My feet were such agony I got married in my wellies… but why are prescription shoes so ill-fitting and ugly to boot
23:24 GMT, 11 June 2012
'I am expected to wear an orthotic insert to enable me to walk more easily – but I can't find shoes that fit,' said Sally Underwood
Sally Underwood has a cupboard full of shoes she never wears.
Yet she’s not a fickle shopaholic — she simply can’t find a shoe to fit.
Last year, she wore cream wellies for her wedding.
Day-to-day, she lives in a pair of worn-out boots.
Since she was 15, Sally has suffered from rheumatoid arthritis, where the body’s immune system attacks the joints.
Like nine out of ten of the 400,000 Britons with the condition, she has disabling foot pain and deformity.
And, also like most sufferers, she’s been given orthotic insoles — custom-made supports for shoes. The problem is, they won’t fit in a single pair.
Orthotics is the standard treatment, not just for rheumatoid arthritis but also for hundreds of thousands of people with diabetes, polio or neurological disorders such as multiple sclerosis, who often suffer severe problems with their feet.
But studies show most patients find orthotics no help at all with mobility.
Also, the insoles require deeper and wider footwear than usual — often in the form of prescription shoes. But these are so ugly and uncomfortable that many people can’t bring themselves to wear them.
Some experts describe the situation as scandalous.
And Sally, 36, a knitwear designer from Hastings, says: ‘It’s taken me a long time to manage my symptoms, but at last I’ve got a life that works.
'Or at least it would if I could only get my feet sorted out.
'I am expected to wear an orthotic insert to enable me to walk more easily — but I can’t find shoes that fit.’
The damage to her feet is typical of rheumatoid arthritis. On her right foot she has a large bunion and badly deformed toes that veer out at angles, beyond the side of her foot.
Properly fitting footwear doesn’t just help their mobility, it can stop further degeneration.
According to the Department of Health in 2004, for every 1 spent on orthotic services, the NHS saves 4 by preventing the need to treat the damage that would otherwise occur.
Last year, Sally wore cream wellies for her wedding. Day-to-day, she lives in a pair of worn-out boots
Yet a report from Arthritis Research UK, revealed today exclusively in the Mail, has found fewer than half of people with rheumatoid-arthritis foot problems believe their insoles are a useful aid to mobility.
Eight out of ten have problems with their prescription shoes. These are normally from a selection of prefabricated ‘stock’ shoes.
In severe cases they’re tailor-made. The shoes are expensive (200 to 700), but at least one in three people find them so ugly, heavy and large, they discard them immediately or soon after getting them.
What’s more, the insoles — which often arrive by post following a brief consultation months earlier — frequently don’t fit prescription shoes or indeed other shoes the patients want to wear.
There are calls for the shoe-designs to be more attractive, particularly for women.
Dr Lynne Goodacre, senior lecturer in long-term conditions at the University of Central Lancashire, says: ‘The limited choice can have a huge impact on self-image and a woman’s ability to present herself how she wants to.’
Sally didn’t even try on prescription shoes when she started having problems at the age of 22.
She says: ‘After being shown the shoes, I refused. They were intensely ugly and huge.
'The orthotics were minimal and I found shoes to accommodate them. But as my feet deteriorated, the orthotics got larger.
‘Now getting shoes that fit is a nightmare. It was such a relief to find wellies for my wedding.
'Now getting shoes that fit is a nightmare,' said Sally
‘My last success, a pair of Timberland boots, are nearly worn out — and they don’t have laces so they’re not giving me the support I need.
'As a result, I’ve got corns under my feet due to the build-up of pressure.
‘My husband, Scott, is getting used to the fact I walk very, very slowly.
'Sometimes the only way I can move is to balance on the outside of my feet.’
Sally is also facing delays in getting new orthotics for the latest deterioration.
‘My current one causes pain in my hip but I’ve been waiting since March.’
So what’s going wrong Dr Anita Williams, senior lecturer at the University of Salford’s Directorate of Prosthetics, Orthotics and Podiatry, says: ‘Specialists frequently fail to consider foot problems, focusing on diagnosis and medication for the condition as whole. But feet can deteriorate as the conditions progress.
‘When people finally get asked about their feet by their GP or consultant, they often already have irreversible damage.’
Another issue is that patients often fail to get the basic assessment to ensure their orthotics fit.
Dr Williams says: ‘The foot’s range of motion should always be measured, normally with video gait-analysis technology.
‘Frequently, however, the sole of the foot is simply measured by placing the foot in a box of foam and taking an imprint.
The orthotic is then made without consideration for the extra support needed when the foot changes shape during walking.
‘This basic error means the whole process has to be started again — while the foot deformity is likely to be worsening.’
Additionally, people with diabetes often get preferential service to rheumatoid-arthritis patients because diabetics’ feet issues can end in amputation.
There are a few good-practice models showing how to provide better services.
One is the Podiatry Clinic at Salford Royal Foundation Trust, headed by three podiatrists, an orthotist, a physiotherapist and rheumatologist.
They stock boxes of different prescription shoes for patients to try on, as well as catalogues of the styles.
Podiatrists are also trained to measure feet for shoe-making. The clinic takes referrals for anyone with foot problems.
Principal podiatrist Jane McAdam says: ‘We get people who simply need advice, and we’re very happy to see people long before they need an orthotic insole or a prescription shoe.
'We make it a rule never to tell people what they’ve got to wear.’
Dr Anthony Redmond, head of clinical biomechanics and physical medicine at Chapel Allerton Hospital, Leeds, thinks all clinics should made patient choice a priority.
He says: ‘I wear glasses but would not let the optician choose my frames, so why should people let a podiatrist or orthotist dictate their footwear’
Some experts believe that Department of Health intervention is needed to truly improve the service, though.
Dr Williams says: ‘We desperately need an orthotic tsar, someone who can knock heads together and bring change.
‘This scandal has to be confronted to give rheumatoid arthritis sufferers the decent service they are entitled to.’
Change would make a world of difference to Sally.
She says: ‘I’ve given up all thoughts of wearing high heels but the shoes I’d adore would look like a platform from the outside, while inside they’d be deep enough to hold my orthotic insole.
‘I’d give them plenty of wear.’