5 Reasons You May Not Need A Podiatrist To Prescribe Your Custom Orthotics

Podiatrists Are Not The Only Profession Who Understand Feet.

Podiatrists have extended training in the anatomy and function of the foot. A podiatrist in order to qualify, must study extensively to receive a bachelor’s degree which can be done at Universities all over the developed world. Podiatry is an extremely well established profession, and rightly so. If you have an ingrown toenail or some other foot specific complaint you should definitely consult a good podiatrist.

The truth is that there is a lot more to mechanical problems with the feet than ingrown toenails and there is a lot more to biomechanics than podiatry. Many of the most serious issues that can arise from mechanical issues with the feet are musculoskeletal in nature, and many are problems that manifest in the ankles, knee, hip and spine. This means that you could have flat feet for example, and this be the cause of your stubborn lower back pain; and yes you can have that issue without having had a days foot pain in your life. As another example, you can have a history of severe ankle sprains and the primary cause be high arches or some other issue with your feet.

In these instances, where you may have a musculoskeletal complaint that is being caused by your feet you are in an area where you may need a professional who best understands the connections between the feet and biomechanics in the rest of the body. This person could most definitely be a podiatrist, but similarly a good physiotherapist, sports doctor, chiropractor or osteopath may be the right fit for you. Podiatrists are well trained to deal with foot problems but they are not the ‘keepers of knowledge’ when it comes to foot pain, ankle pain, knee pain, hip pain, back pain and how all those issues can fit together.

The Feet Connect To The Spine

A huge number of you have back pain and mechanical spinal issues that are caused directly by what happens when your feet contact hard surfaces. 

We generally use the term ‘posture’ to describe what we do with our upper bodies in a sitting or standing position. The broader and wider story of posture extends from the top of your head down to the tip of your toes. Needless to say the spine plays a major part in all this, and hopefully also it should be pretty obvious that the feet and the spine are profoundly connected. 

podiatry, feet, spine

The human spine connects profoundly with the mechanical issues in the feet traditionally treated by podiatrists.

The arch of the foot can drop and collapse in exactly the same way that our shoulders can drop forward when our ‘posture’ slumps. The knee and hip can also ‘collapse’ inward in their own way that is the exact equivalent to bad sitting posture. All these postural abnormalities occur most commonly in the lower body during standing, walking and running. When these changes do occur it has a profound effect on the spine. 

Chiropractors understand the mechanics of the spine and what it takes to maintain healthy spinal mechanics better than anyone. Chiropractors are also trained extensively in the anatomy and physiology of all the bodies joints, muscles, nerves and connective tissues. This means that in many ways chiropractors are ideally placed to assist people whos feet issues are affecting their spines. This applies in the same way podiatrists are excellent at treating people whos feet issues are generating foot pain.

Having your orthotics prescribed by a chiropractor as opposed to a podiatrist may be the best choice if part of the problem being caused by your feet is back pain. If your chiropractor is a European style chiropractor they should also be able to help you with any other joint issues you may have from your ankle through to your knees and hips 

The Feet Connect To Sports Injuries

The alignment of your foot when you bear weight is a major building block of your quality of life. If your arches collapse when you walk for example it can cause major trauma to your feet, ankles, shins, knees,hips and spine. This damage occurs over millions and millions of steps taken for every year that we live, and can happen extremely quietly without our realising.. until something happens. 

Staying with the arches collapsing example, what this does over time is it weakens and predisposes the tissues to injury. In much the same way narrowing of an artery predisposes to heart attacks, weakening of soft tissues predisposes us to sports injuries. 

physiotherapy and custom orthotics

Foot issues can cause the sports injuries most commonly treated by physiotherapists as opposed to podiatrists.

In the overwhelming majority of ankle sprains for example, there has been some weakening in the ankle ligaments caused by mechanical issues with the feet. Some people notice a sense of weakness, discomfort or ankle pain prior to their first ankle sprain. Unfortunately however, there is often no warning whatsoever about this, and the first sign of trouble is a serious sprain that occurs during some sport or activity. This story also often applies to knee injuries, hip pain and back injuries. 

