t need to have a pair that’s made to measure at €300.
“Then, there will be other foot shapes or restraints with footwear that the made-to-measure ones are best suited to,” she continues.
“It all comes back to the clinician having that general understanding about materials, forces and what you are trying to achieve with the orthotic. You could buy the wrong one and make the problem worse.
“One type of orthotic won’t suit every foot; it is very specific. As clinicians, we talk about the ‘dose’ of the orthotic – the prescription – the shape, the different materials used and their properties and densities.”
Painful bunions – an orthotic could be made that would have a lift under the metatarsal heads (the balls of the foot you push off when you walk) to deviate pressure away from the pain.
Feet rolling in too much; causing pain in knees, shins or into the foot arch – firmer material would be used at the arch to stop this happening.
Preventing ulcers in those with diabetes – orthotics can be used to rebalance the foot away from the sore part.
Arthritis – different components within the orthotic can be used to move pressure away from the part of the joint which is limited in movement.
Gillian Walker is a chartered physiotherapist and foot specialist based in Cornelscourt, Co Dublin. Like Mary, she also sees clients arriving with a bag of orthotics in hand.
“I say, ‘Yes, but are they the right orthotics?’” she says.
She sums up her approach to foot pain. “When it comes to foot, ankle and heel (pain or problems) you have to look at the whole chain (the upper body – knee, hip and spine also). You then have to rehab it carefully – mobilise the joints and stretch and strengthen the muscles where necessary, and when you provide an insole it has to be fitted into the right shoes.
“Unfortunately, what happens is that some people get the insole and they don’t get the other bits of the jigsaw (the assessment and exercises).”
Her description of orthotics is that they improve the relationship of the foot to both the shoe and the ground and facilitate a better gait pattern.
“You can use them to alter the pressure patterns and allow the foot to shock absorb better.”
High arch issue
If a person has high arches, it means their feet can’t flatten over when they strike the ground.
“This may lead to pain in the ankle, knees, hips or spine,” Gillian explains. “That’s because they are not transferring those rotational forces through their foot as they step forward.”
Flat feet consequences
For most people, however, the issue is that the foot flattens too much when they strike the ground.
“When they do that, the leg turns in as you flatten the foot and you also lower the profile at the hip,” she continues. “You actually flatten for too long and the foot ends up being a loose bag of bones, so when you go to step off the foot, you haven’t regained your stability.
“Those people tend to get a lot of problems, usually within the foot, because the foot is unstable and the muscles are working in the wrong phases, working too hard and the joints are all open and loose for too long (as you take each step).
“Those people will get acquired adult flat foot (tibialis posterior strains), problems with bunions and hallux limitus and mid-foot pains because they’ve opened up the foot to absorb shock but they’ve kept it open instead of stabilising it again.”
Gillian explains how the foot – which she says is an amazing piece of engineering – has to be two things: a mobile adapter for the first phase (of stepping) and a stabiliser for propulsion.
Following a comprehensive assessment of gait, posture, flexibility, balance, foot function and structure and more, her treatment plan can involve three options:
1 Rehab, which may involve mobilisation of a joint, stretching, strengthening exercises and conditioning of muscles over a period of weeks
2 Better shoes. Sometimes a supportive shoe can reduce tissue stress and make the pain issue settle down.
3 Orthotic – this can vary from a heel raise to a custom made orthotic, if prescribed. Off-the-shelf orthotics can be supplied immediately and modified by physiotherapists over time as the person’s foot and leg muscles strengthen.
Conor Murphy (left) milked cows for 35 years in Duncannon, Co Wexford, before injury forced him to change career.
“I had knee and shoulder operations,” he says. “I was in a lot of pain and taking painkillers and sleeping tablets to get four hours sleep. In my early 50s I thought there had to be more to life than that so a career change was needed. I wasn’t interested in third-level education and manual labour was out, so being familiar with specialised shoes and orthotics through my partner Nancy, I thought that would be the way to go.
“I had also worn orthotics/arch supports myself since the late 1990s, so I had some knowledge of the benefits proper support orthotics gave.
“Early in 2017, I did a course on foot scanning in the Netherlands with a company that is one of the largest orthotics and specialist shoe manufacturers in the US. Then, I spent nine months working alongside Nancy in her Wexford shop, learning the skills of the trade in fitting shoes on customers with problem feet. On 7 December 2018, I opened All About Feet in Gorey, where I sell several brands of shoes designed by podiatrists which can be wide fitting with a mixture of leather, and have a micro fibre top to be suitable for diabetics, as well as for people with bunions or hammertoes. The shoes will also accommodate orthotics to help with foot problems, like plantar fasciitis (heel pain).
“Wearing good supportive, comfortable shoes is very important. Shoes lacking the proper support can affect people’s balance and posture which in turn can lead to joint pain and falls. A good supporting shoe and orthotics will help keep people’s ankles, knees and hips in alignment and will lower joint/back pain.”
Conor says the most common problems people come into his shop with are plantar fasciitis, knee, hip and lower back pain.
“As part of the initial evaluation, customers have their feet scanned on the machine and this tells us the alignment of the plantar arch and where the pressure is on the customer’s feet,” he explains.
“The machine recommends the orthotics which will give the optimal arch support for each customer from the full range of off-the-shelf orthotics for all the different feet and arch types that I carry.
“I’d have a lot of customers who are farmers, too,” he adds. “Farmers often benefit from orthotics because they wear wellington boots, which offer little support. With long working hours and heavy manual labour, farmers can suffer a lot of foot, leg and back pain. Orthotics, in my experience, can support the feet, reduce lower joint and back pain and increase comfort.”
To find a registered podiatrist or chartered physiotherapist, see: