 |
 Podiatry is the modern term for
chiropody and
encompasses the care of all types of foot problems.
Many hospital units seeing children with JIA have a
podiatrist involved with the team and most local health
authorities have podiatrists who specialise in children’s
feet working in the local hospitals or health centres.
Why might we have to see a podiatrist?
The joints of the feet are often affected in
JIA.
The ankles, for example, become
swollen at some point during the disease
in up to 90% of children. When the joint
becomes inflamed, it often stiffens as well
and this immediately has an effect on walking. There are about 35 joints in each foot and any of
these joints may be affected by the disease. As with all
other joints when affected, the joints can become painful
and misshapen. It is the role of the podiatrist to try and
prevent the joints from altering, to improve the position if
deformities have already begun and to work with the
physiotherapist to improve the way a child walks. |
What sort of things can happen to the feet?
Two extremes of the ‘normal’ foot
position are seen in JIA.
1. The first - and more common - is a flatfoot
position.
Nearly all children have flat feet when they are young. The
term ‘flat feet is used to describe feet that have a low arch
and roll in at the ankles so that the heel
is tilted outwards.
With age, most peoples feet change shape by growing in
length and width and the arch also gets higher. If JIA
starts early in life, then the growth of the foot is altered
and the flat foot position may become fixed and doesn’t
improve with time. If the disease begins later when a good
foot position has already developed, then the inflammation may cause the ligaments to stretch, allowing the feet
to flatten out when you stand-up. Over time this position
becomes fixed. As the arch begins to lower with the foot
flattening, the stress is placed on the inside edge of the
foot and ankle, causing discomfort. This position can also
lead to overloading of the big toes and so conditions such
as bunions (Hallux Valgus) begin. Walking with flat feet
can be difficult as the foot has no strength in this position.
2. The other foot position that is seen is the highly arched
foot. This foot has a high instep and often a
slight bend
to
the front of the foot bringing the toes to face inwards. This
foot position often leads to clawing of the small toes and is
a rigid foot which absorbs very little shock during walking.
The outside ankle joint ligaments are
stressed in this foot
type and ankle sprains may occur more often.
Nobody really knows why the foot becomes
misshapen but part of the reason may be due to the
way that the disease affects growth of bone. If growth
within an individual bone is uneven, then the joint surface
may not be level and the neighbouring bones can slide
into abnormal positions.
Will the walking be affected if other joints in
the legs are inflamed?
When the knees are affected in JIA, a knocked-knees
position sometimes results. This position can cause the
feet to become more flatfooted since the body weight falls
between the feet, which are wider apart than usual. The
knee is also an area where a lot of growth occurs and if
one knee is affected more than the other then the growth
in that leg may also be altered. The feet themselves often
take up a new position in response to changes in other
joints in the leg. This is called ‘compensation’ and occurs
in response to the way body weight has to be balanced.
What treatment does a podiatrist provide?
The role of the podiatrist is to prevent and control the
development of foot deformities and to improve walking
posture. Foot deformities are usually treated with insoles (orthoses). These are made by firstly taking a model
of
the foot. Wet plaster of Paris is wrapped around the foot
and the foot is held in a corrected position. After 3 or 4
minutes the plaster hardens and the cast can be
removed. This is then used as a model on which a plastic
or rubber insole is made.
The insole is placed in the shoe and so holds the foot
in a better position during walking. When the legs have
grown to different lengths, the podiatrist will often add an
extra sole to the shoe of the short leg in order to balance
the pelvis. If the ankles are stiff, a rounded sole (rocker)
may be added to the shoes to make the foot roll forwards
better.
The podiatrist will also deal with any corns or
callosities that may develop when the skin is subjected to
high pressures.
Is there a particular style of shoe that can
help my feet and walking?
Boots are often recommended because the higher sides
gives greater support to the ankles. Shoes or boots
should have a firm heel counter so that the heel is well
supported in a vertical position. Ideally the shoes should
If a podiatrist is not attached to the unit you visit, then the
hospital may have somebody that covers several units or
a podiatrist may visit your GP surgery. All podiatrists
working within the NHS are state registered. If you arrange
to see a podiatrist in a private capacity, always check that
they are state registered look for the initials SRCh.
