A Brief insight into Podiatric Bio-Mechanics

Podiatric bio-mechanics provides a system by which the cause of a symptom(s) can be pinpointed and correction applied, when the origin of the symptom lies in the structure or function of the foot or ankle. It is now widely acknowledged that the symptom may not be restricted to the foot and ankle but may extend as far as the lower back. Although there may be debate over the cause of a pain (symptom), it is usually possible for us to make our evaluation using measurements of the structure and by assessing, qualitatively, the joint action of the lower limbs, in order to either remain in the debate or leave it. Put simply, if the structure is correct and if it works normally, treatment of the symptom should be re-directed.

Certain clues indicate when the structure, or its function, is likely to be unsound. The structural and functional condition can be measured and correction or protection then prescribed, as the case deserves. Therefore the viability of Podiatric Bio-mechanics is usually a clear cut issue.

Podiatric bio-mechanics is the route to the solution of many lower limb and often lower back problems, particularly when it seems that all else has failed.

Note 1 It is worth remembering that symptoms caused by bio-mechanical inconsistencies generally have only a bio-mechanical solution, other solutions tend to be either temporary or to mask the problem by relying upon pain control.

The lower limb structure is subject to a high rate of structural change during growth. For this reason until approximately age eight years podiatric intervention using orthotic devices is normally inappropriate except when applied by a paediatric specialist. Beyond this age positive results may still be achieved through an exercise routine, however in certain cases the careful use of prescribed orthotic shoe inserts will be appropriate. It is clear that in early life a regime of high activity and physical exertion is good preparation for strong leg muscle development and it is the muscles not only of the foot but of the lower leg which support the structure of the foot and ankle so well. However:

Note 2 Reliance upon muscle development in order to correct a structural abnormality may; upset the natural balance of the associated muscle structure, may revert to the original state if the routine is relaxed, may revert with increasing age and, on balance, may be more troublesome than the application of simple structural correction.

There is no upper age limit to the beneficial use of orthotic insoles, but certain types may be deemed unsuitable for feet which have been placed "at risk" by underlying medical conditions.

The use of orthotic devices in sport is growing apace as awareness of bio-mechanical function slowly takes its place. Those indulging in extreme competitive effort are increasingly addressing the questions surrounding the issues of “self protection”, “over-use”, the age effect and the need to resolve that niggly little problem. The tiring mantra that physiotherapy is the solution to all sporting aches and pains is finally and rightly, being tested.

Typical In-Shoe Orthotic Solutions

Following is a list of some of the more easily observed problems producing symptoms which may be successfully treated with in-shoe orthotic devices. This list is by no means complete since a number of conditions exist which cannot be observed or otherwise perceived except by examination.

  • Flat Feet - Inner arches low or collapsed
  • High arched Feet
  • Feet angled Toe Outwards in stance or gait
  • Feet angled Toe In
  • Tibia or genu Varum (Bandy legs)
  • Tibia or genu Valgum (Knock knees)
  • Pronating Ankles - usually accompanied by foot rolling inwards & inner ankle bone prominence
  • Ligamentous Laxity - Joints are loose, with a greater than normal range, often referred to as “double joints”
  • Heel pain - Fasciitis

Symptoms Often Resolved with Orthotics

Following is a list of frequently encountered symptoms caused by foot/ankle structural or functional abnormalities, which may respond to treatment with orthotic devices. Again this is not a complete listing but it should be noted that any symptoms occurring along with any red starred items above will strongly indicate a podiatric bio-mechanical issue.

  • Flat Feet - Inner arches low or collapsed
  • Miscellaneous fore-foot discomfort - including the toes and the flexible joints behind the toes. METATARSALGIA, NEUROMA, CAPSULITIS, TOE CLAWING
  • Main arch pain
  • Upper surface discomfort
  • Pain on the outer border of the foot including CUBOIDAL SYNDROME
  • Heel pain - either under the middle or the border of the heel- PLANTAR FASCIITIS, BURSITIS, TENDONITIS
  • Ankle pain
  • Achilles Tendon tenderness - ACHILLES TENDONITIS
  • Shin splints
  • Knee discomfort
  • Leg fatigue and early discomfort during or after exercise
  • Lower back ache during prolonged standing or especially shop browsing
  • Lower limb discomfort at night **

** Leg pains can indicate serious issues e.g. deep vein thrombosis, and therefore may be referred to the GP