What all this means then is that issues with the feet are as much a part of physiotherapy as they are a part of podiatry. Podiatrists know a great deal of valuable information about the feet themselves but it is physiotherapy that specialises more in sports injuries. Working with a physiotherapist as a opposed to a podiatrist to design rehabilitation and custom orthotics might be the perfect option for you. A deeper understanding of how injuries throughout the lower body relate to the feet is likely to be of great value if you are looking to prevent recurrence of injuries in the longer term. 

Your Feet Might Have Scar Tissue

Scar tissue is a major part of how your body actions repair, in fact it is the final phase of repair that the body must completely in order to fully resolve trauma. Scar tissue is a far more complex and common issue than most people realise. 

If you have been striking with the wrong part of your heel, if you have flat feet or even if you have unusually high arches you are very likely to develop scar tissue in your feet over time. It is obviously a well known fact that you can develop scar tissue after a major injury, you can also develop scar tissue in relation to chronic repetitive strain in the body too however. 

to illustrate scar tissue which is not traditionally treated by podiatrists

Scar tissue in the foot is usually not treated by podiatrists.

Have you or anyone you know ever tried to wear orthotics or insoles and found that you had more pain as a result? If so, this was almost certainly caused by scar tissue. If you have stubborn knots or scar tissues that have developed in your feet over time they can cause foot pain (that’s pretty much what plantar fasciitis is). This kind of scar tissue is very sensitive to change, and one the things it can grumble about most of all is new orthotics. This can lead to the most expensive and ironic pains of all…. the pain my expensive new orthotics caused me. 

Traditionally (and I am sure there are exceptions) podiatrists do not manage or treat scar tissue. This narrative is not part of the traditional podiatrists training. This fact makes itself known in my office on a weekly basis when I am talking to people about why their custom orthotics ended up in a drawer because they just made their pain worse. These people having been prescribed orthotics by their podiatrist and discovered that their pain was worse due to scar tissue that had not been treated.

The sad thing is that scar tissue of this type is extremely easy to treat if you know how. By using scraping tools on the feet you can over time easily break down the scar tissue that causes increased pain from custom orthotics. In many cases this means that the orthotics can be worn in complete comfort leaving you the patient free to enjoy their benefits. This job is so simple when you know how it could be done by any physiotherapist, chiropractor, podiatrist, acupuncturist or osteopath. Combining this kind of treatment with orthotic prescription greatly increases the number of successes that come from custom orthotic prescription. 

Gait Analysis Reveals All

Gait analysis is a high tech movement scan of what the foot does when you walk and run. X Rays and MRI scans are obviously hugely important technologies, the problem for most of us however is that our pain relates to movement not medical conditions. Using plaster cast impressions of the feet to make custom orthotics like traditional podiatrists do is useful but it also looks only at the structure of the foot and not how it moves. This is where movement scans like gait analysis come into play. 

Creating a clear picture of the way a person heel strikes, transitions weight to their mid-foot and propels themselves forward with their forefoot is essential if you really want to understand their pain. If you have a clear picture of this you will not only understand their foot pain, you will usually also understand their back pain, hip pain, knee pain and ankle issues. In a sense this is where technology takes over from humans.

In the same way a car can get you somewhere quicker than anyone can get there on foot Gaitscan does the same for your understanding of lower body pain. What this means is that you don’t need to be a podiatrist to do this job, because to some degree the computer does it better than any human can. There is obviously a great deal of knowledge of biomechanics required to make use of the information but podiatrists are not the keepers of that knowledge. This is knowledge held by all good physiotherapists, chiropractors and osteopaths and of course podiatrists. 


2 replies
  1. James Borst
    James Borst says:

    It is interesting that you may build scar tissue over time if you have flat feet or high arches. My wife has talked about foot pain for the last couple of years and we’ve considered taking her to a professional. We may consider looking at different sport medicine practitioners to see what they recommend.


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