"Would have liked more thorough care"

About: NHS Forth Valley

(as the patient),

I recently went for podiatry treatment because I have fallen arches and have lived with insoles I got from a physio for years. These do a half job as they are not made to measure so I decided I would go privately for a consultation whilst I was waiting on my NHS appointment in the Forth Valley area coming through the door.

My care was so diverse. I understand you get what you pay for but I couldn't believe the difference.

The NHS care I got was so basic.

Privately I got the fallen arch measured on each foot and was told I could get a regular insole built up to suit each foot and I shouldn't need to change my footwear to suit an insole and with the NHS I was given an insole out of the cupboard and told it would do the job because I shouldn't need any other support than what I was given and if I did need more support I should change my shoes (I don't wear very adventurous shoes as it is).

I have been wearing the insoles now for a short period of time and get worse pain from them than I did from my old ones so im back to square one again and wearing my old insoles.

I asked about getting the arches in my feet measured and getting specific insoles built up so my feet sit properly but was told I would have to wait and see how I got on with these first. I said at the time I couldn't feel any support in the new insoles but was told again I didn't need much support, even though at the start of the appointment I was told my arches were severely fallen and it would be very bad to carry on how I was.

The appointment was strange and I felt like I got no information just a few exercises. I asked why my feet were like this and some advice on this as I was curious as to why my feet are in this state and was told its just how you are.

I would have liked more detailed information and thorough service. I don't blame the NHS podiatrist because im sure there are limited resources, but more thorough care would ensure patients are not back using the NHS time and time again.

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Response from Arlian Mallis, Person Centred Health and Care Co-ordinator, Department of Nursing, NHS Forth Valley

Thanks for your feedback, I have shared this with our Podiatry team who will get back to you with a response. I apologise for the delay in responding, I hope we can provide you with some helpful information.


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Response from Arlian Mallis, Person Centred Health and Care Co-ordinator, Department of Nursing, NHS Forth Valley

Thanks for your posting, It might help to answer some of your points if you have some further information.

It is the case that some podiatrists may attempt to measure certain biomechanical angles during assessment and others do not. This is because there is no definitive evidence base that proves one way is more effective than another. This is because measurement can be inaccurate and is subjective to the assessor and therefore many podiatrists carry out assessment by visual interpretation during an assessment.

It is also the case that very few insoles would ever require to be made to measure and indeed where you have long term deformity and bone changes in a foot it is likely that correction to “normal” angles would be unlikely.

Therefore most conditions can be accommodated by propriety insoles which can be fitted as provided or adapted. Most of these insoles while looking quite normal already have up to 4 degrees of tilt built into the heel as well as arch contouring.

As with any treatment it is necessary to see how the first intervention has worked and then from that point decide what other future interventions can be made where possible to improve a condition.

I hope this information will help explain some of the differences you have expressed in your experience.

As part of your treatment it may have been necessary to provide exercises. Where provided these are an integral part of the intervention and are often as important if not more so to the improvement of the condition than the insoles.

Some flat foot conditions are congenital and some acquired and it is therefore difficult to comment on any discussion regarding information that was provided at the consultation but it is regrettable that you obviously felt that the information supplied did not meet your expectations.

Gordon Mclay

Specialist & Ambulatory Care Services

AHP Outpatient Services-Podiatry

AHP Co-ordinator

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