14/4/2008

Features

Cared-for feet take the burden off your body

The old song which goes “the toe bone’s connected to the foot bone, the foot bone’s connected to the leg bone...” contains more than just a basic description of how the skeleton is pieced together.

Dem Dry Bones also demonstrates how all these parts of the body are linked to each other. And at the bottom of this pile of bones are the feet.

Marcia Hammond is a podiatrist based at Mercury Biomechanics in North Camp, and it is her job to make sure feet and body are working in harmony.

It seems most of us have a less-than-ideal style of walking. When you consider that the average person takes at least 2,000 steps each day, it is hardly surprising that many of us suffer from aching feet, not to mention joint and postural problems.

Marcia likens the results to a concertina-style clothes dryer — if the bottom of the dryer is lop-sided, then the levels above will also be out of kilter.

“A podiatrist is educated to understand how the foot is constructed and how it works in relation to the rest of the body,” she said.

“Most people don’t realise how complex the gait process is and because the feet affect everything above them, something wrong in the foot can cause problems higher up the body.

“Runners, for example, can get pain in the knees related to an imbalance in the foot.”

Marcia explained that pronation is the part of the gait cycle when the foot turns slightly inward, but the majority of us are guilty of  spending too long in this phase and/or turning the foot in too much.

The popular Ugg-style boots show this tendency well, as many of them are clearly trodden down on the inside, with the wearer walking on the sheepskin rather than the sole.

The reason we do this has its origins in our evolution. The foot, with its raised arch, was designed by nature to walk on soft surfaces such as sand or soil which rise up to meet the instep, giving support.

Because we now walk on hard surfaces in shoes, this can’t happen and so the foot rolls inwards to compensate. It’s a subtle movement that occurs in the joints just below the ankle but its effects can be magnified.

“Excessive pronation can cause problems over time, which means that years of poor walking will eventually catch up with you as flexibility and the ability to repair tissue  starts to decrease with age,” said Marcia.

“The big toe is important in the gait cycle because as we step it bends and propels the body forwards. Pronation disrupts this process so the smaller toes have to carry too much of the body’s weight — something they are not designed to do.

“It can also cause the shin bones to twist leading to pain in the knees and hips, and even in the back and neck, as the joints higher up the body compensate, trying to keep the body in balance.”

Runners can be particularly vulnerable to damage because of the extra impact on joints during the running cycle, but problems are by no means restricted to athletes or older people.

“Children can have foot and leg problems,” continued Marcia. “And women after pregnancy may become more prone to damage as the ligaments throughout their bodies, which become more relaxed in preparation for childbirth, never fully regain their previous tension.”

Wearing the right shoes can go a long way in the prevention of aches and pains, but perhaps surprisingly, not all flat or so-called ‘sensible’ shoes can be good for the feet.

“The fashionable sheepskin boots, for example, give no support to the foot, and ballerina pumps, mules, flip-flops and court shoes can all cause the toes to ‘claw’ in order to keep them on,” said Marcia.

“This can result in bent toes which then rub on the inside of shoes leading to corns and calluses. Crocs, too, require this clawing if the heel strap isn’t worn, and because of the way they are designed, these shoes really don’t fit at all as they don’t touch any part of the foot.

“Footwear plays a large part in many people’s problems, and it is not just about wearing high heels. Men can suffer as much as women.

“These days, feet tend to be much broader at the front, yet shoes are narrower, and people tend to buy according to size rather than fit, whereas the opposite should be the case.

“As you get older, your feet become longer and wider as your arch lowers, so you might find you need a larger size than you used to take.

“When trying shoes, you should have a one centimetre gap between the longest toe and the end of the shoe, and you should go shopping for shoes in the afternoon, when your feet are slightly larger than in the morning.

“Buy shoes which give good support around the heel, and choose ones which fasten with straps or laces, as they won’t rely on grip to keep them on. But I wouldn’t say no to small heels — up to two inches high is fine.

“Of course, children should always have well fitting shoes to prevent their soft feet being moulded into an incorrect shape and to allow for growth.”

Although prevention is always better than cure, Marcia can offer help to those for whom damage has already occurred and this is mainly in the form of custom-made shoe insoles which support the foot and encourage a proper posture and gait.

To design the correct insole, Marcia first finds out in detail where and when the patient is experiencing pain before assessing their feet, joints and stance.

She then videos them walking on her treadmill so that their gait action can be scrutinised in slow motion.

If she decides insoles are necessary, she will then take appropriate foot measurements and she might also prescribe exercises to stretch or improve strength in specific areas. Alternatively, she may send the patient to a chiropractor or physiotherapist for more specific treatment.

“People are often asym-metrical in their conformation and the way they walk — for example, they might have one leg slightly longer than the other or feet of slightly different sizes — which means the insoles have to be tailor-made for each foot,” she said.

“The insoles will last for about two to ten years, depending on the patient’s weight and on how much walking they do.

“Most people have a structural problem and will have to wear insoles for the rest of their life but they soon become accustomed to them.

“I always give them a programme for their new insoles so they can build up their wearing time gradually.

“After years of walking incorrectly, there can be some discomfort at first as the body learns to adjust and I don’t want this to put people off the insoles by overdoing it.

“It usually takes about two weeks to get to full-time wearing.

“Even with insoles, looking after your feet doesn’t have to mean giving up fashionable shoes — just shop around for suitable ones. But please —save those four-inch killer heels for special occasions only.”

For more details, call 01252 545454 or visit www.mercurybiomechanics.com.

First printed in: The News and Mail Series