Living on a Caribbean island may be a great lifestyle choice, but it can also be bad news for people’s feet.
Ray Anthony, a podiatrist for more than 25 years, and at Chrissie Tomlinson Memorial Hospital since September 2003, points to the wearing of flip flops and other non-supportive, low-heeled shoes as the cause of arch strain.
Dr. Ray Anthony Repairs a patient’s orthotic device. Photo: Iris Stoner |
‘The problem is endemic here and is one of Cayman’s most serious foot problems,’ he said.
Plantar fasciitis, the technical term for arch strain, can result in great pain.
‘The foot is inherently unstable. It has design flaws and is not the miracle of engineering.
‘Most feet collapse into being flat-footed,’ Mr. Anthony explained.
While the treatment is relatively straightforward, implementation is another issue.
Mr. Anthony is an expert on foot orthotics, specially designed supports that are placed in shoes. This field has come a long way in the last few decades, with the supports evolving from bulky cork and leather designs to high-tech carbon fibre creations ranging from 1mm to 2.8mm thick.
Using kits, Mr. Anthony custom builds these carbon-fibre supports to correct each patient’s individual foot function.
Despite being almost too thin to be noticed, however, using any foot support here is a tough sell.
‘When it comes to treatment, it is very difficult for us. There is no place to put the support. People don’t want to wear closed-in shoes. But if they are really in severe pain, they will do it,’ he said.
The reluctance to wear the necessary shoes has forced Mr. Anthony to come up with creative alternatives to try to help his patients.
‘You have to be inventive if you can’t use a foot support for a closed-in shoe. If you understand the mechanics of the foot, you can cheat the foot,’ he said
For example, Mr. Anthony explained that, contrary to popular perception, shoes without heels are not the best things for your feet.
‘It is absolute nonsense that flat shoes are good for you. It is mechanically untrue.
‘A small heel takes the stress off the arch and mechanically shortens the foot. All feet are better with a heel,’ Mr. Anthony said.
He added that some shoe companies perpetuate what he calls mechanical myths. He particularly cites running-shoe manufacturers.
Noting the use of shock-absorption gel bags in the heels of some of these shoes, Mr. Anthony said that these are built on a myth that misinterprets how people absorb shock.
He set the record straight. ‘It’s by the bending of the joints – like a piston. When you try to supplement that with airbags under the heels, you are creating instability.
‘Here’s an analogy: If the shock absorbers in your car are shot, would you pump up your tyres to compensate?’ he said.
Mr. Anthony is well-qualified to comment on sports shoes, having treated top-class athletes and worked with the British Olympics team.
‘Most sports injuries are not due to impact. Almost every sports injury is due to instability — abnormal pronation or rolling in of the foot,’ he explained.
Mr. Anthony added that the foot does better, and is designed for, a rigid surface.
‘When you put softer surfaces in sports shoes, you compromise efficiency in small ways. Rigidity is the name of the game,’ he said.
How you walk can also affect your back, Mr. Anthony explained. Gait-related back pain can be relieved in varying degrees by foot supports.
Mr. Anthony referred to a 1999 study done by US podiatrist Dr. Howard Dananberg in which he treated patients complaining of lower back pain. All of the subjects in the study had abnormal gaits and each received specially designed inserts for their shoes. Out of the 32 patients in the study, 27 improved and reported varying reductions in lower back pain.
Mr. Anthony has helped his own patients through the same method. People with back pain get referred to him by their doctors.
‘People go to the doctor with lower back pain, but there are no clinical signs. Scans and X-rays are negative but they are in chronic pain.
‘It seems strange to go to a foot specialist when you have back pain, but a lot of people get significant benefits from the foot supports,’ he said.
In addition, if there is a pathological reason for the back pain, Mr. Anthony can still help. In those instances, he has to be extra careful.
‘As podiatrists, we go very gently with that. Often, we can help patients if the back is in a very bad state pathologically,’ he said.
In Cayman, though, these treatments are also hampered by the aversion to closed shoes.
Mr. Anthony qualified as a podiatrist in the UK in 1980. He received the same training as that offered in other countries, even going through a longer course than in the US, but podiatrists in the UK are not called doctors.
Mr. Anthony still maintains a clinic in the UK and owns the second-largest foot orthotics laboratory in Europe, in which supports are custom built for patients.
He met Dr. Steve Tomlinson in 1989 when he was spending a year in Cayman Brac writing a book on foot orthotics.
‘Dr. Tomlinson said to me, ‘I’m going to build a hospital one day and I’m going to invite you to be the podiatrist’, and he did,’ Mr. Anthony said.
When not treating patients, he is working on a master’s degree in fiction writing, and plans to continue on to a PhD.
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