Orthotics - a useful treatment for foot pain

As a physiotherapist with EM I am amazed at the number of people whose first presentation of Em was foot pain - myself included as I was fairly convinced I had had some sort of acute arthritis developing, both feet were really sore underneath and generally puffy. The classic red of Em was not a feature at this point.

It seems that another popular presentation is plantar fascitis,with a pain under the foot from the heel to the pads of the toes. Ankle injury and even gout like symptoms have been mentioned.

In most cases that I have read on the site ,the pain seems to be quite acute and have immediate impact on walking.

This is a really important point in that I think you can effect your ultimate EM outcome. At this stage it seems that for many the foot pain is accompanied by some swelling and extreme touch sensitivity. Unchecked there is a danger that this becomes an entrenched cycle with awkward gait patterns ie limping,and avoiding touch will reinforce the already pathological nerve impulses. This can lead down the path of Chronic Reflex Pain Synndrome, were sensation is so disordered that everything s felt as pain. This becomes a cycle that feeds on itself and can spread further through the body and even cause physical manifestations such as muscle atrophy and contractures.

Orthotics can be a vital tool in restoring a normal gait pattern, and avoiding a limp can avoid setting up bad feedack loops of pain. It is important that the brain gets normal feedback from the feet from a regular gait otherwise the faulty feedback patterns of CRPS can be given a start.Also the less foot pain the fewer flares.

I visited a podiatrist who made me a thin rigid orthotic that had strategic padding. In my case padding was just before the pads of my toes ,to shift the worst pressure off them so I could roll my foot from heel to toe when walking. It took a bit of faffing about to get the padding in the right position.

The ideal is to allow walking wiIth as little discomfort as possible and they certainly worked for me and after about 6 months I have not needed them. MYy ability to stand is still limited by EM just not additioal foot pain .Some may need orthotics permanently , but you will probably like them if they offer relief!!

Trying to minimise swelling is also important in pain management :especially of the foot as it has so many small tightly ligamentous joints that don’t tolerate stretching well. Elevation is good , walking in a pool is fantastic ,cautious epsom salt foot baths useful,and cautious cooling of the foot . The latter methods are under icing post ,which you really should read for some parameters and also check with your doctor. I suggest telling the doctor exactly what you intend eg epsom salt foot bath three times daily no longer than 20min at a time.
Gentle , very light massage is also useful in reducing swelling under the foot and as desensitisation.
For the ladies an alternative may be shoes with a rocker bottom,you know the ones that have a rigid sole ,often a slight platform with the front part of sole sloping up.You can rock the whole shoe back and forth. These can be great as the rocking action tips over the metatarsil heads or pads of toes and takes the pressure off-seem to have plenty of styles in ordinary shops!!
If you cannot afford a podiatrist, pharmacies have a good range of pre-made orthotics that are really quite good. Dont go for anything to hard or maybe get the stick on teardrop shaped pad and experiment on placement in shoes. These soft teardop pads should sit with the broadest bit just behind toe pads, and the point into the arch of the foot diresting toward the little toe side . You will need to do a quick tape ontno sandal and stand and rock to see if it feels right (takes a few goes) then mark sandal with a pen ,peel off pad backing and attach permanently.
Good luck and do consider orthotics or padding ,
as of course the less foot pain the fewer flares - Tizzy

Thank you for sharing this Tizzy. I am glad it has helped you so much. I’m not sure how much help this would be for me personally as I rarely wear shoes but I can definitely see it being of some help to many.
Take care,